Nearly one in 28 children is the result of medically assisted procreation (MAP) in France, i.e. 3.6% of births. Heterosexual couples can use it as well as all lesbian or single women. How’s it going ? What is the price ? Definition, indications, effectiveness, risks and legal framework in force.
[Mise à jour mercredi 15 septembre à 16h20] On June 29, 2021, Parliament definitively adopted the bioethics bill including the flagship measure of access to medically assisted procreation (MAP) for all women (lesbians and singles). The decrees relating to the application of the text must be published by the end of September. On September 15, the Minister of Health Olivier Véran has a budget of “8 million euros additional to establishments authorized to practice assisted reproduction” for “reduce waiting times (for future parents, editor’s note) to less than 6 months”. In 2019, nearly 27,180 children were born from assisted reproduction including 5.3% children from a donation (1,433 children), i.e. 3.6% of children born from the general population. What is a PMA? Who can use this technique to date in France? Is it reimbursed in France? The main thing to know.
Medically assisted procreation (MAP) or medically assisted procreation (MAP) is intended to respond to a parental project. It allows a couple or a single woman diagnosed with infertility to have a child. For this, it uses different methods, such as in vitro fertilization (IVF) and artificial insemination. The objective being to allow the meeting of a sperm and an egg in order to start a pregnancy. As the Public Health Code updated on September 15, 2021, it is accessible in France to any couple made up of a man and a woman or of two women or any unmarried woman.
The law does not indicate an age limit for access to assisted reproduction, but health insurance coverage ends at 43 years old.
In 2019, according toBiomedicine Agency, there have been 157 593 tentatives d’AMP, grouping together intrauterine inseminations, in vitro fertilization (IVF) with or without micro-injection (ICSI) and thawing ofembryos frozen with gametes and embryos resulting or not from a donation. In total, nearly 27,180 children were born from an AMP carried out in 2019, including 5.3% children from a donation (1,433 children), i.e. 3.6% of children born from the general population. The proportion of children conceived by AMP among children born each year in France has increased since 2009 (2.6% in 2009, 3.3% in 2018). We think that nearly one in 28 children comes from a PMA.
- AMP attempts are carried out with the gametes of the two members of the couple in 95.5% of cases,
- With oocytes, spermatozoa, or embryos from donation in 4.5% of cases.
- The artificial inseminations represent 30% of ART attempts and contribute to 21.4% of births from an AMP in 2019. They use donor sperm in 6.3% of cases. This is the simplest technique.
- The IVF (excluding ICSI) contribute 13% births from ART.
- The ICSI contribute to 28% of births issues d’une AMP.
- Steadily increasing embryonic thawing concerns in 2019, 41.6% of ART attempts excluding intrauterine inseminations.
- Countries allowing assisted reproduction for lesbian couples and single women: Spain, Portugal, Ireland, United Kingdom, Belgium, Netherlands, Denmark, Sweden, Finland, Luxembourg and since June 2021, France.
- Countries allowing assisted reproduction for lesbian couples but not single women: Austria.
- Countries allowing assisted reproduction for single women but not lesbian couples : Estonia, Latvia, Poland, Hungary, Slovenia, Croatia, Bulgaria, Greece, Cyprus.
- Countries banning assisted reproduction for lesbian couples and single women : Lithuania, Germany, Czech Republic, Romania, Italy, Malta, Slovakia, Slovenia.
Medically assisted procreation is intended to respond to a parental project. As the Public Health Code updated on September 15, 2021, it is accessible in France to any couple made up of a man and a woman or of two women or any unmarried woman. Access to the GPA may not be subject to any difference in treatment related to the marital status or sexual orientation of the applicants. Both members of the couple or the unmarried woman must first consent to artificial insemination or embryo transfer.
In the case of a couple, obstruct the insemination or transfer of embryos:
- The death of one of the members of the couple;
- The filing of a request for divorce;
- The filing of a request for legal separation;
- The signing of a divorce or legal separation agreement by mutual consent in accordance with the terms provided for in Article 229-1 of the Civil Code;
- The cessation of the community of life;
- The written revocation of the consent provided for in the third paragraph of this article by either member of the couple to the doctor responsible for providing medically assisted procreation.
PMA for all women was authorized on June 29, 2021 by Parliament, after more than two years of parliamentary shuttle. this is the main measure of the bioethics bill. As a reminder, access to assisted reproduction for all women (lesbians, single), had been adopted by the deputies to the National Assembly on the night of Wednesday 9 to Thursday 10 June 2021, for the third time. From now on :
- A woman in a relationship with another woman can benefit from ART with a third-party donor and claim a sperm donation. The costs of the assisted reproduction are reimbursed by Social Security.
- To establish a bond of filiation, the two women having recourse to the assisted reproduction, married or not, must produce an “anticipated joint recognition” of the unborn child.
- A person of full age, male and female, meeting the age criteria can resort to the conservation of his gametes in order to carry out a MAP later. Stimulation and puncture are reimbursed (with age limits set by decree), but the conservation of the oocytes remains the responsibility of the persons concerned.
Surrogacy corresponds to surrogacy, that is to say that a woman called a “surrogate mother” brings the pregnancy to term, for the couple, when the woman is unable to carry on a pregnancy, at the following artificial insemination. This practice is prohibited in France but authorized in several European countries and some states in North America.
A couple whose wife is under 35, after ten to 12 months of unsuccessful trials, can consult for infertility. This delay may be reduced in the event of a history of endometriosis, polycystic ovary syndrome, interventions on the genital tract or thyroid disease. Beyond 35 years, an opinion can be requested after 6 months of unsuccessful attempts.
ART is offered according to 3 techniques: intrauterine inseminations (the simplest technique), in vitro fertilization (IVF) with or without micro-injection (ICSI) and thawing of frozen embryos for couples with both members are sterile or if there is a risk of transmitting a genetic disease to the child.
According to the Biomedicine Agency, the proportion of children conceived by AMP among children born each year in France has increased since 2009 (2.6% in 2009, 3.3% in 2018, 3.6% in 2019). Couples are offered additional chances of success as soon as it has been possible to save extra embryos.
The main contraindications to ART are the woman’s age and uterine malformations preventing a pregnancy to term. A severe psychotic state can also constitute a contraindication.
PMAs are reimbursed until the woman’s 43rd birthday under certain conditions.
Social security covers LDCs until Woman’s 43rd birthday for a maximum of 6 artificial inseminations and 4 in vitro fertilizations. Please note, this reimbursement extends to all women over the age limit for care (that is 43 years) and who have had to stop their ART course because of the confinement, announced Olivier Véran, Minister of Health announced on Wednesday June 10 during a hearing by the Senate Social Affairs Committee. This reimbursement will only be effective for “families benefiting froma MAP course in France“and not for families engaged in an assisted reproduction program abroad, since”we are not in a legal situation (…) as long as we have not voted for the law on bioethics “, specifies the minister according to AFP. If it is definitively adopted, the bioethics bill will authorize in particular the use of the PMA for single women and couples of women, the second reading of which should take place from July 27, 2020 at the National Assembly, just before the summer break.
PMA requires great patience on the part of couples having recourse to it, psychological follow-up may sometimes be necessary.