PMA for all: will there be first conceptions "before the end of 2021", as Véran wishes?

For women who would like to embark on a PMA, once the law is implemented, several weeks or even months will be necessary to make an attempt.And the success rate is low.

After two years of work, the Parliament adopted definitively on Tuesday the bioethics bill and its flagship action for the medically assisted procreation for all women, a campaign promise of Emmanuel Macron.Less than a year from the end of the five -year term, the implementing texts were prepared so that the first children can be designed before the end of 2021, "promised the Minister of Health Olivier Véran.

A short -term promise that could be difficult to achieve, because if thousands of women will be able to successfully benefit from a PMA in the months and years to come, the course is long and can be sown with obstacles, not to mention thatthe chances of success are limited.

What are the techniques used for PMA?

The PMA "consists in manipulating an egg and/or a sperm to promote the obtaining of a pregnancy.It makes it possible to make up for certain difficulties in conceiving, without necessarily dealing with the cause of infertility, "explains Inserm.The law passed Tuesday is expanding its access to couples of women and single women, who therefore do not necessarily have fertility problems.Different techniques are used, with variable costs and success rates.

Artificial insemination consists "in relation to relating one or two oocytes obtained by ovarian stimulation and sperm introduced directly into the uterus", explains the site of health insurance.They are introduced with the right "timing since we control the ovulation of the woman, and we maximize it", explains to BFMTV.Com Michael Grynberg, Head of the Reproductive Medicine Service and Preservation of Fertility at Antoine-Béclère Hospital (Hauts-de-Seine).If there is pregnancy, it is therefore in a certain natural way.

In vitro fertilization (IVF) is "heavier, but more efficient", explains the doctor.Unlike artificial insemination, during which the embryo is created in the body of the future mother, with this technique it is carried out in the laboratory.An oocyte is fertilized by a sperm, then the fertilized egg is located in the uterus.

Variations in these techniques exist, and there are also possibilities for preserving fertility, such as gamete conservation, to keep oocytes and sperm for potential pregnancy later.It is also possible to keep embryos, for example during IVF which would have given more than what it is authorized to introduce.

What route?

The course to reach the act, whether IVF or artificial insemination, "is a certain heaviness, for the body, but also psychic," warns Michael Grynberg.And in particular for women, who will have to go through an ovarian stimulation process, a hormonal treatment to have the best possible ovulation.

Before getting there, consultations with the gynecologist or various specialists are necessary to assess the health of patients, and the best technique to adopt.Then can start the pre-PMA treatment, in which ovarian stimulation is included.

When treatment of ovarian stimulation, "transient side effects are frequent: heat puffs, abdominal pain, vaginal bleeding, weight gain", explains Ameli.fr, adding that this can go as far as more serious symptoms, for which a doctor must be consulted urgently: "Swelling and violent abdominal pain, sudden weight gain, digestive disorders".

IVF insemination is then achieved at the best time in the cycle.These steps can take several weeks as a month, depending on the patient.In case of failure, you must wait with a new test."Couples sometimes have the feeling of a waste of time, but the body must rest," said Magazine Dr François Olivennes, gynecologist and infertility specialist to Health Magazine and Infertility Specialist."You have to wait two or three months between each IVF.We can't go faster ".

What chances of success?

The successes of these techniques are variable, but overall quite weak, "less than half of the couples arriving for a PMA come out with a child," explains Michael Grynberg.

According to data from the Biomedicine Agency, in 2015, "54.167 attempts at artificial insemination led to the birth of 6,188 children "and 62.230 attempts at in vitro fertilization (including with gamets) allowed the birth of 18.651 children ".Respectively, this represents 11 and 30% success in France.These chances of success vary depending on the technique used and the profile of patients.

Age thus plays in the success of the PMA."Beyond 38 years old, it is common to quickly go to IVF which offers better chances of success," notes Inserm.On the other hand, "medically assisted acts of procreation are taken care of until the 43rd anniversary of the woman", explains health insurance, because the chances of success after this age are much lower.

What cost?

Today in France, French health insurance covers 100 % of the costs linked to a PMA, up to the limits of six artificial inseminations and four in vitro fertilizations.Additional attempts are borne by patients.Abroad, the cost can increase to several thousand euros by attempts, depending on the country and the method used.

In France, according to an assessment of the High Authority for Health, however dated 2011, an AMP cycle is priced between 2545 and 3019 euros in the public sector by health insurance.The Franche-Comté PMA center has prices ranging from 1200 and 1,400 euros per stimulation cycle, but it is specified that the cost "is very variable from one patient to another because it is depending on the medication chosen,of its dose and the duration of treatment ".In addition, the upstream examinations and the costs of ovulation induced drugs are not taken into account in this calculation.

Pregnancies quickly?

This course, already long and trying, can be delayed by other factors, such as the need for a donation of gametes, oocytes or sperm.The offer is much less important than requests in France, and the latter may increase with couples of single women who will need donations.The wait can already go today from 12 to 18 months, underlines Michael Grynberg so for the moment, future patients "especially the right to put themselves on the waiting list".

In this sense, the promise of Olivier Véran of first pregnancies by the end of 2021 could be difficult to hold.Between the fact that there is not yet a decree of implementing this law, the chances of success of a PMA or the few sperm donations, for Michael Grynberg in this period of time, "it will happenpossibly, but for a very limited number of women ".

PMA (Medically assisted procreation)