All about medically assisted procreation: when does it succeed, who can use it, and what are the best conditions for carrying the pregnancy to term. We discuss the issue with Dr. Pasquale Totaro, head of the Medically Assisted Procreation Center of the Santa Maria Hospital, in Bari, Apulia, part of GVM Care & Research.

What is MAP and why is it used?

MAP is an acronym that indicates “Medically assisted procreation” and is a set of practices, procedures, techniques that help couples unable to conceive naturally.

Who can access a MAP?

All couples who have proven difficulties in conceiving naturally can undertake MAP. Especially nowadays there is a tendency to fertilize in a more delayed manner. The effects of bad life habits should not be overlooked: smoking, nutrition and above all pollution. The latest report from the Italian National Institute of Health said that women conceive at an average of 36 years.

What are the stages of the process?

The first stage is consultation. The couple arrives here, books a consultation, that starts from the collection of anamnesis data, the basis for the treatment plan. We try to understand what is the reason of infertility and if there is any physical reason. There are some couples, in fact, who suffer from infertility called “sine causa”, that is, without an apparent cause. Then we prescribe all those necessary exams in order to refine the diagnosis and then, we indicate the correct treatment, which can be the simplest one, second-level, or first level depending on the needs of the couple.

What are the success rates of MAP?

The success rates of the Santa Maria Hospital are absolutely in line with the percentages at a national and international level. Here we have an overall percentage of 25%-30%. Clearly the factors that influence this percentage are dictated by the age of the woman. Under 30 we have a very high percentage, we even reach 60%. After the age of 42-43 this percentage drops dramatically.

Causes of success and failure of MAP

The main reason for success is the young age of the woman, especially if she does not suffer from some frequent pathologies such as fibroids, endometriosis which is a characteristic disease of women, endometrial polyps and all those other pathologies or uterine or ovarian malformations that they can affect the engraftment of the embryo. The male causes are above all the almost absence of spermatozoa. I emphasize that the final goal of the treatment is that of birth, so it is always preferable for the woman to be healthy in order to carry out the whole pregnancy correctly, not just conception. The healthier a woman is, the greater the chances of success.

What are the techniques and technologies available today at the Santa Maria Hospital?

The techniques available include intrauterine insemination, egg freezing, embryo cryopreservation, in vitro fertilization and Intracytoplasmic Sperm Injection (ICSI). We were the pioneers  for these techniques. We carry out all the procedures, that may be useful for helping couples, from the first to the second level.

What are the numbers of MAP’s cases at the Santa Maria Hospital?

In 2016 we celebrated 25 years of activity with a great congress. It is truly a pride for the Santa Maria Hospital. Since we started in 1991, nearly 13,000 couples have come here and more than 2,500 children have been born. We currently carry out about 1200 procedures per year, with excellent percentages.