Reiterative changes in the Italian regulation on IVF: the effect on PGD patients’ reproductive decisions

National legislations represent one of the main factors influencing access to assisted reproduction treatment. The Italian situation in the last decade is an example of how the treatment of patients for preimplantation genetic diagnosis (PGD) was more dependent on regulators than on medical choices. This report analysed how the changes in Italian regulation affected the number of PGD referrals to this study centre, as well as their decision to opt for cross-border reproductive care (CBRC). The analysis showed that during the period in which PGD was actually not performed because of the restriction imposed by the Italian law on IVF (from 24 February 2004 to 7 May 2009) there was a significant decrease in the number of referrals asking for PGD (2.5% of total referrals) compared with the previous years (3.3%; P < 0.025) and following years when PGD was legalized (5.1%; P < 0.001). The number of couples opting for CBRC had an opposite trend, reaching a maximum when PGD was banned from Italian centres (55 couples), whereas after the readmission of PGD, only eight couples went abroad for treatment. Concomitantly, since May 2009, the proportion of couples performing a PGD cycle in this centre has constantly increased.National restrictions in the Italian law on IVF affect dramatically the access of preimplantation genetic diagnosis (PGD) for couples carrying a monogenic disease and/or a translocation. These couples are often forced to travel abroad to receive an IVF treatment (so-called ‘cross-border reproductive care’), and this often entails a series of discomforts for patients, including the interruption of employment and high expense, which are related to travel and long-term accommodation as well as to the PGD treatment itself. Even more critical is the situation of couples that already have children, especially if affected by a severe pathology. This study analyses the impact that the Supreme Court Decision on 8 May 2009 (which declared the law to be partly unconstitutional) had to the flux of PGD couples coming to our centre. This figure was significantly higher compared with two previous periods: from January 1998 to 23 February 2004 when no regulation on IVF matters existed and from 24 February 2004 to 7 May 2009 during which the law banned any kind of treatment. The number of couples opting for receiving treatment abroad is also reported, showing a substantial decrease after PGD was readmitted in Italy. Results indicate that if patients have the possibility of performing a treatment cycle in their own country, they opt for this choice, and, hopefully, the phenomenon of cross-border reproductive care come to an end.