Baby in arms. That’s what they call it, the goal of every medically assisted procreation (PMA) procedure and of every journey of hope towards the most renowned clinic or the most innovative technique. «Did they give you “baby in arms” guarantees?» couples looking for a child ask themselves in online forums and in the corridors of clinics. Behind this sentence there is a world of hopes, which fade away every month: the baby doesn’t arrive. And no one can give the guarantee of holding him – one day – in your arms.
Infertility is recognized by the World Health Organization as a true pathology and in
Italy concerns 15 percent of couples of reproductive age, almost 60 thousand new cases every year. Added to these are the approximately 9 thousand cancer patients who must undergo treatments that can compromise fertility to defeat cancer.
In the Italy of the birth rate and growth – below – zero, where there are more people over eighty than children under 10 years of age and where in 2024 only 370 thousand births were recorded (there were 577 thousand in 2008) there is also an army of women and men who want to become mothers and fathers, but with “natural methods” they just can’t. According to the latest report on Medically Assisted Procreation (PMA), presented in Parliament at the beginning of February, in 2023, children born thanks to artificial insemination procedures were 17,235.
The average age of women who undergo Pma is almost 37 years. Many celebrities have spoken about their complicated paths to having a child: for example Antonella Clerici, who resorted to treatments to conceive her Maelle (born when she was already 45 years old), and Mariah Carey, who said she followed fertility paths after a miscarriage. In 2011 she then became the mother of twins.
Cecilia Rodriguez also declared that she conceived her daughter Clara with Pma techniques. “Generally a couple arrives at an assisted reproduction center after a prolonged period of failure to conceive,” gynecologist Francesco Gebbia, co-director of the IVI clinic in Rome, which carries out around 2,000 cycles a year, tells Panorama. «The indications are clear: under 35 it is advisable to start the tests after a year of unsuccessful attempts, above 35 already after six months. But it is not a rigid rule: each couple must consciously decide if and when the moment is right.”
At that point a journey begins which is neither easy nor without both economic and psychological repercussions, and which is carried out with a mechanism of “increasing complexity”. «Once the general picture of couple infertility has been defined, different approaches can be proposed» continues Gebbia. «We start with simple ovulation monitoring strategies and then move on to real treatments. These are divided into first, second and third level procedures, and range from “simple” intrauterine insemination, to IVF, i.e. in vitro fertilization, and procedures with thawing of oocytes or embryos. Up to heterologous techniques, with oocytes or spermatozoa from anonymous donors.”
The process, if carried out privately, has a considerable cost: it ranges from 1,000/2,000 euros per attempt for intra-uterine fertilisations, up to 7,000 for IVF and 11,000 euros for treatments with gamete donation. If you address the public, there is the problem of waiting lists and the lack of availability of the centers: despite this, more than 60 percent of the most advanced treatments (i.e. level II and III) carried out with the couple’s gametes are performed in the public. Again according to the latest report presented in Parliament, the MAP centers registered in the National Register are 316: 96 public, 18 private affiliated and 202 private. More than half are located in 4 regions: Lombardy, Campania, Lazio and Veneto.
A separate story in the field of fertility preservation concerns cancer patients. In Italy, every year, almost 9 thousand young people of childbearing age need to be treated for cancer. “The diagnosis of cancer, especially at a young age, places patients in a situation of uncertainty and worry about life prospects in the following years”, explains Ieo gynecologist Fedro Peccatori, one of the pioneers of oncofertility in Italy. «Preserving the fertility of these patients means giving them the opportunity to imagine a future as parents after the illness, and this, for many young patients, has enormous value. Today we know that ovarian stimulation does not worsen the oncological prognosis, not even in hormone-sensitive tumors, and also that in the majority of cases a delay of 15-20 days in starting treatment has no impact on survival. Therefore, patients (and also patients, in the case of sperm sampling) who want to reserve this possibility can do so in total serenity.”
Naturally it is essential that the entire process is carried out in the shortest possible time. «Cancer arrives without warning, and immediate responses are needed», concludes Peccatori. «This is why there must be paths without waiting lists, in which the patient is seen within 24-48 hours. First of all, reproductive counseling is needed that takes into account the person’s wishes, and immediately after a timely collection of the gametes, because then it is necessary to operate and start chemotherapy or radiotherapy to treat the cancer.
From this need, oncofertility centers like ours at the IEO were born, which bring together oncologists, surgeons, radiotherapists and reproductive specialists, to create a rapid and patient-centred path.” The logic is simple: if you collect the gametes before the treatments damage the reproductive system, you can later use them for fertilization. Faced with these numbers of infertility for various causes, it is easy to understand how the ever-increasing use of assisted procreation procedures already has – and will have even more in the coming years – a strong impact on employment. According to estimates by the Italian Society of Embryology and Human Reproduction (Sierr), within ten years the demand for embryologists will double, i.e. those professionals who deal with the fertilization of oocytes in the laboratory, monitor the development of the embryos and select the most suitable ones to be transferred to the uterus.
And so universities are starting to establish postgraduate courses with the aim of providing skills in the field of clinical and experimental embryology and bioinformatics and bio-engineering sciences. First of all, the University of Pavia did it, with the annual second level Master’s degree in “Reproductive Biology and Biotechnology”, created in collaboration with Ivirma, a giant in assisted reproduction. «Our course includes the contribution of over 80 teachers, and covers all the topics that revolve around Pma, from basic research to clinical, up to industrial applications», Professor Maurizio Zuccotti, coordinator of the Pavia Master, tells Panorama. «We don’t just deal with technique, but also with the relationship with the patient, the psychological aspects, nutrition and everything that a couple experiences during an assisted procreation process».
The aim of the course is in fact to train not only clinical embryologists, but all-round professionals, with a broad vision of job opportunities in the sector. «Graduates in Medicine and Surgery, but also in Biology, Biotechnology and other similar master’s degrees can access it», concludes Zuccotti. «The idea is to offer a solid in-depth path to those who want to work in the field of reproduction. In the first three cycles of the Master’s degree, approximately 80 percent of the students found a position, between public and private, often already during or immediately after the course”.
Because in Italy, which for a thousand reasons no longer has children, more and more professionals will be needed to help those who – however – still dream of the “baby in their arms”. In spite of every obstacle.
