PMA: industrialization vs customization

In vitro fertilization or medically assisted procreation (PMA) was born in 1978 in Great Britain and after over 40 years of existence, many steps forward have been made, even in Italy.

Some data to date In Italy there are over 200 level II MAP centers: - 72 record from 201 to 500 cycles of level II procedures per year - 32 record over 500 - The other 100 centers are smaller and record a significantly lower number of cycles per year.

What is industrialization? In recent years, however, in Italy and around the world, a particular phenomenon has occurred in the panorama of some larger PMA centres, namely their purchase by multinational financial groups which are often speculative investment funds whose objective is obviously profit.

This has probably accentuated certain operating methods aimed at maximizing profits by also intervening on greater standardization of diagnostic-therapeutic protocols to limit the cost of each individual procedure.

How does it affect couples? Patients often complain about centers where they seem to be part of an "assembly line", they say they were received by some gynecologists but then were followed by continuously different others in the subsequent phases of monitoring and treatment.

Many patients complain that in large clinics, previous failures are not investigated enough and, therefore, standardized protocols are followed that are more or less the same for everyone.

This emerges when couples compare themselves with others without delving into the differences that could lead to the solution of problems perhaps at the root of the failures suffered.

The massification of therapies discourages patients greatly and does not make them feel part of a team that works built for them, where doctors are often overworked and are unable to follow patients as individuals different from each other nor to empathize with them.

That is, patients say that there is often a lack of true personalization of the therapeutic path.

Personalization is actually very expensive for medical facilities because continually deviating from predefined patterns for the mass of couples implies a strong investment in time and materials on the part of the facilities themselves.

This, therefore, may conflict with the philosophy of industrialization and, above all, aims to improve results and make couples feel at ease.

Biofertility and personalization Biofertility is among the Italian centers that close to 200 cycles per year and which wants to make the personalization of treatments the main prerogative of its reality.

During the first visit, an accurate general medical history of the couple is carried out and then a particular one, trying to fully understand all the problems of all kinds that affect both members of the couple.

Women's analysis Conditions such as PCOS, reduced ovarian reserve, endometriosis, decompensated insulin resistance and thyroid pathologies are studied and treated if present.

We investigate possible genetic pathologies and surgical interventions that have been carried out in the past, proceeding with the gynecological investigation aimed at evaluating the ovarian and uterine morphology.

We then move on to checking the hormonal tests and in particular those relating to the ovarian reserve on which the type of protocol to be used depends.

A lot of research is done into any previous PMA attempts carried out in search of the reasons for failure and through a transvaginal ultrasound the antral follicles are counted (possibly in the first days of the cycle).

Male analysis In-depth andrological investigations are carried out via spermiogram and, if necessary, with other specific investigations including andrological or urological consultation because the man must not be neglected.

Diagnosis and therapies Once all this data has been collected, a diagnosis of infertility is formulated or the causes of previous failures are hypothesized and on the basis of this further investigations, supplements or drugs are started to be prescribed which can improve the ovarian reserve and the quality of the oocytes as well as the conditions of the spermiogram.

For everyone there is generally a different therapy.

Interview with Prof Manna It is always the director of the center who follows the patients from the first meeting.

The preliminary interview lasts no less than 90 minutes for many reasons.

In fact, Professor Claudio Manna stops to talk to patients to understand, in addition to the clinical aspects, also the emotional ones and the psychological situations that have accompanied the souls of his patients over the years. He personally follows all the phases of the therapies, personalizing them 100% and not following a one-size-fits-all protocol.

Finally, he personally carries out pick-ups and transfers during the PMA.

This is the only effective way to best follow patients, completely personalizing treatments even in the laboratory phases.

Being always present, never abandoning patients in their often long and tiring process, also facilitating them in logistical and bureaucratic aspects, is an essential prerogative of Biofertility.

Personalization as a shared value Prof.

Manna is closely supported by his team who shares this life and professional philosophy with him down to the smallest details.

Everyone follows the therapies step by step in unison, trying not to leave the patients alone in their emotional and psychological trouble, ensuring that they always feel unique and never a number.

Biofertility protocols are in fact highly personalized based on the needs of the person/couple and are never the same for everyone.

Total customization, in fact, has become the main and distinctive prerogative of Biofertility over the years: the team in fact works 7 days a week, because we are the ones who follow everyone's response to therapies and not vice versa, for example for the trend of Progesterone which must not exceed certain levels during the stimulation.

Patients, therefore, must not feel part of a mechanism that is the same for everyone but pampered and considered special.

For example, ovarian stimulation protocols are generally different from each other (just ask anyone who is doing the Biofertility program in the same period of time to realize this).

Finally, Biofertility leaves no stone unturned, especially in the most difficult cases.

In short, not industrialization but personalization is the motto or, if we want, the daily challenge of Biofertility.