Personalization and age in PMA #3

PERSONALIZATION AND AGE IN PMA For some years, couples have started PMA cycles at increasingly older ages.

In fact, if women over forty who performed PMA in 2005 represented 20.7%, in 2020 they reached 35.8%.

According to data from the Higher Institute of Health (ISS), this makes these cases increasingly difficult because the success rates decrease progressively and strongly with increasing female age, especially after the age of 40.

On the other hand, it is well known that personalization and good quality in the execution of PMA techniques greatly influence the results and, therefore, these methods should be used precisely in these more difficult cases.

Unfortunately, this is not always the case for various reasons: The waiting lists to start PMA are often long. The personalization of the procedures in many cases is limited (protocols are the same for everyone and repeated even in the subsequent cycles of the same patient, impossibility of monitoring and pickup on the weekend, lack of progesterone monitoring during stimulation and after the transfer). When the first PMA cycle begins, the subsequent ones (often the 3 programmed ones) are spread over very long periods of time and the age, often already at the limits in the first attempt, risks to be prohibitive after the last one.

This is true both in fresh cycles and those with cryopreserved embryos for which generally only one embryo is transferred at a time.

The industrialization of procedures in more and more ART centers does not go in the direction of personalization.

In fact, the aim of industrialization (with the homogenization of production processes as in any industrial activity) must minimize costs and maximize profits.

In fact, many PMA centers in Italy have been purchased by foreign investment funds. If the first PMA attempt is started at the age of 40, the last of the planned series could take place from the age of 43 onwards when even the maximum level of personalization could not give appreciable results. However, if between the first and the last attempt of a series carried out without personalizing the therapies, at least one carried out with extreme quality and personalization were inserted, the woman would have better and more acceptable chances of success. The above is evident if one observes the official case studies of “fresh” PMA cycles (those in which it is not possible to cryopreserve embryos, i.e. the vast majority of cycles after a certain age).

The statistics of the results when we consider them as the number of births per PMA cycle in women aged 40 and over were: 10% according to the scientific publications of the Biofertility center and 4.7% for the average of the Italian centers in the official data.

Unfortunately, when available time is running out, we often end up having only one option: the use of eggs from other younger women, i.e. egg donation.

Nonetheless, even in this case it is not certain that the use of these oocytes leads to much higher successes.

In fact, with egg donation, the official Italian statistics from the ISS tell us that in 2020 the % of births per cycle started was 22.7% and that of abortions was 22.8%. Unfortunately, this option is often proposed as the only one possible, especially when techniques such as PGT-a have failed and are presented as the only possibility for selecting healthy embryos.

For this technique, however, the ISS certifies that of all the couples to whom it was proposed, 28% of them had in fact not been able to do it (presumably because the embryos had not even reached blastocysts) and what's more miscarriages had occurred in 16.7% of transfers.

Furthermore, of the patients who were offered this technique, only 17% had achieved birth at the end of the entire tiring and expensive process.

All this without considering the intrinsic biological limits of this technique (the biopsy done on one point of the embryo does not ensure that the situation of the chromosomes is the same in all its parts, the embryo also has the ability to self-correct many of its errors).

Knowing these statistics can be of great help in better orienting yourself in choosing the most appropriate path.