Assisted Reproductive Technology (ART)

Implementation of the law on Assisted Reproductive Technology: the 2018 report

In 2018, a slight decrease was recorded in the use of Assisted Reproductive Technology (ART) procedures involving fresh non-donor gametes and embryos (51,087 cycles, compared to 53,014 in 2017). Conversely, the number of FER (frozen embryo replacement) and FO (frozen oocyte) cycles, i.e. cycles using cryopreserved embryos and oocytes, rose to 20,905 in 2018 from 18,672 in the previous year.

When considering all ART procedures, a total of 97.509 cycles were performed in 2018. That included level I procedures (intrauterine insemination - IUI), as well as level II and III techniques such as  FIVET (in vitro fertilization and embryo transfer), ICSI (in vitro fertilization with intracytoplasmic sperm injection), FER and FO.

The number of cycles using donor gametes continued to rise, totalling 8434 across all levels of treatment.

Accessibility

Overall, 345 (143 level I and 202 level II-III) ART facilities were operational across the country in 2018: 106 of them were public, 219 fully private and 20 private but affiliated with the National Health Service. In 2018, most of the operational facilities (61.2%) were based in just 5 regions: Lombardy (58, or 16.8%), Campania (44, or 12.8%), Sicily (38, or 11%), Lazio (36, or 10.4%) and Veneto (35, or 10.1%).

Adequacy of provision and efficacy of treatments

The adequacy of the service provided was assessed using the ART activity indicator, which measures the total number of treatment cycles offered, for all level II and III procedures, per 1 million women of childbearing age (i.e. aged 15 to 45 years) living in Italy. In 2018, this amounted to 7341 cycles (+235 compared to 2017), which was less than the 2015 European average of 7795 cycles (latest available European IVF Monitoring figure, calculated only for the 18 countries that in 2015 reported data from 100% of their facilities).

Efficacy of treatments, especially those using cryopreserved embryos (FER cycles), also improved in 2018. The cumulative pregnancy rate (i.e. the sum of pregnancies resulting from fresh cycles and frozen embryo transfer cycles), calculated in relation to the number of cycles started, was used to ensure a realistic assessment of the application and efficacy of ART procedures. This parameter provides a better and more accurate picture of how ART procedures are applied in our country. In 2018, the cumulative pregnancy rate was 28.4%, 0.9% higher than in 2017.

Births

The number of live births from all ART treatment cycles increased to 14,139 (3.2% of live births in the general population). The percentage of multiple births continued to decrease, dropping to 10.9% from 12.3% in 2017, which reveals increased attention to safety when applying these procedures.

Mothers

The average age of women receiving treatment with fresh non-donor gametes remained high, at 36.7 years, compared to the European average of 34.9 years. It was even higher when procedures involved donor oocytes, but lower when donor sperm was used (34.8 years). The older age of women undergoing donor cycles seems to indicate that this technique is mainly applied to address age-related physiological infertility rather than specific conditions.

Procedures using donor gametes

In 2018, an increase was observed in the number of cycles performed (8434 compared to 7514 in 2017, +12.2%) and live births (up from 1737 to 2002). Once again, treatment with female donor gametes (oocytes) was the most common procedure (5901 cycles, 46.5% of the total), followed by treatment with donor embryos (2783 cycles, 41.1%) and with donor sperm (839 cycles, 12.4%). The number of ART cycles using pre-implantation genetic diagnosis also increased (3441), and so did the number of facilities where this service was offered (rising from 42 in 2017 to 46 in 2018). Overall, 705 live births were recorded as a result of the application of these techniques.

The website

The surveillance system of the ISS National ART Register is still recording all of the cycles performed in our country in all authorized facilities, and the website www.iss.it/rpma includes up-to-date fact sheets for all facilities, broken down by Region and type of services offered, so as to provide a comprehensive overview of ART activity in Italy.