Assisted Reproductive Technology (ART)

Implementation of the law on Assisted Reproductive Technology: the 2019 report

A total of 99,062 Assisted Reproductive Technology (ART) cycles were performed in 2019 for all procedures. That included level I procedures (i.e. 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 (frozen embryo replacement) and FO (frozen oocytes).

The number of FER and FO cycles, involving frozen-thawed embryos and oocytes, increased again in 2019 (23,157 cycles, compared to 20,905 in 2018), while ART procedures using fresh non-donor gametes and fresh embryos were applied less frequently (50,324 cycles, down from 51,087 in 2018).

The number of cycles using donor gametes continued to rise, totalling 9686 across all levels of treatment (9.8% of total cycles).

Accessibility

Overall, 346 ART facilities were operational across the country in 2019: 106 of them were public, 220 fully private and 20 private but affiliated with the National Health Service (SSN). To ensure good accessibility to services, 63% of all performed cycles were covered by the SSN.

Adequacy of provision and efficacy of treatments

The adequacy of the service provided was assessed using an ART activity indicator, which measures the total number of treatment cycles offered, for all level II and III procedures, per 1 million people living in Italy. In 2019, this amounted to 1341 cycles, which was slightly less than the 2016 European average of 1410 cycles (latest available European IVF Monitoring figure).

Efficacy of treatments improved in 2019. This was especially true for treatments using cryopreserved embryos (FER cycles) and frozen-thawed oocytes (FO cycles): compared to 2018, the pregnancy rates per thaw rose from 30.6% to 31% and from 16.9% to 17.8%, respectively.

A commonly used indicator in Europe is the cumulative pregnancy rate, which is the sum of pregnancies resulting from fresh cycles and those achieved with cryopreservation. The cumulative pregnancy rate indicates the likelihood of achieving pregnancy in an ART cycle, including frozen embryo transfer cycles.

The number of ART cycles using pre-implantation genetic diagnosis increased (4709), and so did the number of facilities where this service was offered (rising from 46 in 2018 to 56 in 2019). Overall, 2289 live births were recorded as a result of the application of these techniques.

Births

In 2019, the number of live births from all ART treatment cycles increased to 14,162, or 3.4% of live births in the general population in that year. The percentage of multiple births continued to decrease, dropping to 9.3% from 10.9% in 2018, as a result of fewer embryo transfers. The decline reveals increased attention to safety when applying these procedures and translates into a reduction in obstetric and neonatal conditions.

Mothers

The average age of women receiving treatment with fresh non-donor gametes remained high, at 36.8 years, compared to the European average of 35 years. As expected, it was higher when procedures involved donor oocytes (41.6 years), but lower when donor sperm was used (34.6 years).

Procedures using donor gametes

In 2019, an increase was observed in the number of cycles performed (9686 compared to 8434 in 2018, +14.8%) and live births (up from 2002 to 2289). Cycles with female donor gametes (oocytes) totalled 6867 (70.9% of the total), those with male donor gametes (sperm) 1596 (16.5% of the total), and those with female and male donor gametes (double donation) 532 (5.5%). Overall, 9.8% of all ART treatment cycles were performed using donor gametes.

The ISS surveillance system

The surveillance system of the ISS (Istituto Superiore di Sanità) 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. The restricted area of the website includes performance indicators, which allow regional coordinators to assess the activity of all facilities operating in their respective regions.