PMA with the National Health Service, the possibility of using it everywhere has been postponed until 2025. Why is it still late?

Another postponement, another possibility that vanishes for many couples who would like to have a child with Medically Assisted Procreationwithout finding themselves forced to turn to private structures.
From last April 1st, the PMA should have become an operational part of the LEAs, the Essential Levels of Assistance guaranteed by the National Health Service. However, following the protests of a large number of Regions who requested and obtained the postponement of this provision – as they are not yet adequately equipped to be able to adequately offer the service to all couples who would request it – the Ministry of Health has however extended the The entry of the PMA into the LEAs on 1 January 2025, the date on which it is hoped that Italians will be able to see their application in a uniform and homogeneous way in their territories.

Of the need to give all couples the opportunity to access PMA with the same success rates – and of the innovations in scientific research regarding an increasingly personalized approach in the ovarian stimulation phase (first step in medically assisted procreation paths) – we spoke in Milan on the occasion of a conference organized by IBSAa pharmaceutical company engaged in the research and development of treatments and therapies for infertility, in which the main representatives of some of the most important Italian companies linked to reproduction took part, all agreeing to highlight the worrying increase in levels of infertility in the world population, including Italy.

LEA, the PMA (can't) wait

According to recent estimates, from 2012 to 2022 in our country there was a 73% increase in the use of PMA techniques, with 3.7 births out of 100 obtained with assisted procreation. In particular, in vitro fertilization with transfer of embryos into the uterus (IVF) is confirmed as the most used technique going from 37% to 48% in ten years. Medically Assisted Procreation procedures will also become part of the Essential Levels of Assistance (LEA), albeit starting next year.

«The introduction of Medically Assisted Procreation (PMA) techniques in the Essential Levels of Assistance (LEA) and therefore in the services provided free of charge or upon payment of a ticket through the National Health Service (SSN) represents an important step for all couples with fertility problems who are looking for a child, regardless of the region of residence”, he commented Luca Mencaglia, President of the PMA Foundation. «For the first time, in fact, these services, which to date have been provided through the NHS only in a few Italian regions mainly concentrated in Northern Italy, will have to be guaranteed throughout the national territory in a suitable time, therefore giving all women the opportunity to approach a path that in many areas was still only accessible for a fee. At least this is what the law provides. However, we know that to implement these provisions, many Regions will have to adapt to equip themselves with the structureswhether public or private, capable of meeting local needs.
Unfortunately, it is news these days that the entry into force of the new LEA tariff relating to
specialist outpatient care, which includes PMA services, has been postponed further to
January 2025. A postponement which concerns services of a different nature, but which weighs particularly heavily in the field of reproductive medicine where the time factor plays a crucial role in
probability of success of the treatments, at least for those couples who approach these paths already at an advanced age.

What exactly do the new LEAs foresee for the PMA?

According to what is established by the new LEAs, «women can access ART programs through the NHS up to the age of 46 submitting up to a maximum of six cyclesThat they include both first and second level techniques and homologous and heterologous techniques, regardless of the attempts already made previously”, adds Mencaglia. «Access to these treatments must be guaranteed within a certain time, set at 120 days for the acceptance of patients from the moment of the request. If the couple is unable to access the program within the scheduled time or there are no facilities in the Region ready to provide the service, they will have the right to go and carry out the treatment in another region at the expense of the region of residence. All this will probably also be reflected in the demand for these services which we estimate could increase by 30%, also making up for the slight decline recorded in 2023, probably due to the wait for the LEA tariff to come into force”.

Infertility, the extent of an increasingly widespread problem

He currently suffers from infertility 1 in 6 people, a phenomenon that affects 17.5% of the world's adult population. In Italy, where it is already facing a significant decline in births, it suffers approximately 15% of couples. In 2021, 86,090 couples were treated in 340 ART Centers in Italy and over 16,000 children were born alive through these procedures, equal to 4.15% of births in the general population.

«On a global and national level we are witnessing a delay in the average age of first motherhood: smore and more couples believe they can easily conceive even after the age of 40-45, ignoring the biological limits”he highlighted Nicola Colacurci, Past President of the Italian Society of Gynecology and Obstetrics (SIGO) and coordinator of GISS Reproductive Medicine. «It is therefore essential to promote education on motherhood and responsible sexuality that raises couples' awareness ofoptimal biological age to have children, considering that reproductive capacity decreases from the age of 35, and this also affects the success of the ART process. Furthermore, it is important to improve access to quality maternal and child care services during gestation and birth, ensuring optimal care in all birth centers.
Finally, it is crucial to strengthen diagnostic and therapeutic services for infertility, guaranteeing all
couples access to specialized centers throughout the national territory, to reduce the challenges related to fertility and offer greater opportunities to couples wishing to have children”.

The possible causes behind a failed pregnancy

The age of the first pregnancy is certainly one of the main causes behind the inability to procreate, but it is not the only one. «Common causes for women include reduced ovarian reserve, tubal problems, endocrine infertility and endometriosis, while male infertility occurs when the number of healthy sperm is low or when there are problems with sperm function that make fertilization difficult of the oocyte under normal conditions,” he added Guglielmo Ragusa, President of the Italian Society of Human Reproduction (SIRU). “The suggestion for couples with difficulty conceiving is not to wait too long to consult a gynecologist, especially if the woman is over 35 years old.”