Medically Assisted Procreation

For almost half a century, MAP has been used to treat previously insoluble reproductive problems of couples suffering from infertility. Depending on the type and severity of the problem, so-called first or second level techniques can be chosen.

First level MAP consists of a mild hormonal stimulation of the woman (induction of ovulation) followed by the painless insertion of the partner’s sperm into the uterine cavity, after appropriate treatment. It is a relatively simple technique but associated with not very high therapeutic successes. Furthermore, the risk of twin pregnancies is less controllable. To proceed with this technique it is first necessary to verify the patency of the fallopian tubes and that the quality of the seminal fluid has not deteriorated excessively.

Second level MAP (in-vitro fertilization) consists of more intense ovarian stimulation (ovulation induction) to obtain a high number of ovarian follicles and consequently oocytes. At the end of the stimulation, after general anesthesia, the oocytes are extracted from the follicles by means of a thin needle inserted vaginally under ultrasound control. The mature oocytes obtained are fertilized with the partner’s sperm and placed in an incubator where they transform into embryos (after 2/3 days) and then into blastocysts (after 5/6 days).

Fertilization of oocytes is achieved by allowing the spermatozoa to independently access the inside of the oocytes (traditional in-vitro fertilization, now little used) or by injecting the spermatozoa inside the oocytes under microscopic control (so-called Intracytoplasmic Sperm Injection – ICSI).

The transfer of the embryos thus obtained is a painless technique that does not require anesthesia.

Embryos or blastocysts not immediately transferred to the uterus can be frozen and used in further therapeutic cycles which do not require ovarian stimulation but only a pharmacological preparation of the endometrium with estrogen and progesterone.

The blastocysts can also be analyzed (with the so-called Preimplantation Tests – PGT) to verify the presence of all chromosomes or evaluate any genetic diseases present in the couple.

The chronological age, especially female, is an extremely important factor for the diagnosis, prognosis and choice of therapeutic tools to be used. Advancing female age is in fact associated with a reduction in the number of ovarian follicles and the genetic quality of the oocytes.

All factors potentially causing sterility must be carefully studied and evaluated to guide the choice of optimal therapeutic tools for the couple.