Assisted reproduction at the expense of the SSN? In at least four regions this is still not the case

Five months after the entry into force of the new Lea (essential assistance levels) on Pma (medically assisted procreation), four regions still fail to ensure full implementation of the legislation. They are concentrated in the Centre-South, including Puglia, Calabria, Molise, Sardinia. But there is no shortage of delays in the North, where sometimes most public centres only guarantee the first level (i.e. intrauterine insemination) and therefore not in vitro fertilisation (second level), let alone testicular recovery of spermatozoa with advanced surgical procedures (third level). And there are Regions, such as Marche, that are struggling. This despite the fact that there are tens of thousands of couples who turn to the national health service. Three years ago (last available data) almost 80 thousand (78,105) resorted to medical procreation. A therapeutic route that led to the birth of 15,583 children. That is to say, with a success rate close to 20%. And demand is constantly growing, as confirmed by Siru, the Society for Human Reproduction.

"Procreative mobility is still massive, with couples moving from one region to another, just as the exodus to foreign countries to perform heterologous procedures is still strong: there are still few public centres that guarantee it in Italy," says Paola Piomboni, president of Siru, as well as lecturer in applied biology at the University of Siena and director of the PMA laboratory at the Tuscan city's university hospital. The time factor and a vast network of specialised health centres are crucial, however, as the scientific society itself demonstrated at its national congress in Verona. Generally speaking, couples with fertility problems take four or five years before embarking on a proper course of action, which may also require Pma. 'Delaying the start of IVF causes a reduction in the chances of success, an effect that is particularly acute with advanced maternal age and in the presence of a known cause of infertility,' Piomboni explains. In practice, in women aged 36-37, 38-39 and 40-42, even a delay of 6 months reduces births by 5.6%, 9.5% and 11.8% respectively. If the delay is 12 months in women over 40, the chances of success decrease by as much as 22.4%.

A problem exacerbated by the interminable waiting lists for access to treatment: from a minimum of six months to over a year (it can even reach two). With the aggravating circumstance that many regions, especially those subject to re-entry plans and with the most critical issues in terms of health service efficiency, are not even able to ensure heterologous fertilisation. 'In Italy there are no oocyte donors and all the healthcare companies are forced to turn to certified foreign banks, continually diversifying the sources of supply,' Piomboni continues. 'It's just that even a minimum stock of six oocytes costs 2,500 euros and not all regions have the necessary financial availability. Then there is the issue of the lack of homogeneity at the national level of the procedures for access to therapies, also due to the Regions' discretion in the concrete application of the regulations. 'The provisions should be the same throughout the country, but many are not able to apply them,' Piomboni says. 'Moreover, the co-payments for each step of the pathway also change. The regions should organise themselves better and when they cannot provide for it with their own public centres, they should still guarantee the services through the offer of private facilities with special agreements'. An offer that often does not exist.

Thus, in the face of regions that shine, with a vast network of public and private centres (from Lombardy to Veneto, Emilia-Romagna and Tuscany), there are others that are still lagging behind. In the Centre South, Molise does not even have a public centre and the Lea are not guaranteed. Then there is Marche, which has only one third-level public facility. Lazio has only one contracted private clinic even though it guarantees five public third-level centres. Things seem to work better in Campania. Although with eight SSN centres, only four are third level. Moreover, it does not even offer a private contracted clinic. Then there is the case of Apulia, which has four public facilities, but none of them are able to guarantee the third level, and there are no private accredited ones: here, complete compliance with the Lea is not guaranteed. While Calabria (two National Health Service facilities) only Catanzaro can guarantee the most advanced treatment. In Calabria, then, there are no private accredited centres. Sicily has eighteen centres between public and private but only three specialised to offer third level care. Finally, Sardinia has two health service facilities but no accredited clinics.