Medicine is not enough, the problem is that people don't want any more children

If numbers don't lie and - knowing how to read them - tell not only about the past but also about a perspective for the near future, then the provisional data presented at the Eshre congress on Embryology and Reproductive Medicine underway in Paris, beyond a negative balance - 176,830 fewer cycles in 2022 compared to the previous year, a year in which the Covid effect was also felt in assisted procreation - tell of a trend towards cycles that increasingly avoid twin pregnancies and of a world, that of Reproductive Medicine, which often resorts to egg donation, which uses preimplantation genetic tests more, which records a greater number of interventions to preserve male and female fertility. With pregnancy rates that remain stable despite the decrease in cycles. And this means that the techniques have been refined.

The provisional numbers of assisted reproduction published by Eshre reveal in 2022 a total of 960,347 treatment cycles in 1371 centers in 39 countries against the 1,137,177 treatments of 2021, with a reduction of 15.6%. The lower number of cycles has not translated into a lower pregnancy rate and this is because the transfers of two embryos are decreasing and those of a single embryo are increasing, considered the goal by specialists also for lower risks for the pregnancy and for the health of mother and child.

From egg donation to fertility preservation

The highest numbers of cycles with ICSI (365,905 cycles), a technique in which a single sperm is injected into an oocyte, are lower than those of in vitro fertilization (137,148 treatments), in which sperm and oocytes are put together in a test tube without further external interventions. And then there are the transfers of frozen embryos (365,905), the 41,138 cycles with oocyte donation and 92,677 genetic preimplantation tests. And there were 30,758 interventions in 14 countries to preserve fertility between freezing of oocytes, ovarian tissue, sperm and testicular tissue.

The results

The pregnancy rate remains fairly stable: for IVF the pregnancy rate per transfer was 33.5% in 2021 and 32.7% in 2022. For ICSI 33.5% versus 32.5% in 2021. In particular, Eshre stresses the fact that single embryo transfer continues to increase, growing from 60.5% in 2021 to 62.6% in 2022, with an increase in single pregnancies growing from 90.4 to 91.5%, while twin births dropped from 9.5% to 8.4%, with triple births stable at 0.1%.

The idea of ​​parenthood has changed

“What the Eshre numbers tell us is undoubtedly positive from a clinical point of view,” comments Alberto Vaiarelli , gynecologist and scientific coordinator of the Genera center in Rome, “treatments are becoming increasingly safe, effective, and personalized. But there is one fact that we cannot ignore, especially in Italy: the very idea of ​​parenthood is radically changing, and the desire to have children is in sharp decline. The drop in cycles recorded in 2022 is not just an organizational or economic issue: in part, the reduction in treatments may be linked to post-Covid reorganizations, but in Italy a structural problem is emerging: couples are coming to terms with fertility later and later, and in many cases, they simply never get there. The time for family planning is extending, there is a tendency to postpone, and in many cases the very desire for parenthood is disappearing.”

We need an alliance for birth rate

Not only is there no concrete support, but there is a lack of "a cultural narrative of parenthood as a desirable choice. And this is even more true for the younger generations". Even the growth in fertility preservation practices - over 30,000 in 2022 - should be read on the one hand as protection of one's future fertility, "on the other as an idea of ​​postponing parenthood in a social context that continues not to provide the time, protection and prospects to truly build a family. We need an alliance between medicine, institutions and society to bring the issue of birth rate back to the centre, without hypocrisy or moralism, but starting from a fact of reality: if you no longer want to become parents, medicine is not enough".