Assisted Reproduction: a long and costly journey

Couples seeking assisted reproduction (ART) treatment are increasingly of a more advanced age, more educated and in stable employment. Couples seeking ART are increasingly of a more advanced age with mean paternal age being 39.8 in 2016 vs. 37.7 in 2008 and mean maternal age 36.7 years in 2016 vs. 35.3 years in 2008, have a higher education level and more stable employment. These couples tried to have a child for a mean time of 3.9 years and began to worry after 15.5 months of failed attempts vs. 12.2 months in 2008. Time to seeking medical advice has lengthened too (10.9 months vs. 9.2 months in 2008).  Mean time from first seeking medical advice to going to an ART clinic is more than one year, namely 12.7 months, and even longer for less educated couples (19.2 months). Most couples (72%) seek advice from a gynaecologist, and the percentage of those seeking advice from an ART clinic specialist has doubled to 14% compared to 2008. A specific clinical cause of infertility was identified only in 55% of couples (some 9 percentage points less than in the previous survey) either by an ART clinic specialist (40%) or a gynaecologist (36%). This is what emerged from the survey titled “Becoming parents today: the point of view of couples on ART” conducted by CENSIS in collaboration with the IBSA Foundation, eight years after the first survey on this theme.
Waiting times vary depending on the ART clinic. Waiting times before getting access to ART treatment vary depending on the chosen ART clinic. 33% of couples had to wait for less than 3 months (percentage rising to 49% for couples treated at a private practice),  26% of couples for 3 to 6 months (percentage rising to 41% for couples treated at a private practice providing services under a subcontracting agreement with Italy’s NHS), 24% of couples for 6-11 months (percentage rising to 32% for couples treated at an NHS clinic) and 17% of  couples had to wait for one year or more before starting ART treatment (percentage rising to 29% for those treated at an NHS clinic).
Geographical differences: more expensive in central Italy. Analysis of information regarding the last ART treatment shows that costs were fully covered by Italy’s NHS for 14% of couples, there was cost-sharing (co-payment) for 49% of couples while costs were entirely borne by the couple for 35% of couples, mostly in Italian regions where there is a greater presence of private practices, i.e. regions in central Italy where the percentage of couples bearing the full cost of ART treatment rises to 67%, and  in southern Italy where the percentage reaches 51%. For couples who had to pay out of their pocket, the average cost of their last ART cycle was around €4,000 (€4,200 in northern Italy, €5,200 in central Italy, and €2,900 in southern Italy). For those who shared the costs (co-payment) of ART treatment at NHS clinics or private practices on a subcontracting agreement with Italy’s NHS, average cost was €340 euro (€280 in northern Italy, €700 in central Italy and €370 in southern Italy).
Difficulties of couples on ART. 82% of couples felt frustrated due to failed attempts which had repercussions on their daily lives. 61% of couples named as a major source of distress their difficulties in reconciling treatment with their work schedules. 52% of couples said infertility became a constant thought to the point they could hardly think of anything else. 46% of couples were concerned with treatment side effects. 42% of couples cited as a major source of distress the medicalisation of aspects of their intimate life like sexuality and reproduction. 41% of couples said the source of distress was feeling different from other couples. 30% of couples, mostly young ones (42%), reported lack of understanding of their problem by their close family and friends.
Amendments to Italy’s Act 40/2004. Nearly all couples said they agree with the changes already introduced into Act 40/2004. 90% of them said they are favourable to pre-implantation genetic diagnosis to prevent passing on serious diseases to the child and 81% of couples believe every couple should have the possibility of using donor eggs or sperm. Lower, yet still significant, are the percentages of those favourable to other changes in legislation that have not yet been introduced, with 46% of couples believing restrictions on surrogacy should be lifted, 45% of couples thinking surrogacy should be available to single parents too and 42% of couples being of the opinion that it should be available for same-sex couples as well.