The President of the Republic, Emmanuel Macron, who pleaded at the beginning of the year for a “demographic rearmament”, proposed to “open up oocyte self-preservation to private centers, until now reserved for hospital establishments”, in an interview to Elle, at the beginning of May. He also defends the organization of “campaigns in favor of self-preservation of oocytes for women who want to have children later”.
Since the revision of the bioethics law in 2021, women aged 29 to 37 who wish can preserve their oocytes for personal reasons and no longer just medical ones. By this technique of puncturing and then freezing female gametes, called “oocyte self-preservation”, they can preserve their chances of pregnancy for several years. As soon as the law came into force, demand surged, well beyond what the dedicated centers could absorb, since, until now, only public or private non-profit hospitals provided this support. in charge.
How many people are affected? What are the concrete steps? Why is demand struggling to be met? Six questions to understand this major and discreet societal change.
The revision of the bioethics law opened medically assisted procreation (MAP) to all women, whether they are alone, in a relationship with another woman or in a heterosexual couple. Until now, only the latter could benefit from it in France.
This same text authorized the freezing of gametes (oocytes or spermatozoa) without medical reason, to use them later. Women can use frozen oocytes until their 45th birthday via PMA, donate them, or even destroy them.
Previously, this was limited to patients whose medical treatment (particularly against cancer) could alter fertility. It is now a non-therapeutic option, covered by Social Security, with the exception of freezing, which costs around 40 euros per year.
Accompanied or not by their midwife or gynecologist, women wishing to use oocyte self-preservation contact directly approved centers, the vast majority of which are the Centers for the Study and Conservation of Human Eggs and Sperm (Cecos) located in public hospitals.
The process begins with a fertility assessment in order to assess the benefit-risk ratio of oocyte retrieval, that is to say to determine whether the person has sufficient ovarian reserve to carry out an intervention with chances of success.
A cycle of ovarian stimulation is then scheduled for approximately two weeks, via hormone injections, with ultrasound and biological monitoring, before carrying out an ovarian puncture in the operating room during a short operation.
The process can be repeated several times with a delay of a few months between each attempt. Once the oocytes have been collected, they are stored in approved centers after being frozen by vitrification and stored in liquid nitrogen.
From 2021, the requests exceeded the capacities of the thirty-three Cecos, since, in addition to their historic mission of supporting infertile couples in their PMA journey with a third party donor, new profiles of single women or in homosexual couples were added.
The second mission of these centers is the preservation of fertility in the event of treatment affecting gamete production, to which is now added oocyte self-preservation, but also self-preservation of sperm for men between 29 and 44 years of age also planned. by the law.
“The demand they face has increased eightfold,” notes Marine Jeantet, director general of the Biomedicine Agency, the public establishment which supervises the PMA. “The centers are overwhelmed and the professionals are under tension,” observes Professor Catherine Guillemain, head of the reproductive biology department at the Marseille hospital at the head of the Cecos federation. She recalls that although the CHUs obtained a budget of 7 million euros when the bioethics law came into force, they did not systematically direct them towards approved centers.
“The increase in demand was completely underestimated,” believes Marine Jeantet. As a result, processing times are extended, while “the time factor is crucial”. The Biomedicine Agency has identified nearly 20,000 requests for self-preservation of eggs for only 4,000 treatments, according to data compiled until August 2023. Some centers have not opened waiting lists, we do not cannot measure the invisible share of French women who were unable to apply and/or who turned to centers abroad.
To get a first appointment, you have to wait eight months on average in France and more than a year in the Paris region, where the situation is very tense.
In Ile-de-France, the opening of three centers in 2023 has already partly reduced the wait, and the regional health agency indicates that six authorizations could be issued by the fall, examination of new files having started. This would result in sixteen approved centers in the region.
65% of women are between 35 and 37 years old, the age limit at which it is possible to access self-preservation, according to data from the Biomedicine Agency.
“The issue around quickly obtaining a first appointment is therefore decisive,” underlines Hélène Malmanche, midwife in Paris and doctor in anthropology. Especially since the chances of success in assisted reproduction drop sharply after age 38, specifies Marine Jeantet, who recalls that “self-preservation is a major societal advance, but not a guarantee of pregnancy.”
It is above all field observations that make it possible to understand it. Like other professionals, Hélène Malmanche notes that a very significant proportion of her patients are single.
They are also women in relationships who have doubts about their desire to have children. Self-preservation is “a tool for managing marital uncertainty,” analyzes the midwife. Contrary to popular belief, professional concerns rarely come into play.
Emmanuel Macron’s announcement consisting of “opening oocyte self-preservation to private centers” will therefore have to involve a modification of the law. Indeed, the 2021 text specifies that egg self-preservation must be ensured in public or private non-profit hospital establishments, and not by private centers, unlike what exists for example in Spain. This decision results from long-standing concerns around the commercialization of gametes, both male and female.
However, this openness does not surprise PMA professionals. “Since the revision of the bioethics law, the place of the private sector is already the subject of discussions,” notes Marine Jeantet of the Biomedicine Agency, recalling that PMA follow-ups in the context of fertility problems are ensured at 50 % by the private sector.
If the law is the subject of new debates, the general director of the agency calls for questioning the supervision of private centers, by considering a gamete traceability system, but also questions of cost, “in limiting, for example, excess fees” to maintain equal access to care.