PMA, ASL Roma 1 assisted fertilization an alternative to natural fertilization

PMA, ASL Roma 1: assisted fertilization, an alternative to natural fertilization

The road to conception for some couples can’be bumpy, and IVF techniques today are an’alternative for many would-be parents who desire a baby’. In short, the dream of becoming mom and dad’ is not impossible at all.

We sometimes hear about homologous and heterologous techniques, but what are the differences in practical terms and costs? You can access it through the SSN or you have to go to private centers? And how does the pandemic also affect the psychological sphere of couples who are candidates for these IVF pathways?

L’Dire news agency asked Arianna Pacchiarotti, director PMA Asl Roma 1

She’s in charge of the PMA service at the Asl Roma1, the only public center in Lazio to perform heterologa. First, what are the differences between homologous and heterologous? And there are waiting times?

“Homologous Pma encompasses several IVF techniques that can be level I, II and III. The choice varies according to the degree of infertility’specific to the couple. In the case of the homologous technique, the gametes (which are the oocytes in the woman and the spermatozoa in the man) of the couple are used. While in heterologous fertilization, which is characterized by the donation of gametes from one or both members of the couple, it’s necessary to resort precisely to external gametes.

In the case of heterologous fertilization with us the waiting time is about three months for the first visit, then the specific case is studied and the gamete order is made. Within a minimum of 2 to a maximum of 6 months these arrive at our center and you can then begin the pathway. So we have calculated that from the first visit in 8-12 months you can complete the whole process.

The time for homologous fertilization, on the other hand, is estimated from the first visit to the completion of the cycle to be about 8 months”.

Can you give an’idea to those who follow us of the preparation time for a single cycle and the total cost at your facility with the SSN?

“Pricing is’established by a decree within which the rates for each individual service are clearly expressed. As for homologous for level I techniques the patient gets to pay about 350 euros, for level II and III techniques she pays a sum between co-pay and maxi co-pay that comes to a total of about 950 euros.

As for heterologous, although the technique is’included among the services of the SSN,&#8217the procurement of oocytes involves a maxi ticket that is’about 4 thousand euros with regard to oocytes and 3500 euros in total with the technique with regard to semen. 1500 euros if it is the level I technique or intrauterine insemination. Coming to the technique with regard to the procedure of level I homologous is very simple and involves the man&#8217s semen, after being processed, being inserted directly inside the uterus.

In level II techniques there&#8217s a jump in invasiveness’ because’the patient has to undergo a small surgical procedure to remove the oocytes and this involves antecedently an administration of drugs for oocyte stimulation that are administered independently at home through subcutaneous injections. After extraction of oocytes under deep sedation these are fertilized in the laboratory and embryos are produced, which are grown in the incubator for up to 5 days and then transferred to the uterus.

In the Level III technique, usually the male partner does not produce his own gametes externally so a testicular biopsy technique by surgery must be used and then proceed all the way as mentioned above. In case these gametes are not produced by the man, the couple is informed of the possibility’of resorting to heterologous fertilization”.

What is the’identikit of your patients and the’average age’of the couples? They come after many failures had for example in private or the National Health System is’ the first choice?

“In the Lazio region, the legislation provides for access until the woman reaches the age of 43 and for a maximum of three attempts with level I, II and III techniques whether using own or donated gametes. Our target audience is young patients who, before turning to the private sector, seek the public way as long as their age allows them to do so.

The’average age of our patients is therefore around 33 -34 years old and not all of them have had a pathway within a private center. Many couples before the introduction of the heterologous fertilization technique in the public necessarily resorted to private centers. In any case, Asl Roma 1 is’the only public referral center for heterologous fertilization in central and southern Italy, and we clearly welcome many patients from Tuscany down’. That is why today we see more’ even quite young couples.

Clearly finished the three attempts as they said couples are forced to turn to the private”.

What other services pertaining to Pma or fertility preservation techniques’do you offer, I am thinking of pre-implantation diagnosis or oncofertility diagnosis’?

“These two services are within the Asl Roma 1, in our company there are two points of IVF centers territorially very distant and therefore cover different services. The Sant’Anna Center, of which Dr. Rampini is in charge, deals mainly with oncofertility’ and pre-implantation diagnosis while as the San Filippo Neri center we deal with heterologous fertilization and gamete preservation for example in patients with endometriosis. I think Asl Roma 1 is the only company, in the public, that guarantees all the services that can affect assisted fertilization”

Coming more to the’actuality’à how do couples in times of pandemic experience this already very unique pathway? Someone gives up for fear, in case of positivity’ of infecting the fetus? In general, Covid has loosened up a little bit’everything?

“We can speak in my opinion of a first and second lockdown, although this time it&#8217s not a real lockdown. In the first phase there’s been a stop for these imposed couples who have passively accepted. One thing that has surprised us a lot, that we have studied, observed and translated into our own work published in a scientific journal and validated by the WHO is’that many couples who are infertile ‘sine causa’ and on the list at our center to access IVF techniques have conceived spontaneously in lockdown.

As for the next phase, at present we have managed to relocate all the couples who were waiting to access the Pma pathway in Phase I of the pandemic. Today we continue to work and couples are more’frightened at the idea of not being able to come to the hospital than the other way around. We receive a lot of phone calls especially from couples from outside the region, we have a catchment area as far as Sicily.

Many are concerned about the possible closure of regions that would make it difficult to access Pma. For now and until different government regulations we are able to ensure the service”.