PMA in the New LEA: A Step Forward for Couples and Emotional Support for Women Facing Infertility

Since December 30, 2024, Italian couples struggling with infertility have gained a new concrete opportunity to fulfill their dream of becoming parents.

With the approval of the new tariff decree by the State-Regions Conference, Medically Assisted Reproduction (PMA) has officially been included in the Essential Levels of Care (LEA), becoming part of the services covered by the National Health Service (SSN).

LEA services are those that the SSN must provide to all citizens, either free of charge or with a co-payment (ticket), regardless of their place of residence.

The inclusion of PMA in the new LEA introduces significant changes, improving service organization and access for couples. The main updates include:

- Ambulatory-Based Procedures: PMA techniques, both homologous and heterologous, will primarily be performed in outpatient settings, with hospitalization required only in specific medical cases.

- Age Limit and Number of Attempts: Women up to age 46 can access up to six PMA cycles, with no restrictions on techniques. Attempts made before December 30, 2024, will not be counted.

- Standardized Ticket Costs: Fees for services and co-payments will be the same across all regions, following the model adopted in Emilia-Romagna, which covers all cycles, including gamete retrieval and related monitoring.

- Tariff Adjustments: The decree, following recommendations from the PMA Technical Committee (March 28, 2022), includes additional tariffs for follicular aspiration, in vitro fertilization (with or without ICSI), and embryo transfer.

Infertility is a growing issue, affecting 15-20% of couples in Italy and 10-12% worldwide. By recognizing infertility as a medical condition requiring treatment, the new LEA ensures broader, more equitable access to PMA procedures.

Beyond the medical and financial aspects, infertility carries a significant emotional and psychological toll, especially for women. The desire for motherhood is deeply ingrained, and the inability to conceive can lead to frustration, guilt, and depression. In many cultures, women who cannot have children face intense social pressure, often experiencing stigma or even ridicule. The emotional burden becomes even heavier when access to fertility treatments is limited or costly, making women feel even more isolated and powerless.

Including PMA in the LEA is not just a medical advancement—it is also an acknowledgment of the psychological impact of infertility. Providing accessible treatment means offering hope to thousands of women who feel inadequate or excluded, helping them navigate this journey with greater dignity and peace of mind.

The number of PMA cycles is expected to double in the coming years, positively impacting birth rates. Currently, 4.2% of births in Italy result from assisted reproduction, and this percentage could reach 7% in the near future, thanks to the new decree.

This progress in public healthcare is not just about treatment accessibility; it is a meaningful step toward recognizing and supporting couples and women struggling with infertility, addressing both their medical and emotional challenges.