A year and a half after its adoption on August 2, 2021, would the bioethics law which opens access to medically assisted procreation (MAP) to couples of women and unmarried women be a victim of its own success? The data published this Wednesday, March 8 by the 5th monitoring committee confirms the extent of the demands of this new public, but also the difficulties that arise in responding to them.
“In total, between August 2021 and the end of December 2022, 23,800 requests for assisted reproduction with sperm donation were submitted by women in couples or singles and nearly 11,800 initial consultations were carried out. This marks an unprecedented increase in activity since before the law, there were approximately 2,000 requests from male-female couples per year. “, notes Claire de Vienne, referent doctor in MAP of the Biomedicine Agency.
An increasing wait time
As a result, the average waiting time, at the national level, between making an appointment and the first attempt has fallen from 12 months to 14.4 months. “But the hiring of new personnel should make it possible to reduce this delay. This is the objective of the public authorities and the health professionals mobilized to make the course more efficient”she continues.
Another element could contribute to this: after having increased sharply during the first half of 2022, reaching 9,000, requests stabilized during the following half, around 6,000. If confirmed, this drop should have a positive impact on the care of people on the waiting list. They were nearly 5,650 on December 31, including 26% male-female couples, 36% female couples and 38% unmarried women.
“All these requests can only be met if there is a sufficient number of donors and a sufficient stock of sperm straws”, emphasizes Doctor Claire de Vienne. For the moment, the problem does not arise, but it could arise soon.
The bioethics law provides that at a given time – which remains to be fixed by decree – the authorized centers will only be able to use straws from donors who have consented to access to origins, guaranteeing the right for children born from a donation of gametes to know, at their majority, the identity of the donor.
A stock of sequins soon to be unusable
So far, the available stock of 110,000 past donor straws has enabled more than 444 “ongoing pregnancies” (more than 12 weeks of amenorrhea) and 21 deliveries since the adoption of the law for couples of women or unmarried women. But as soon as the decree is issued – we still do not know when – this stock will be unusable. “The challenge is therefore to increase the stock of sperm straws from donors who have consented to this access to origins, which is currently around 17,000 straws”explains Claire de Vienne.
The shortage of oocytes is already a reality. Probably because the donation process for women is more complicated, with medical risks. But also because on average, two donors are needed for an ART attempt, whereas the 40 straws from a single sperm donor allow ten attempts. So much so that, despite an increasing number of donors, the list of women waiting for a donation is close to 2,000 and the average time for treatment is 23 months. “Which leads many of them to give up their project because of the age limit or to go abroad to carry it out”underlines the referring doctor.
Reduce inequalities of access
Last novelty organized by the law: the possibility for any woman between 29 and 37 years old to keep her gametes, except for medical reasons, with a view to the subsequent realization of an ART. Here again, the number of requests – 11,500 – is twice as high as the intake consultations carried out – 4,800 – and the average processing time remains high: 7 months on average at national level and up to 24 months in Île-de-France. Reducing this unequal access is one of the priorities of the Biomedicine Agency.
“But this new right is not a 100% guarantee of having a child when you decide, contrary to popular belief”, says Doctor Claire de Vienne. Studies in Spain and Belgium show that the probability of having a child using this technique is 80%, provided that the woman is under the age of 36 and has retained between 20 and 25 her oocytes.