The International Institute of Reproductive Medicine (IIRM), also in collaboration with its national and international partner clinics, offers a wide range of cutting-edge services and treatments to address the challenges of infertility. Each patient is unique, and we are committed to providing personalized solutions based on the latest research and innovations in this field.

Services and Treatments

Infertility occurs when an individual or a couple has a reduced ability to conceive spontaneously. Infertility can be due to numerous factors, including:

 
- Age (especially female) 
- Genetic factors 
- Congenital factors 
- Incorrect lifestyles (overweight, smoking, etc.) 
- Pathologies or infections (endometriosis, sexually transmitted infections, varicocele, etc.)

 
 
The severity of infertility, and therefore the ability to treat this condition successfully, depends on the number of factors involved and their extent. 
 
There are also cases in which no obvious cause of infertility is found, and we therefore speak of unexplained or idiopathic infertility. 
 
Sterility, on the other hand, is the total impossibility of conceiving naturally. It is generally caused by irreversible and permanent damage to the reproductive organs or lack thereof.

1. Infertility and Sterility: Let’s Make Clarity

It is important that women and men know that they can confidently turn to a specialist in Reproductive Medicine not only when looking for a child that does not arrive, but in all phases of their reproductive life. 
The specialist, in fact, can give useful advice to prevent future infertility problems, can diagnose potential problems early and can propose the most appropriate therapeutic indications for each individual case. 
 
In general, if you are trying to get pregnant, it is advisable to contact a specialist after 12 months of intercourse that has not led to the desired result.

2. The Specialist in Reproduction Medicine: What He Does and When to Contact Him

The diagnostic process must be personalized based on the characteristics of individual patients and individual couples. There are diagnostic tests and examinations with different degrees of invasiveness and complexity that Translated from Italian to English - www.onlinedoctranslator.com they can help diagnose any causes of infertility and identify the most appropriate treatment.

3. The Diagnostic Process of Infertility

The first consultation with the specialist constitutes the initial step of the process aimed at identifying the presence of any reproductive problems, their cause, their extent and to evaluate, based on this, the most appropriate treatment options. 
 
The first consultation can be carried out in person or via teleconsultation. In preparation for the interview, the couple will be able to send the reports of any tests or treatments previously carried out and fill out a specific medical history questionnaire to allow the specialist to make a more accurate assessment of the case. During the interview, the specialist will ask the patients questions aimed at gathering useful information on their history, will prescribe any further necessary tests, will outline the recommended therapeutic procedure to the patients and will respond to any requests for clarification. 
 
The first consultation is an important moment of exchange and interaction, during which patients can feel free to ask all the questions they deem appropriate to consciously face their journey. Patients can then request further consultations with the specialist whenever they feel the need.

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4. The First Consultation

The basic diagnostic process of female infertility includes: 
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- Assessment of Personal and Family History: objective examination 
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- Dosage of AMH(Anti-Mullerian Hormone): it is a blood sample that can be performed on any day of the cycle and which allows you to evaluate the ovarian reserve. 
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- Antral Follicle Count (AFC): it is a transvaginal ultrasound that must be performed within the 5th-6th day of the cycle and which allows the ovarian reserve to be assessed by counting the number of antral follicles present in both ovaries. 
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- 3D Ultrasound: it is a transvaginal ultrasound that must be performed before the start of the menstrual cycle and which allows you to evaluate the shape and size of the uterus, as well as the presence of any anomalies that could compromise its functionality (polyps, fibroids, etc. .). It can be supplemented with a hysteroscopy for a more complete evaluation. 
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- Hysteroscopy: it is an examination which involves the insertion of a thin optic inside the uterine cavity to have a direct vision and to remove any small anomalies that may be present (adhesions, polyps, etc.). In the latter case we speak of operative hysteroscopy. It can be supplemented with 3D ultrasound for a more comprehensive evaluation.

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Any further tests may be indicated by the specialist

5. Diagnosis of Female Infertility

The basic diagnostic process of male infertility includes:

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- Assessment of Personal and Family History

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- Objective examination

 
 
- Spermiogram: it is a test that consists in the analysis of a sample of seminal fluid to evaluate the number, morphology and motility of the spermatozoa present in it. It is important that it is carried out in qualified laboratories to ensure its accuracy.

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Any further tests may be indicated by the specialist.

6. Diagnosis of Male Infertility

Once the diagnosis has been formulated, the specialist will be able to indicate the most appropriate path for each individual case. 
Depending on the causes of infertility and their extent, the path may include: 
- A waiting period during which to seek spontaneous conception and at the end of which to reevaluate the situation in case of failure 
- A medical or surgical intervention aimed at restoring, where possible, the natural fertility of the individual or couple 
- A medically assisted procreation treatment

7. The Treatment of Infertility

It is estimated that 1 in 6 people of childbearing age worldwide are affected by reproductive problems. It is therefore very important to know what they can be, how they can be prevented and what help medicine and science can give to resolve them.

Diagnosis and Treatment of Infertility

- Specialist consultancy 
- Gynecological ultrasound, also 3D 
- Diagnostic and screening tests 
- Sonosalpingography 
- Diagnostic and operative hysteroscopy

The Gynecological Diagnosis and Therapy Service provides the following services:

Gynecology is the branch of medicine that deals with the female reproductive system. It is important for women to undergo periodic checks to monitor their health status, identify and treat any pathologies early and prevent potential sexual and reproductive problems.

Diagnosis and Gynecological Care

- Specialist consultancy 
- Andrological ultrasound 
- Diagnostic and screening tests 
- Spermiogram/Sperm separation test 
- FISH test 
- Andrological surgery

The Andrological Diagnosis and Therapy Service Provides the Following Services:

Andrology is the branch of medicine that deals with the male genitourinary system. It is important for men to undergo periodic checks to monitor their health, identify and treat any pathologies early and prevent potential sexual and reproductive problems.

Diagnosis and Andrological Care

The continuous evolutions of medicine and research have made it possible to identify genetic factors related to numerous pathologies and conditions, including infertility. Genetics can support Reproductive Medicine in the case of infertility due to genetic causes linked to specific chromosomal alterations, in the presence of particular mutations (such as those associated with thrombophilia or cystic fibrosis), in the presence of cases of multiple abortions or in couples affected by or carriers of genetic pathologies decide to resort to pre-implantation diagnosis to reduce the risk of transmitting these diseases to their offspring.

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If the desired pregnancy is achieved, genetic counseling can support prenatal diagnosis tests. In the presence of specific indications, personalized genetic counseling is therefore extremely useful to allow couples looking for a child to evaluate their reproductive risk and to analyze, with the help of a specialist, the various treatment options available in each individual case.

Genetic Diagnosis

Normally, in each cycle, a single follicle matures. To increase the chances of achieving a pregnancy, in some selected cases it is possible to carry out mild ovarian stimulation by taking specific drugs, then planning intercourse based on the expected ovulation date.

1. Induction of Multiple Follicular Growth

Intrauterine insemination involves the introduction of suitably prepared seminal fluid inside the uterus using a special catheter. It can be preceded by light ovarian stimulation to induce the maturation of a greater number of follicles and can be carried out using seminal fluid from the partner or a donor. It is indicated in cases of unexplained infertility or in the presence of a mild male infertility factor.

2. Intrauterine Insemination

The acronym IVF stands for in vitro fertilization and in utero transfer of embryos. This technique requires the woman to undergo ovarian stimulation and surgical retrieval of the eggs. In the laboratory, each individual oocyte is brought into contact with a sample of appropriately treated seminal fluid and fertilization then occurs naturally, even if in vitro. The embryos thus obtained can be transferred directly to fresh or cryopreserved and transferred in a subsequent cycle. 
IVF is particularly indicated in cases of tubal infertility, endometriosis and in cases of mild male infertility factor.

3. IVF

The acronym ICSI indicates the intracytoplasmic injection of a single appropriately selected spermatozoon directly into the oocyte. As with IVF, this technique also requires the woman to undergo ovarian stimulation and surgical retrieval of the ovocytes. In the laboratory, a sperm is then injected into each individual egg. The embryos thus obtained can be transferred directly to fresh or cryopreserved and transferred to a subsequent cycle. 
 
ICSI is indicated in the case of severe male factor infertility, if a pre-implantation genetic diagnosis (PGT) needs to be carried out or if thawed oocytes are used (as happens for example in many cases of egg donation)

4. ICSI

There are circumstances in which it is not possible to proceed with the fresh transfer of embryos and it is therefore necessary to proceed with their cryopreservation. This is done, for example, when: 
- The number of embryos obtained is greater than that suitable for transfer 
- The patient is at risk of ovarian hyperstimulation syndrome or is in suboptimal health 
- It is necessary to perform a pre-implantation genetic diagnosis. 
 
The embryos are cryopreserved in liquid nitrogen (at temperatures of -196&deg;C) and can be transferred in subsequent cycles without having to carry out new stimulations. Freezing does not affect the reproductive potential of the embryos and the success rates are similar to those of fresh transfers.

5. Transfer of Cryopreserved Embryos

In order for the ovocyte to fertilize and give rise to an embryo, it must have reached an adequate level of maturation. It is possible to recreate in vitro culture conditions that allow egg cells taken from the ovary while still immature to grow and mature, thus making them ready for fertilization.

6. In Vitro Egg Maturation (IVM)

It is possible to freeze ovocytes and sperm in liquid nitrogen to preserve them over time, keeping their conditions unchanged. This technique can be used to preserve male and female fertility in the event of pathologies or treatments that could compromise it (for example surgery or chemoradiotherapy) or if you wish to postpone maternity or paternity in time. The cryopreserved gametes can then be used for future assisted conception cycles.

7. Fertility Preservation and Social Freezing

Preimplantation genetic diagnosis is a technique which, through the analysis of a sample of biological material taken from the embryo, allows us to evaluate whether it presents anomalies in the number of chromosomes (aneuploidy), anomalies in the structure of the chromosomes (translocations) or specific pathologies. genetics. In the first case the technique is called PGT-A, in the second PGT-SR and in the third PGT-M. Once the analysis has been performed, it is possible to plan the transfer of embryos that do not present the anomalies sought. 
 
PGT-A is indicated in cases of advanced maternal age, severe male factor infertility, repeated failures of ART treatments, recurrent miscarriages. PGT-SR is indicated in cases where the person seeking pregnancy is a carrier of a translocation. 
PGT-M is indicated in cases where those seeking pregnancy are affected by or are carriers of a genetic pathology.

8. Preimplantation Genetic Diagnosis for Chromosomal Anomalies (PGT-A), Monogenic Diseases (PGT-M) and Translocations (PGT-SR)

Gamete donation is a PMA technique that involves carrying out an assisted conception cycle using oocytes and/or sperm from a donor external to the couple. 
 
Embryo donation is a PMA technique that involves carrying out an assisted conception cycle using embryos from donors external to the couple. 
 
Egg donation is indicated in cases of advanced maternal age, early menopause, previous failures of PMA cycles with homologous oocytes, previous medical or surgical treatments that may have compromised ovarian function or in the presence of genetic pathologies that can be transmitted to offspring from the maternal side. 
Sperm donation is indicated in cases of azoospermia, severe male infertility factor, ejaculatory dysfunction or in the presence of genetic or infectious pathologies that can be transmitted to offspring from the paternal side. Embryo donation is recommended when one or more indications for egg donation and sperm donation exist simultaneously.

9. Donation of Gametes and Embryos

Endometrial Receptivity Tes What is it? 
It is a test which, through the analysis of a series of specific genetic markers, allows us to identify the moment in which the endometrium, i.e. the mucosa that lines the uterus, is most receptive to the implantation of the embryo. To carry out this test it is necessary to carry out a preparatory therapy similar to that for embryo transfer and to take a small sample of the endometrium by biopsy. The transfer can be carried out the following month according to the timing recommended by the test. 
 
The test is particularly suitable for patients who have had numerous previous implant failures.

10. Test and Procedures Complementary to Medically Assisted Procreation

These acronyms indicate a surgical removal of spermatozoa from the seminal tract. By MESA we mean a sample from the epididymis, by TESE (or microTESE) a sample from the testicle. 
 
MESA and TESE/microTESE are necessary if the male partner has azoospermia (i.e. lack of sperm in the ejaculate). This condition can be due to various causes including obstruction of the seminal ducts or severe alterations in the testicle&#39;s ability to produce sperm. The surgically removed spermatozoa are used for in vitro insemination of oocytes, using the ICSI technique.

11. Surgical Sperm Sampling (MESA – TESE/Micro TESE)

In many countries there are registries that collect and analyze data relating to medically assisted procreation treatments to evaluate their effectiveness and safety and to give clear information to patients regarding their chances of success. All IIRM partner centers share this philosophy and adhere to these principles in communicating data relating to the activities they carry out, presenting the results and numbers of procedures performed in a clear and transparent way.

12. Results of Medically Assisted Procreation Techniques

Medically assisted procreation is made up of a series of more or less complex techniques that allow the treatment of various cases of infertility and sterility. Here are the main ones, in order of complexity:

Medically Assisted Procreation (PMA)

Smoking, even passive, negatively affects both male and female fertility and is extremely harmful during pregnancy. When trying to have a child, it is therefore important that smokers consider quitting for their own good, that of their partner and of any child on the way. To do this in an effective and long-lasting way, it is possible to request the advice of a specialist, who will be able to give targeted advice and indications on the methods to follow to achieve this objective.

Consultancy for Smoking Cessation

It has now been demonstrated that a healthy lifestyle can contribute positively to the success of a medically assisted procreation treatment and that, in some cases, reaching a normal weight level can even favor the restoration of spontaneous fertility. It should also be considered that in addition to increasing the risk of failure, overweight and obesity can increase the risk of complications if pregnancy is achieved. 
 
The support of a specialist can be useful for patients to eliminate unhealthy habits, maintain a balanced diet and control their weight. A small effort that can bring big benefits

Nutritional Consultancy

Dealing with a diagnosis of infertility or sterility and subsequent treatments requires a great expenditure of physical, psychological and economic energy on the part of patients both individually and as a couple. The risk of failure and the fear of being judged can contribute to further increasing the level of stress in dealing with this experience. 
 
The psychological consultancy service aims to support patients in the assisted reproduction process, encouraging reflection and awareness about its implications and helping to process feelings related to the treatment and possible failures. 
 
Psychological consultancy is strictly interconnected to clinical treatment to encourage the emergence of specific needs of the couple or individual and to respond to their specific needs before, during and after the assisted reproduction process.

Psychological Consulting

Dealing with infertility and sterility involves significant challenges for individuals and couples. It is therefore essential to prepare as best as possible both physically and psychologically.

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