Specialized Center

Medically Assisted Procreation

PMA (Medically Assisted Procreation)

Center specialized in assisted fertilization

The center aims to diagnose the causes of sterility in the couple and, where possible, to remove them in order to allow pregnancy to be achieved naturally.
When this is not possible, the center will offer available medically assisted reproduction techniques to achieve pregnancy. The IGEA Clinic's assisted reproduction service is staffed by professionals (doctors, biologists, and nursing staff) specialized in the diagnosis and treatment of sterility and infertility in couples. Most services are provided under an agreement with the National Health Service (SSN).

All procedures provided for in PMA techniques are performed in accordance with the current legal provisions on the matter.

Levels of intervention

Ultrasound Monitoring
Ovulation Stimulation
Level I Medically Assisted Procreation (targeted intercourse, Intrauterine Insemination)
Level II Homologous Medically Assisted Procreation (IVF, ICSI, Embryotransfer from frozen oocytes)
Level II Medically Assisted Procreation of the Heterologous Type (ICSI)
Embryo Transfer by Heterologous Fertilization

ULTRASOUND MONITORING

The simplest level of ART is ultrasound monitoring of ovulation, which consists of monitoring, through a series of ultrasound scans, the growth of the follicle until the moment of ovulation.
In fact, more than a true PMA technique, it is placed between a diagnostic method and a therapeutic method: from a diagnostic point of view, it allows to verify whether ovulation occurs or not and whether all the parameters evaluated are within the norm.

From a therapeutic point of view, it can increase the chances of conception by allowing the couple to have sexual intercourse targeted to correspond exactly to the day of ovulation.
Ovulation monitoring involves a series of pelvic, abdominal and transvaginal ultrasound scans performed daily or every other day from the end of menstruation until ovulation occurs.
Ultrasound scans may be accompanied by hormone measurements of estradiol (before ovulation) and progesterone (after ovulation).

OVULATION STIMULATION

One of the most common infertility therapies consists of administering drugs that stimulate the activity of the ovaries and therefore the production of follicles.
Ovulation induction is when therapy aims to trigger ovulation in women who would otherwise not ovulate, i.e., those suffering from chronic anovulation. Ovulation stimulation is when therapy aims to stimulate follicle production in women who would ovulate even without medication.

In this second case, for example, it could be women who suffer from oligomenorrhea and who therefore, since they ovulate less frequently than normal, are less likely to become pregnant.
Gynecologists often recommend gentle stimulation even to women who ovulate normally, so that the ovaries produce more than one follicle and thus increase the chances of conception.

The drugs used are clomiphene and gonadotropins. They are the same as those used in IVF, but at much lower doses, to prevent the formation of more than 2-3 follicles and thus increase the risk of multiple pregnancy.
Precisely to monitor the number of follicles that have developed, as well as to establish the moment of ovulation, ultrasound monitoring must be performed during therapy, possibly accompanied by serial hormone tests.
When monitoring indicates that ovulation is imminent, you can have targeted sexual intercourse or perform intrauterine insemination.

MEDICALLY ASSISTED PROCREATION LEVEL I

INTRAUTERINE INSEMINATION

Intrauterine insemination is a technique that seeks to increase the chances of gametes (eggs and sperm) meeting inside the tube. It is therefore a technique of in vivo fertilization.
Mild multiple follicular growth (maximum 2-3-4 follicles) is induced through the subcutaneous injection of low doses of gonadotropins (follicle-stimulating hormone) or, in selected cases, the oral intake of Clomiphene citrate. After a few days of therapy, the woman begins ultrasound monitoring of ovulation, which aims to evaluate the number and size of the follicles and, if deemed essential, a measurement of plasma estradiol and progesterone.

Once a correct follicular diameter has been reached (around 17-22 mm) and an endometrial thickness of at least 7 mm with characteristics of maturity, ovulation is induced by means of a subcutaneous or intramuscular injection of HCG and insemination is carried out (around 36-38 hours later), that is, the transfer of the spermatozoa into the uterus, previously treated in the laboratory in order to make them more suitable for reaching the oocyte.
Insemination takes place in an outpatient setting using a soft catheter inserted through the vagina and cervix.

After insemination, the woman remains lying on the gynecological bed for a few minutes, then she gets up and can resume her normal activities. Generally, from the evening of insemination, a luteal phase support therapy is started by taking progesterone for 14 days after insemination.
The purpose of taking progesterone is to support the endometrium (the lining of the uterine cavity) and make it more suitable for the possible implantation of a pregnancy.
After 14 days from the procedure, the woman is asked to take a blood sample to detect HCG and therefore evaluate a possible pregnancy.

If the pregnancy test is negative, the procedure can be repeated several times, in many cases without a break between one stimulation cycle and the next, provided that a control ultrasound is performed to verify that there are no obstacles to proceeding.

MEDICALLY ASSISTED PROCREATION LEVEL II

The main technique of extracorporeal fertilization is called IVF, in vitro fertilization and embryo transfer: it consists of collecting oocytes after hormonal stimulation and fertilizing them in the laboratory with sperm from the seminal fluid to obtain an embryo that is subsequently transferred to the woman's uterus.
It is indicated for couples with tubal factor infertility, severe male factor infertility, multiple failures of first-level techniques, but also couples with multifactorial infertility (advanced maternal age, endometriosis, reduced ovarian reserve).
The patient undergoes controlled ovarian stimulation through daily subcutaneous injections of gonadotropins and, simultaneously, undergoes serial ultrasound and hormonal monitoring (approximately 5 checks over a 2-week period) to assess follicular maturation. The drug dosages are higher because the goal is to obtain the highest possible number of follicles, and therefore oocytes, to give the couple the best chance of success.

Once the follicles reach the desired diameter (817-22 mm), corresponding to adequate oocyte maturation, ovulation timing and ultrasound-guided oocyte retrieval (or "oocyte pickup") are performed. This simple surgical procedure involves aspiration of the follicular contents using a thin needle transvaginally. The procedure is performed in the operating room, under deep sedation, to minimize patient discomfort.

Simultaneously, the male partner collects the semen. The biologist in the laboratory performs in vitro fertilization using IVF or ICSI (intracytoplasmic sperm injection) techniques, which leads to embryo formation. The resulting embryos are cultured for 2-5 days.

Subsequently, if the patient's clinical conditions and hormonal profile are adequate, one of the embryos is transferred into the uterus via embryo transfer, a minimally invasive procedure that takes place in the operating room without the need for sedation and does not cause discomfort to the patient.

OVYTE COLLECTION

The procedure is performed in a dedicated operating room and, for the patient's comfort, under sedation. This means it is painless and generally lasts about twenty minutes. Using a thin needle connected to a vaginal ultrasound probe, the doctor reaches the ovaries and aspirates the fluid contained in the follicles. This fluid is immediately examined by the biologist in the laboratory, who identifies and collects the oocytes.

Once the blood collection is complete, the patient is monitored for a few hours. You may experience mild abdominal pain, similar to menstrual pain, or a little vaginal bleeding. However, the risks are minimal, and barring rare complications, you can go home the same day.

IN VITRO FERTILIZATION TECHNIQUES

Oocyte fertilization can be achieved through two techniques:
• IVF (Fertilization In Vitro and Embrio-Transfer) in which a certain number of spermatozoa are placed in the same culture medium as the oocyte, then one of them penetrates the oocyte starting the process of fertilization and cell division;
• ICSI (Iin Cytoplasmic Sperm Injection) where a single sperm is injected into the egg cell using a microneedle.

EMBRYO TRANSFER

Embryo transfer refers to the transfer of embryos into the uterine cavity. Insertion occurs using a thin plastic catheter and is, in most cases, completely painless. Embryo transfer occurs approximately 1-2 cm from the uterine fundus and is performed in a sterile operating room under controlled conditions. Only in very rare cases may general anesthesia be necessary to overcome entry obstacles. After embryo transfer, the woman continues hormone therapy, typically including progesterone (and sometimes estrogen), to support the uterine environment and promote embryo implantation. This therapy is continued for several weeks after the transfer.

In the following days, there are no particular restrictions for the patient, but it is advisable to avoid excessive physical effort.

Approximately 10-12 days after the transfer, a pregnancy test is performed, which consists of a blood sample to measure the level of beta-hCG (the hormone that signals the beginning of pregnancy). This test is essential to determine whether the embryo has implanted properly in the uterus and has begun producing the pregnancy hormone. If the test is positive, further tests are performed to monitor the progress of the pregnancy.

EMBRYO TRANSFER FROM HETEROLOGOUS FERTILIZATION

At the PMA Center, it is also possible to perform heterologous fertilization treatments with egg donation (female gametes) obtained from foreign banks with which the IGEA Clinic has signed collaboration agreements.

The couple requesting to undergo heterologous fertilization treatment will follow a clinical path structured as follows:

First visit for anamnesis collection and explanation of the clinical and administrative path
Second visit to check the required tests (blood tests, clinical tests, instrumental tests, psychological counseling and other tests deemed necessary) and signing of informed consents
Filling out the phenotypic sheet with the physical characteristics of the recipient patient (hair color, eye color, skin color, etc.) in order to select a donor who is phenotypically compatible with the recipient
Performing a genetic screening test for genetic diseases on the male partner to allow comparison with a similar test to which the donor is subjected
Collection and freezing of the semen sample at the IGEA Nursing Home and sending it to the foreign bank
Donor research and selection according to criteria and clinical pathways compliant with European and national guidelines: clinical evaluation, infectious disease tests, psychological evaluation, genetic testing for common and rarer genetic diseases, etc.
Pharmacological stimulation of ovulation and egg collection from the donor
Fertilization of the donor's oocytes with the semen of the male partner of the recipient couple and obtaining the blastocysts
Blastocyst freezing
Sending blastocysts to the IGEA Nursing Home
Pharmacological preparation of the recipient patient for embryo transfer of the thawed blastocyst at the IGEA Nursing Home

The foreign banks with which collaboration agreements have been signed comply with the quality criteria set out in national and European regulations regarding guarantees for patients, selection of donors, clinical and laboratory procedures and protocols.

At IGEA Nursing Home, we guarantee data protection and confidentiality. All data, including genetic information, is anonymized so that neither the donor nor the recipient can be identified, in compliance with the anonymity and privacy provisions (Legislative Decree No. 191/2007).

Furthermore, the donor's contribution is solely of a genetic nature, in fact the gamete donor does not acquire any legal parental relationship with the unborn child and cannot assert any rights towards him or be the holder of obligations (Legislative Decree no. 191/2007).

Our team is available for information and clarifications at the following numbers/emails:

Phone: 02/70142408

Mobile: 344/3612842 344/3612842

Email: centrosterilita@casadicuraigea.it

Medical Genetics Clinic

To meet the growing demand from patients for accurate diagnoses and personalized care, the IGEA Clinic offers a Medical Genetics clinic, led by geneticist Dr. P. Castorina. The clinic is able to meet most emerging needs by offering a comprehensive list of genetic tests and multiple genetic screenings, with rapid turnaround and reporting times.

Genetic testing is prescribed as part of the genetic counseling provided by the IGEA Nursing Home's geneticist and can be covered by the Regional Health Service.

Chromosomal abnormalities can also be screened for by analyzing fetal DNA in maternal blood. Access to the analysis is granted after a consultation with the geneticist, who will also review and deliver the results.

A genetic counseling service is available for infertile couples. Approximately 10-15% of male infertility cases and 8-10% of female infertility cases are caused by or associated with genetic alterations, which may include chromosomal or single-gene alterations.

From a genetic standpoint, couples undergoing assisted reproductive techniques are at higher risk than the general population, and therefore in recent years it has become common practice to offer these couples the option of genetic diagnosis and genetic counseling. This is done not only to achieve a more accurate diagnosis of infertility, but also to inform couples about their reproductive risk and the risk of passing genetic abnormalities on to their children.

Heterologous fertilization

Embryo transfer from heterologous fertilization

At the PMA Center it is also possible to perform heterologous fertilization treatments with donation of oocytes (female gametes) obtained from foreign banks with which the Igea Clinic has signed collaboration agreements.

The couple requesting to undergo heterologous fertilization treatment will follow a clinical path structured as follows:

First visit for anamnesis collection and explanation of the clinical and administrative path
Second visit to review the required tests (blood tests, clinical tests, instrumental tests, psychological counseling, and other tests deemed necessary) and signing of informed consent forms.
Completion of the phenotypic form with the physical characteristics of the recipient patient (hair color, eye color, skin color, etc.) to ensure the selection of a donor who is phenotypically compatible with the recipient.
Performing a genetic screening test for genetic diseases on the male partner to allow comparison with a similar test to which the donor is subjected
Semen sample collection and freezing at the Igea Nursing Home and shipment to the foreign bank.
Donor search and selection according to criteria and clinical pathways compliant with European and national guidelines: clinical evaluation, infectious disease tests, psychological evaluation, genetic testing for common and rarer genetic diseases, etc.
Pharmacological stimulation of ovulation and egg retrieval from the donor.
Fertilization of the donor's eggs with the semen of the male partner of the recipient couple and obtaining blastocysts.
Blastocyst freezing.
Sending the blastocysts to the IGEA Nursing Home.
Pharmacological preparation of the recipient patient for embryo transfer of the thawed blastocyst at the IGEA Clinic

Our team is available for information and clarifications at the following numbers:

Phone: 02/70142408
Mobile: 344/3612842
Email: centrosterilita@casadicuraigea.it

Performances

Ovulation Tracking and Intercourse Timing
First level medically assisted procreation techniques (IUI)
Second level medically assisted procreation techniques (IVF-ICSI)
Level I medically assisted procreation techniques of the HETEROLOGOUS TYPE (IUI)
Level II medically assisted procreation techniques of the HETEROLOGOUS TYPE (IVF-ICSI)
Freezing of seminal fluid
Oocyte and embryo freezing
Andrological consultation and visit
Obstetric-gynecological consultation and visit
Endocrinological consultation and visit
Hormone assays
Genetic tests and visits
Genetic screening tests for numerous individual or couple diseases (gene screen)
Prenatal genetic screening tests on maternal blood (prenatalsafe)
Diagnostic pelvic ultrasound
Pelvic ultrasound for antral follicle count to evaluate ovarian reserve
First trimester obstetric ultrasound
Sperm DNA Fragmentation Test
Spermiogram, capacitation test, sperm culture, sperm test, sperm detection in urine after ejaculation and other tests on semen sample
Bacteriological and bacterioscopic examination of vaginal and cervical secretion; research on chlamydia, mycoplasmas, gonococcus, trichomonas on biological material and other specific research on request.

Traceability and Security

The “Witness” system is a technology used in the field of Medically Assisted Procreation (PMA) to guarantee the traceability and safety of biological samples during the entire treatment process. Here is how it works and its main advantages:

1. **Traceability and Identification**: Each biological sample (sperm, eggs, embryos) is provided with a label with a barcode or an RFID chip. These identifiers are linked to the patient profile, ensuring that each step of the treatment is accurately tracked and monitored.

2. **Error Prevention**: The system helps prevent sample mix-ups between patients. Each time a sample is handled, the system verifies that the operation is performed on the correct sample associated with the right patient.

3. **Documentation and Quality Control**: The Witness system keeps a detailed record of every handling and movement of samples. This is useful both for legal purposes and to ensure a high standard of quality control.

4. **Patient Safety**: By reducing the risk of errors, the system increases safety for patients, providing greater peace of mind during a process that can be emotionally and physically demanding.

5. **Automation and Efficiency**: Automating verification and traceability processes allows PMA professionals to focus on the clinical and scientific aspects of treatment, improving the overall efficiency of the laboratory.

In summary, the Witness system represents a significant advancement in the management and safety of ART processes, offering greater confidence and peace of mind to both patients and professionals in the sector.