After the refusal of a third reading by the senators, Thursday, June 24, the new bioethics law must return to the National Assembly, Tuesday, June 29, to be definitively adopted. In particular, it provides for the opening of medically assisted procreation (PMA) to all women (lesbian couples and single women), and no longer only to heterosexual couples suffering from infertility problems. Here is what you need to know about this often long and complex procedure and the changes made by the law.
So far, who could have assisted reproduction?
In his bulletin Population & societies published in June 2018, the National Institute of Demographic Studies (INED) recalls that PMA now represents one birth in thirty (or 3.4% in 2018).
Before the adoption of the new bioethics law, only heterosexual couples (married, civil union or in cohabitation) with fertility problems noted by a doctor could have recourse to it, as well as if one of the members of the couple was a carrier of ‘a serious illness that can be passed on to their babies. These medical practices were governed by the latest law on bioethics, of July 7, 2011.
To conceive a child, lesbian couples and single women had to travel abroad to perform this procedure. According to a survey by The cross published early 2020, at least 2,400 single women or lesbian couples go to Belgium or Spain each year to seek assisted reproduction. Depending on the course and the country, an assisted reproduction can cost between 400 and 11,000 euros, not including travel and accommodation costs.
How is the journey of an assisted reproduction going today?
Lesbian and single women will now be able to have recourse to an assisted reproduction program in France, enjoying the same rights as heterosexual couples. As is already the case for infertile couples, women can have assisted reproduction until the age of 43.
Any patient wishing to benefit from medically assisted procreation must have several interviews with a doctor or a medical team specializing in fertility, which seeks to identify the motivations of future parents and aims to inform them about the various medical techniques, as well as their consequences. For heterosexual couples, the doctor looks for the existence of factors favoring female or male infertility.
After a reflection period of one to two months depending on the case, people wishing to continue their ART course must confirm their request in writing to the doctor. Four attempts at in vitro fertilization and six artificial inseminations are reimbursed by Social Security at full rate. An artificial insemination costs on average 950 euros, and an attempt at in vitro fertilization, between 3,000 and 4,000 euros, according to figures provided by Medicare.
What are the different types of assisted reproduction?
Medically assisted procreation (AMP) can take different forms through in vitro fertilization (IVF), artificial insemination, embryo transfer, or even the conservation of gametes (oocytes and spermatozoa), germinal tissues (fragments of ovarian or testicular tissues) and embryos. Whether from a therapeutic or psychological point of view, each course will be significantly different and it is difficult to establish a unique pattern. But if the method varies, the goal is common: it is to allow the meeting of a sperm and an egg in order to provoke a pregnancy.
For the in vitro fertilization (IVF), we use a sperm donation or an egg donation depending on the origin of the fertility problems. The practitioner then presents an egg and sperm in the laboratory. The sperm injected into the egg, the embryo is then inseminated in the woman’s uterus.
- If both members of the couple have an infertility problem, in case of risk of transmission of a genetic disease to the child, or in the case of a lesbian couple whose surrogate mother is infertile, people can turn to to the embryo transfer after a judge’s decision. Thus, the embryo of anonymous donors is transferred to the uterus of the wife of the recipient couple.
- Finally, some couples resort to a artificial insemination. The doctor introduces sperm into the woman’s uterus to make it easier to meet the egg (or oocyte). Artificial insemination can be done with the partner’s sperm or frozen sperm from an anonymous donor.
If the treatments do not require hospitalization, psychological follow-up is encouraged for the parents, as the journey can be trying. In 2018, 25,120 children were born thanks to medically assisted procreation (after almost 150,000 attempts), according to Medicare, or 3.3% of children born in the general population that same year.
Does the law of bioethics imply novelties in the pathways of assisted reproduction?
Besides the opening of the ART, another major change in the bioethics law concerns the lifting of the anonymity of sperm donors or egg donors. Article 3 opens the right, for any person conceived by medically assisted procreation with a third-party donor, to access, at his majority, to the identity of this donor. This is a fairly radical change since today the anonymity of the donor is the rule. Many adults born from these gifts claim the possibility of knowing the identity of their parent.
This is a question that European states respond to differently: Denmark allows children from MAP to know their identity; on the contrary, Spanish law provides that donations are anonymous. In France, what does not change, however, is that no parentage link can be established with the donor, even after the anonymity has been lifted.
For lesbian women, how will the relationship be established with the mother who did not bear the child?
The issue of parentage provoked lively debates as soon as the bill was written. Authorization of assisted reproduction for lesbian couples requires clarification on how to recognize the relationship between the child and the mother who did not bear the child.
Since 2013 and the adoption of the law in favor of marriage for all, women who have not borne the child have the possibility of adopting it, at the cost of often long and tedious legal procedures. It has happened that this has been refused. In 2014, the court of Versailles refused the adoption to the wife of the mother of a child conceived by PMA abroad. The decision was finally overturned on appeal following an opinion issued by the Court of Cassation in favor of adoption within a female couple.
A double challenge: not to overturn the civil code too much [et] allow a system of filiation [non] discriminating against female couples
With the current law, the government faced a double challenge. First of all, that of not overturning the civil code too much, guaranteeing questions of filiation. Then, allow a system of filiation that is not deemed to discriminate against female couples. After discussing three options, the solution chosen failed to fully reconcile these two issues.
As regards the woman who has given birth, her filiation link will be established in the birth certificate, as is the case for heterosexual couples. For his spouse, who did not bear the child, the family relationship will be formalized through early joint recognition. This act to establish the filiation of the unborn child must be carried out, during pregnancy, before a notary. In the child’s full birth certificate, it will therefore be mentioned that “The two mothers will have recognized the child on such and such a date before a notary”.
What questions still remain unanswered?
When there are already long waiting times for couples today, how can we ensure that new candidates for assisted reproduction are properly received? Also, the way in which the centers will organize themselves to absorb the new demand and the question of the prioritization of files are not settled.
Moreover, knowing that sperm stocks are barely meeting demand at the present time, how can we ensure that more donors are found, in particular with the new regime involving the lifting of anonymity at the age of 18 of the person born? gift ? These questions lead to another: will many couples and single women continue to resort to assisted reproduction in our neighbors, where the framework is more flexible?