Medically assisted procreation, also called PMA, has been open to all women since 2021, but for several reasons, many women continue to have recourse to PMA abroad. Explanations with Dr Joëlle Belaisch Allart, gynecologist.
In which countries can you do a PMA?
All countries of the European Union authorize MAP. But the legislation is different from one country to another. French women who have recourse to medically assisted procreation (AMP), also known as medically assisted procreation (PMA), abroad mainly travel in Spain, Belgium, the Czech Republic, and, before the conflict, in Ukraine.
Why do French women still go abroad despite the revision of the bioethics law in 2021?
Despite the revision of the bioethics law, women continue to go abroad to have recourse to MAP for several reasons:
► The waiting times : “Until 2021, female couples and single women went abroad because ART was not authorized for them in France. They were basically going in Belgium. Since its revision, the law authorizes recourse to ART for female couples and single women, but waiting times to get sperm are extremely long. In the Paris region, for example, it takes a little over a year“, explains Dr. Joëlle Belaisch Allart, president of the CNGOF. In Belgium, for example, the deadlines are shorter because “the country buys sperm from Danish banks where the donors are paid, something which is prohibited in France”.
► The age limit : In France, the age limit for ART varies according to the technique. A puncture for a In vitro fertilization (IVF) or an ISCI micro injection is only permitted until 43rd birthday wife and no center has the right to do IVF from the age of 43. “Those who still want to try in vitro fertilization after 43 years therefore go abroad.” Intrauterine insemination is allowed until the 45th birthday but the results of the inseminations after 42 years are very bad. “This is the reason why, despite the law, we do not inseminate after 42 years.“Finally, in any case, the spouse must be under the age of 60.
► The egg donation : It is very difficult for French women to be able to benefit from egg donation because of a real shortage.
► The preimplantation diagnosis : Finally, some women leave for Spain or Belgium after repeated miscarriages for example, to have recourse to a preimplantation diagnosis because in France, embryo analysis is reserved for couples with a high probability of transmitting a genetic disease particularly serious to their child. This disease must be known beforehand.
Who can do a PMA abroad?
Legislation depends on each country. Some countries, like Italy, still reserve ART for heterosexual couples. In the countries where French women go the most, namely Spain and Belgium, the PMA is open to heterosexual couplesto lesbian couples, single women and transgender people in gestation capacity. Regarding the age limit, it has not been set by Spanish law but is estimated at 50 years, the presumed age of menopause. In fact, it seems quite rare for clinics to perform assisted reproduction beyond the age of 45. In Belgium, the request for implantation of embryos or insemination of gametes can be made until the woman’s 46th birthday and the procedure can be performed until her 48th birthday.
To start, “usually women contact the clinic abroad on the Internet. Since the Covid, the first meeting can take place by video“, explains Joëlle Belaisch Allart. At the same time, a French gynecologist accompanies the future parents during their journey. medical examinations will be requested in order to constitute the file for the clinic. As part of a couple of women, they will have to sign the acts of joint recognition in advance and consent to the AMP at a notary In France. The protocol proposed by the clinic can then begin.
What is the price and is it refunded?
The price of the treatments can vary according to the clinic and the origin of the gametes. In Spain, for example, artificial insemination can cost between 500 and 1700 euros approximately while an in vitro fertilization can range from 3000 to 5000 euros, according to the rates presented on the website of a Spanish clinic. Part of the costs may indeed be covered by health insurance.
What are the steps to be reimbursed from a PMA abroad?
“If the act carried out abroad is a legal act in France, it is possible to request partial coverage which will amount to approximately 1500 euros“, assures Dr. Joëlle Belaisch Allart. For this, the steps are as follows:
► Gynecologist’s certificate: To proceed with the request for partial coverage, the French gynecologist must issue a certificate on which the technique, indication, ART care already carried out, the reason for seeking treatment abroad, the absence of medical contraindications and all the other necessary information must be mentioned;
► The clinic quote : After having chosen the health establishment in which the ART will be carried out, an estimate must be communicated. This must specify the name of the patient and the assisted reproduction technique requested;
► Sending the file to the CNSE : In order to benefit from partial reimbursement, prior authorization from the National Center for Care Abroad (CNSE) will be required. The file must include: the medical certificate of the gynecologist, the medical reports of the care already carried out in connection with the ART, the estimate of the clinic, a letter of motivation. In the event of a request for preimplantation diagnosis, a medical certificate drawn up by a doctor working in a multidisciplinary diagnostic center prenatal will be requested. Finally, in the event of the export of gametes, an authorization issued by the biomedicine agency will be compulsory.
Thank you to Dr Joëlle Belaisch Allart, gynecologist-obstetrician specialized in infertility and president of the CNGOF.