2023-05-22 14:50:24
An auscultation table as a bed facing a television screen and, on the adjoining bedside table, a bottle placed prominently next to a disinfection kit. In this clinically clean cabinet, the decoration is limited to an abstract art reproduction hung next to the instructions to follow. Nothing too exciting and yet ” This is where it all begins “loose, smiling, Professor Thomas Fréour, head of the center for medical assistance in procreation within the university hospital center (CHU) of Nantes.
In 2022, around 50 volunteers marched through one of the four rooms that collect sperm donations. The samples are then sent to the spermiology laboratory which will analyze their quality and then package them in “flakes”.. These plastic tubes, about ten centimeters long and three millimeters in diameter, are duly sealed and identified before being stored at – 200°C in large tanks of liquid nitrogen until they are used.
A bioethics law that upsets the balance
In Nantes, as in the thirty centers for the study and conservation of eggs and sperm (Cecos) spread over the territory, it is this stock that makes it possible to respond to requests for medically assisted procreation (PMA) care. with sperm donation, whether intrauterine insemination (IUI) or in vitro fertilization (IVF).
“A stock that was relatively stable until the bioethics law of August 2021 upset the balance”, emphasizes Professor Fréour. Since then, the management of gamete banks – the scientific name for male (sperm) and female (oocytes) reproductive cells – has become, for the health authorities, a real headache from which it is difficult to see how they can disentangle themselves.
This situation results from the combined effects of two major changes brought about by the new law. Firstly, access to assisted reproduction has been extended to female couples and single women, whereas the technique was previously reserved for female/male couples on medical indication. Then, a right of access to origins was recognized for people born from an ART who can now know, when they come of age, the identity of the donor and some of his characteristics such as his age, his family and professional situation, his country of origin and his motivations at the time of the donation.
A risk of sperm shortage
The first change literally exploded the counters for support requests, which went from an average of 2,000 each year before the law to a total of 24,000 between August 2021 and December 2022. And no one is able, at At this stage, to predict whether this influx will dry up or on the contrary continue to increase, at the risk of causing a shortage of spermatozoa, that of oocytes already being a reality.
Especially since the second legislative change further increases the pressure. The bioethics law specifies that from a certain date – which remains to be fixed by decree –, the glitter from donations covered by the anonymity regime which prevailed until September 2022 can no longer be used. and should therefore be destroyed. However, this stock is considerable: on December 31, 2022, it was estimated at around 113,000 straws at the national level, while those from new donors who had consented to access to origins were barely more than 17,000 on the same date.
How, then, to cope with the increased activity due to the expansion of the PMA to new audiences while organizing, without too much delay, the “change of tank”, a term used to designate the moment when we will pass from old stock to new, as required by law?
Mobilized user associations
In Nantes, Professor Fréour and his team anticipated the problem by multiplying, very early on, fundraising campaigns, particularly among young people. “Initially, we feared that the right of access to origins would deter volunteers. However, we are seeing the opposite: recruitment has expanded and 95% of new donors accept the principle of lifting anonymity”, he points out. Result: the stock of 4,500 “new regime” straws now exceeds that of 3,500 “old regime” straws.
But all the centers are not as dynamic, or do not have the same human and financial resources. A situation deplored by user associations, in particular PMAnonyme, which has been campaigning for access to origins since its creation in 2004. “The 2021 law enshrines this demand for transparency by setting an ethical framework that could not be clearer. However, two years after the adoption of the law, this right remains theoretical since most shopping centers have chosen to exhaust the old stock in order to continue to meet demand. Which is unacceptable because it is a source of harm for the people born from these anonymous donations”underlines Timothée Marteau, its spokesperson.
In fact, once they have reached the age of 18, they will have no other recourse, to answer their questions about their origins, than to initiate a long and uncertain procedure with the Capadd (1), a commission specially created in September 2022 to find donors and collect their consent to disclose their identity.
“We opened up new rights without really anticipating the difficulties that this would cause for the centers, but also the users, donors and beneficiaries”insists Marjorie Chalier, communication officer for the association Dons de gametes solidaires.
An equation with too many unknowns
To break the impasse, the Ministry of Health asked the Biomedicine Agency (ABM) to set up a working group to estimate what would be the right date to switch to the new donation regime, while ensuring the continuity of care for people who have recourse to PMA.
This group, which brings together ABM experts, health professionals from donation centers and representatives of user associations, met for the first time by videoconference on April 17, then a second time on May 10. To finally decide to continue the work. “The Biomedicine Agency has proposed a first scenario which foresees a change of tank around the end of 2024, but its model is based on imprecise aggregated data which does not take local specificities into account”reports Professor Thomas Fréour.
Faced with criticism, the public agency is asking for time to refine its calculations. “How will demand evolve? How many straws will be needed to satisfy her knowing that the number varies according to the technique used – insemination or IVF – and the success rate of each centre? How quickly will new stock build up to replace the old? There are still many unknowns in the equation”, pleads Marine Jeantet, its general manager. Will the third meeting of the working group scheduled for June 6 be the right one? “We can hope to land before the summer. This is, in any case, what the Minister of Health is asking for. »
In the meantime, there seems to be unanimous agreement on one solution: to further increase the number of new donors, from 600 in 2021 to 764 the following year, an increase of 27%. The Biomedicine Agency has already planned to launch, as of this fall, awareness campaigns centered on two targets: young parents aged 18 to 43 and, more unprecedented, young people who say they do not want children for themselves. themselves but are ready to “making parents”.
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The key numbers
The impact of the bioethics law in the field of medically assisted procreation is regularly measured by a national monitoring committee which held its 5th meeting on 6 March. The results observed between July 1 and December 31, 2022 show:
A downward trend in requests for medically assisted reproduction with sperm donation which stood at 6,000 in the second quarter – including 4,200 for couples of women and unmarried women – against 9,000 in the first.
A clear increase in first assisted reproduction attempts with sperm donation which reached 1,545, i.e. 3.5 times more than in the first quarter.
At the end of 2022, 5,600 people were waiting for ART with sperm donation, including 36% female couples and 38% single women. The average time between the request for support and the first attempt is 14.4 months at the national level.
The number of donors continues to increase: they were 764 in 2022 against 600 in 2021 and 317 in 2019.
This data will be updated at the next follow-up committee to be held on June 12.
Source: French Biomedicine Agency, March 2023.
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