Medically Assisted Procreation

Levels of intervention

• Ultrasound Monitoring
• Ovulation Stimulation
• Level I Medically Assisted Procreation
• Medically Assisted Procreation of Level II of the Homologous Type
• 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.
We speak of ovulation induction when the therapy aims to induce ovulation in women who would otherwise not ovulate, that is, who suffer from chronic anovulation. We speak of ovulation stimulation when the therapy aims to stimulate the production of follicles in women who would ovulate even without drugs. In this second case, for example, it may be women who suffer from oligomenorrhea and who therefore, since they ovulate less frequently than normal, are less likely to become pregnant.
Gynecologists often suggest gentle stimulation even to women who ovulate normally, so that the ovaries produce more than one follicle and therefore 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 the occurrence of a multiple pregnancy.
Precisely to monitor the quantity of follicles that have developed, as well as to establish the moment of ovulation, during therapy it is necessary to perform ultrasound monitoring, possibly accompanied by estradiol dosages.
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 3-4 follicles) is induced by subcutaneous injection of low doses of gonadotropins (follicle-stimulating hormone) or, in selected cases, 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, where deemed essential, a dosage of estradiol and plasma 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 consists in collecting the oocytes and fertilizing them in the laboratory. The embryos are then transferred into the uterus.
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 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:

1. First visit for anamnesis collection and explanation of the clinical and administrative path
2. 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
3. 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
4. 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
5. Collection and freezing of the semen sample at the Igea Nursing Home and sending it to the foreign bank
6. 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.
7. Pharmacological stimulation of ovulation and egg collection from the donor
8. Fertilization of the donor's oocytes with the semen of the male partner of the recipient couple and obtaining the blastocysts
9. Blastocyst freezing
10. Sending the blastocysts to the Igea Nursing Home
11. Pharmacological preparation of the recipient patient for the execution of the embryotransfer 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 Casa di Cura Igea we guarantee data protection and confidentiality. All data, including genetic information, are made anonymous so that neither the donor nor the recipient are identifiable in compliance with 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:

• 02/70142408
• 344/3612842
• centrosterilita@casadicuraigea.it

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 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 the blastocysts to the Igea Nursing Home
• Pharmacological preparation of the recipient patient for the execution of the embryotransfer of the thawed blastocyst at the Igea Clinic

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.

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

• 02/70142408
• 344/3612842
• centrosterilita@casadicuraigea.it

Performances

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.

Forms

• Informed Consents for the Medically Assisted Procreation Program
• PMA Triage Questionnaire
• Zika Virus Statement
• West Nile Declaration
• West Nile Information

Contacts Medically Assisted Procreation Igea

Cell. 344.3612842 tel. 02. 70142408
8:00am to 17:00pm Monday to Friday
Email: centrosterilita@casadicuraigea.it