A couple is considered infertile when they cannot conceive after 12 to 24 months of attempts without contraception. In 2015, one in 32 births took place thanks to medically assisted procreation (MPA). Also known as medically assisted procreation (PMA), the AMP brings together several medical techniques that involve manipulating an oocyte and a sperm in order to promote the onset of pregnancy. To have access to these methods, couples go to AMP centers where artificial inseminations where in vitro fertilizations are carried out.
PMA: what is medically assisted procreation?
100% reimbursed by Health Insurance, medically assisted procreation refers to the different methods that allow infertile couples to bear children. They consist in the preparation of gametes (oocytes and spermatozoa) in the laboratory in order to cause pregnancy. Like gestation for others (surrogate mother), double donation of gametes is prohibited in France. If both spouses are sterile, they cannot have access to the MAP.
- Intrauterine artificial insemination
According to Inserm, artificial insemination is the simplest technique for future parents. Initially, the mother receives stimulation therapy to obtain the development of one or two follicles. Follicular development is monitored via ultrasound scans and blood tests. As soon as the follicles are mature, insemination is scheduled.
The sperm is then harvested on the day of insemination. In some special cases, the seminal fluid is frozen. At the time of the follicular puncture, the flakes are thawed in order to recover the mobile spermatozoa.
Insemination does not require hospitalization. Using a catheter, the doctor deposits the sperm inside the vagina. These go up naturally to meet the oocyte. This process is called "in vivo" because fertilization takes place inside the woman’s body.
- In vitro fertilization (IVF)
During in vitro fertilization, the woman receives hormonal injections to stimulate the development of one or more follicles. Once mature, they are removed and sent to the laboratory. As with artificial insemination, sperm is also collected and prepared by the medical team. It is also possible to use frozen sperm or eggs for this type of MAP.
Placed in a culture dish, heated to 37 ° C, sperm and eggs are brought into contact for in vitro fertilization (outside the woman's body). The fertilized oocytes then transform into zygotes (fertilized eggs) and after two or three days into embryos. A few days after fertilization, the embryos are placed in the woman's uterus for implantation.
- In vitro fertilization with micro-injection (IVF-ICSI)
About 67% of IVF now takes place using this technique. ICSI stands for "intracytoplasmic sperm injection", it involves injecting a sperm directly into the oocyte. A biologist performs microinjection with a microscope. The latter is renewed for each fertilizable oocyte. The following stages of IVF-ICSI are similar to those of in vitro fertilization with the insemination of the embryos in the patient's uterus.
- The reception of an embryo
For a PMA, couples can request to receive a frozen embryo belonging to another couple. However, when the woman is over the age of 42, a majority of MPA centers do not wish to perform this procedure. When an embryo is donated, the donors remain anonymous and are not paid for their approach. They do not know the future parents and lose the right to any affiliation with the child.
Who has the right to medically assisted procreation?
In France, PMA is governed by bioethics law. For the time being, it is only allowed to heterosexual couples (married, civil union or cohabiting for more than two years) of childbearing age. To have access to it, two criteria are studied by the PMA centers: the infertility of the couple noted by a doctor or the risk of transmitting a serious illness to the future baby.
What is PMA for all women?
In July 2019, the bill on the opening of medically assisted procreation (PMA) to single women and lesbian couples was presented to the Council of Ministers by Nicole Belloubet, the Minister of Justice. Adopted at first reading by the National Assembly, the bioethics bill narrowly passed to senators in January 2020.
At the end of April 2020, the final decision of the PMA accessible to all women was to be voted in Parliament. But the coronavirus crisis disrupted this project and the government decided to postpone it. The Republic of En Marche member Gilles Le Gendre announced that the text will not be voted "before summer".
Read also :
⋙ PMA: putting the odds on its side with alternative medicine
⋙ Homosexual or single: they became a mother thanks to a PMA abroad
⋙ Testimonial: I did a PMA alone … and I had twins