Medically Assisted Procreation - Casa di Cura Privata San Rossore

About Us

Since June 2016 Fertility&IVF Unit department adopted Eeva Test and Geri (Merck Biopharma group) Incubator to increase your chances of having a successful insemination [for further info click on the logo or here to read our article in Italian]. The Fertility & IVF Unit at the San Rossore Treatment Center is a private center with specialist, diagnostic and surgical facilities that is licensed to practice health care in the field of Gynecology and Obstetrics – offering Medically Assisted Procreation services (DETERM. N. A/FA 720 27.06.02 Comune di Pisa).

View here the certification.

The Fertility and IVF Unit has a team of professionals with multidisciplinary skills and up-to-date scientific knowledges who will follow and support the couple all the way through the diagnostic and therapeutic path: starting from the initial visit, in order to become familiar with the available therapies, through the gynaecological and andrological visits and up to the treatments, indeed, the couple will benefit of the continuous and specialized assistance of our staff; they will also be provided with a private room with ensuite facilities (satellite and digital terrestrial TV, Internet with fee and air conditioning) in order to guarantee a total privacy.staff. The facility also has an Intensive Care Unit for managing emergencies and its own laboratory to ensure safe and rapid analyses.

Furthermore, the Centre has an Intensive Care Unit to manage possible emergencies and an internal Laboratory to ensure safe and quick analyses.

Infertility

Infertility is a condition of the reproduction system that can affect both women and men and which compromises one of the most basic functions of the human body, the ability to have children. Like many pathologies, infertility depends on various physical, environmental and social factors; but like many other conditions, it can often be prevented and overcome. The first obstacle to be overcome is cultural: first of all, because infertility is much more widespread than one could ever think and often those who are affected by it are reluctant to talk about it even with close family members or friends. Second, because infertility is not a genetic disease and, therefore, it may also occur in individuals who were initially fertile, but who have made incorrect lifestyle choices. Finally, there still are many ideological prejudices and there is a lot of misleading information related to this issue, especially concerning medically assisted procreation (MAP).

Preliminary consultation

It includes the acquisition of the complete medical history of the couple and the subsequent prescription of tests to diagnose any conditions that may partially or completely hinder the chances of conceiving.

Genetic counseling

Consultation with a medical geneticist in order to evaluate the need for targeted exams to detect any genetic abnormalities related to infertility or a family history of diseases that are transmittable to offspring.

Diagnostic Plan

Female infertility

Possible causes of female infertility include: ovulation disorders, tubal occlusion, uterine fibroids, congenital malformations of the uterus, endometriosis, a history of pelvic infections, previous pelvic surgery chemotherapy, etc.

The San Rossore Medical Center offers the following diagnostic exams for women:

Hormonal exams to assess FSH, AMH, LH and estrogen levels in combination with other hormones such as prolactin, thyroid and androgen hormones that may affect ovarian function.
Vaginal swabs to assess, both qualitatively and quantitatively, the key populations of micro-organisms (bacteria and fungal organisms) which can colonise in the female genital tract.
Pap test: screening for cervical cancer.
Transvaginal pelvic ultrasound with antral follicle count
Sonogram during the early follicular phase of the menstrual cycle; in addition to excluding the possibility of uterine and ovarian diseases, it enables the estimation of the number of antral follicles present (AFC). The AFC, together with the hormone assays, makes it possible to define the patient’s ovarian reserve and estimate the ovarian response to pharmacological stimulation.
Ultrasound monitoring of the menstrual cycle
It involves a series of transvaginal ultrasound exams performed regularly in order to evaluate the endometrial growth and follicular development. It can be performed for diagnostic purposes and possibly associated with hormonal assays or for therapeutic purposes (targeted intercourse, timing for transfer of cryopreserved embryos or vitrified eggs).
Sonohysterography
Ultrasound method by which an intrauterine injection of a sterile saline solution and air is used, thus allowing the visualization of any abnormalities in the uterine cavity (uterine malformations, synechiae, polyps and fibroids) and tubal patency.
Diagnostic and operative hysteroscopy
It allows to analyze the uterine cavity by passing a small optical fibre instrument (the hysteroscope) through the cervical canal until the entire uterine cavity is visible. In case intracavitary abnormalities (polyps, submucous myomas, uterine septum) are found, it also allows to treat them.
Diagnostic and operative laparoscopy
Visual examination of the anatomy of the pelvis (uterus, fallopian tubes, ovaries) that enables diagnosis and treatment of morphofunctional changes (i.e. adhesions, endometriosis, fibromatosis, uterine abnormalities) that could possibly cause female infertility. It is possible to inject a contrast medium through the cervical canal to verify passage through the tubes.

Male infertility

Some of the causes of male infertility include: diseases affecting the reproductive tract (cryptorchidism, hypospadias, testicular cancer), infections (orchitis, epididymitis, prostatitis, etc.), testicular trauma, torsion of the spermatic cord, diabetes mellitus, liver disease, kidney disease, neuropathy, varicocele and genetic abnormalities. Infertility caused by combined factors: immunological infertility and male/female psychosomatic infertility.

Semen analysis
It allows the evaluation of the physico-chemical properties (volume, pH, liquefaction and viscosity), concentration, motility and morphology of sperm in the sample according to the criteria of the WHO (the World Health Organization).
Capacitation test
It is done to select the spermatozoa with the best motility and morphology and reproduces, in vitro, the physiological changes required to have the ability to penetrate the egg (capacitation). The test, therefore, can be used as a diagnostic exam to help determine the most suitable type of assisted fertilisation treatment for the couple.
Spermioculture
To assess, both qualitatively and quantitatively, the main populations of micro-organisms (bacteria and fungal organisms) that colonize the male genital tract.
Hormone testing
Are useful to assess luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin (PRL) and testosterone (T) because altered levels of these hormones may affect the process of sperm production.
Doppler ultrasound of the testicles
To highlight anatomical and functional abnormalities and the presence of varicocele.

Treatment Programs

The San Rossore Treatment Center offers the following treatment programs:

Ultrasound monitoring of the menstrual cycle
Indications: unexplained infertility, mild male factor infertility.
Procedure: involves ultrasound exams performed to track the menstrual cycle and the ovulatory phase in order to schedule intercourse. Pharmaceuticals may be administered to induce ovulation and/or progesterone may be administered to support the post-ovulatory phase.
Intrauterine insemination (IUI) for natural or stimulated cycles
Indications: unexplained infertility, mild-moderate male factor infertility, moderate endometriosis without compromised tubes, difficulty related to sexual intercourse (impotence, vaginismus).
Procedure: painless outpatient technique that envisages the deposit of the seminal fluid, after preparation in the laboratory (capacitation) inside the uterine cavity in conjunction with ovulation. This can be performed in case of both natural and stimulated cycles or in combination with multiple ovarian stimulation in order to increase the chance of success. It necessitates ultrasound monitoring to track the ovulatory phase.
In vitro Fertilisation (IVF)
Indications: tubal factor infertility, moderate level male factor infertility, endometriosis and multiple failures using IUI.
Procedure: it is a test tube technique that includes ovarian stimulation using multiple pharmaceuticals and subcutaneous injections to increase the production of oocytes. It should be combined with ultrasound monitoring and evaluation of blood samples to measure hormone levels and to assess the response mode and proper follicular maturation and growth. Once there is positive follicular development, the process moves forward to ovocyte retrieval that is guided by transvaginal ultrasound and performed under sedation. On the same day as retrieval, the partner deposits a semen sample which is capacitated and used to inseminate the eggs. The transfer of embryos is carried out 2-5 days after insemination and is a quick and painless procedure.
Intracytoplasmic sperm injection (ICSI)
Indications: severe male factor infertility, obstructive or secretory azoospermia (absence of sperm in the semen) (epididymal or testicular sperm), failure to achieve fertilisation in previous cycles of in vitro fertilisation, cryopreserved oocytes.
Procedure: it is a technique that involves ovarian stimulation and monitoring similar to IVF. It is different only in terms of laboratory procedures; in this case, a single sperm is injected into the cytoplasm of the oocyte and then, after successful fertilisation, the process moves forward with the transfer of embryos into the uterus.
Fine-needle aspiration (FNA) or testicular biopsy
Technique utilised to surgically remove sperm.
Indications: absence of sperm in ejaculated sperm (azoospermia).
Procedure: it is a technique that involves direct aspiration of sperm from the testicle under local anesthesia. If the procedure fails in the retrieval, an open biopsy can be performed by means of an incision in the testis. The isolated sperm can then be used with the ICSI technique.
Cyroconservation of sperm (from ejaculated sperm or fine-needle aspiration)
This procedure is indicated for patients with conditions requiring therapies that may induce damage to spermatogenesis (neoplastic disease, autoimmune disorders, etc.), conditions requiring surgical intervention to the urogential structure that may damage ejaculatory function or patients who must undergo a vasectomy. It is also useful in case of occupational exposure to potentially genotoxic substances, Oligoasthenoteratospermia (OAT) that shows temporary improvement in the quality of the sperm, severe and progressive deterioration of the quality of the semen, cryptozoospermia (very low number of spermatozoa in the ejaculate), or difficulty in collecting the semen on the day of MAP (for psychological or logistical reasons).
Cyroconservation of oocytes
This procedure is indicated in case of

patients with IVF programs where the number of oocytes available is greater than that necessary to obtain a suitable number of embryos for the patient, according to law 40/2004 and the Constitutional Court Judgement Num. 151/2009;
unpredictable reasons (the lack of male gametes on the day of retrieval);
the patient subject to the oocyte retrieval presents a high risk of developing ovarian hyperstimulation syndrome; to preserve the fertility of patients who are to undergo treatments that present the risk of gonadal toxicity such as chemotherapy and radiotherapy.

Cryopreservation of embryos (Constitutional Court Judgement Num. 151/2009)
The 2009 court judgement made it possible to inseminate more than 3 oocytes. The number of oocytes to be used is determined by the gynaecologist considering the age of the patient as well as the causes for infertility. This ensures the possibility of obtaining a greater number of embryos than that sufficient for a single embryo transfer. The developing embryos can then be cryopreserved to be used later in subsequent attempts or for subsequent pregnancies.
Endometrial scratching
The lining of the uterus (the endometrium) is gently ‘scratched’ using a thin catheter (a fine, flexible, sterile, plastic tube) which is passed through the cervix. New research and evidence suggests that scratching the uterine lining causes a ‘repair reaction’ which may increase embryo implantation rates: the repair process releases growth factors, hormones and chemicals. The new lining which grows after the procedure is thought to be more receptive to an implanting embryo and so increases the chances of pregnancy.

Certification

The Fertility & IFV Unit “Pina De Luca” of Pisa is member of the MAP Centers, a list of specialized centers certified by the Italian National Transplant Center and by the Regione Toscana. View the certification here.

FAQ Techinques' related

What’s Intrauterine Insemination?

Inducted multiple follicular growth and ultrasound monitoring
It consists of a pharmacological stimulation in order to induce a simultaneous maturation of a variable number (1-3) of follicles. During the stimulation, the ovarian response to medicines is monitored through ultrasounds and, when the follicles reach an adequate development, a drug is given to induce ovulation. Then, after 36 hours, the intrauterine insemination is planned.
Intrauterine Insemination
It is a quick and painless procedure which consists of an intrauterine injection, via a flexible catheter, of the partner’s seminal fluid, collected on the same day, after a laboratory preparation (capacitation).

Which procedures are required for FIVET/ICSI?**

MULTI-FOLLICULAR GROWTH INDUCTION AND ULTRASOUND MONITORINGIt consists of a stimulation to induce a simultaneous maturation of multiple follicles in order to have several oocytes available; this growth can be reached by means of different therapeutic protocols. The drug, dosage and protocol to adopt is assessed on the basis of the patient’s age, her hormonal features and possible previous treatment cycles. During the stimulation, the ovarian response to medicines is monitored by means of ultrasounds and blood samples (estradiol dosage and plasma progesterone). When follicles reach an adequate maturation connected to an equivalent increase of hormonal levels, a drug to complete the oocyte maturation is given. Then, after about 36 hours, oocytes are taken.
Oocyte samplingPerformed under sedation, therefore completely painless, via echo-guided follicular aspiration, the follicular fluid sample is analyzed with a microscope in order to isolate the oocytes. The so obtained cells are then kept incubated until the insemination.
Oocyte InseminationThe oocytes are cultured inside appropriate incubators which maintain proper conditions for their survival and after 4-6 hours they are inseminated. The seminal fluid is obtained through ejaculation or surgical sampling by means of fine needle aspiration or testicle biopsy, and it can be collected while the procedure is performed, or previously and cryopreserved. The method of insemination is chosen on the basis of the seminal fluid quality and the couple’s reproductive history. It may be the case, for example, to adopt the conventional FIVET or an intracytoplasmic injection of the sperm (ICSI). The inseminated oocyte is then cultured for further 15-20 hours, after which the fertilization is evaluated. From 2 to 5 days after the insemination, the embryonic transfer is planned.
Embryonic TransferThe intrauterine transfer is simple and painless and consists of the insertion of a very thin catheter inside the uterine cavity through the cervix via transabdominal ultrasound guide. The optimal number of embryos to transfer depends on various factors such as the patient’s age, the development phase of the embryo and the results of previous treatment cycles. After the embryonic transfer, a supportive progestogen therapy is advised and a pregnancy test can be performed about 12 days later. In a few exceptional cases (risk of ovarian overstimulation, inadequate endometrial development, excessive number of embryos), the Judgement n.151/09 of the Constitutional Court allows to freeze part or all the embryos in order to postpone the transfer.