Will the practical conditions be met for the PMA for all to become a real right?


Sperm and oocyte contact during in vitro fertilization. – F.Durand / Sipa

  • Opening the right for lesbian couples and single women to access medically assisted procreation, Macron's promise and flagship measure of bioethics law, poses some practical challenges.
  • The PMA for all means an increase in the demand for sperm donations. But today, straight couples wait up to two years to get these precious sperm and only 363 men gave their sperm in 2016.
  • Lack of resources, limited to 29 centers in France, falling sperm donations and destruction of stocks, the PMA for all, if it is voted, risk it to remain a theoretical right? 20 minutes make the point.

We are going to talk a lot about IVF, sperm donation and equal rights in this season. Indeed, the bill on bioethics,
which includes, but is not limited to, providing opportunities for lesbian couples and single women to
Assisted Reproduction (PMA or ART Reproductive Health Care) to have a child may leak a lot of ink. The hearings by the special committee began on Tuesday before MPs study the text in committee from 10 September.

And already, some associations and doctors want to push for the text does not miss an essential point: the material conditions to ensure that this PMA for all is really assured. "We must put means and content consistent with the needs behind the slogans, to make this right effective in practice," says Virginie Rio, founder of the collective Bamp, which accompanies couples in PMA.

Lack of donors

Unsurprisingly, the opening of PMA to all women would increase the demand for sperm (not oocytes). However, the increase has been moderate, as the Ministry has estimated that about 2,000 more women may be using a LDC with one donation per year. A figure based on the ratio of
 National Consultative Ethics Committee (CCNE) which estimated that between 2,000 and 3,000 women crossed the border each year to achieve an LDC, especially in Spain and Belgium. Today, heterosexual couples who resort to a sperm donation –
 numbering 2,200 in 2016 – (in the form of sperm flakes, which will be used for artificial insemination or in vitro fertilization) wait on average between six months and two years. This delay may therefore lengthen.

Especially since the bill of bioethics introduces several changes, beyond the PMA for all. Including the possibility for children born of a LDC with gift to have access, if they wish and with their majority, to the identity of the donor. A provision that could cool some. In European countries that have opened access to the PMA and lifted donor anonymity, gamete donation has dropped for a few months and the donor profile has changed.
According to the Biomedicine Agency, in 2016, only 363 men gave their sperm in France. And already, the
Federation of Centers for Studies and Conservation of Eggs and Sperm (Cecos), the only centers authorized to keep gametes, sounds the alarm: for the past few months, it has noted a decrease in the number of applications for the donation of gametes . Even before the bill is examined.

Knowing that in France, the donation of sperm is and will remain free, the issue of donor recruitment will therefore become urgent if the PMA for all is voted … All our interlocutors assure: a large national awareness campaign is needed. What the Ministry of Health has committed to launch. "But you have to communicate by moving away from fantasies, giving the floor to the people concerned, parents in MPA courses and adults born of a gift," advises Virginie Rio.

Destruction of sperm stocks

Secondly, the law provides for the destruction of the current gamete stock one year after the promulgation of the law. "Once the law comes into force, we can not imagine that two regimes compete, justifies Aurore Bergé, LREM MP and member of the Special Commission on Bioethics. The rule must be the same for everyone. And that each donor knows and accepts that the child, at his 18, can find him.

But concretely, destroying these stocks of sperm is like a huge mess for families waiting and the specialists who accompany them. Knowing that the impact study of the National Assembly reveals that there was a stock in 2016 of 89,000 straws … And that the principle of matching, which involves finding a donor who looks (via his / her skin color) to the requesting couple, can extend the time. "When you have the chance to have glitter from a donor with a rare profile, it's a treasure, moves Catherine Guillemain, vice-president
Federation of Cecos. To be forced to destroy that is furious madness. We would like there to be another proposal than this injunction to destroy. The only way to save these glitters would be to reconnect with all the donors. "

But in the office of the Minister of Health, things are clear: "it is out of the question to recontact all donors. It is physically impossible, some have been able to move, for example. On the other hand, it is possible to think of publicly calling former donors to come forward. "

Agnes Buzyn in the National Assembly on July 23rd. The Minister of Health will bring this bill on bioethics and in particular the opening of the PMA to couples of women and single women.
Agnes Buzyn in the National Assembly on July 23rd. The Minister of Health will bring this bill on bioethics and in particular the opening of the PMA to couples of women and single women. – JP PARIENTE / SIPA

On the side of the deputies, the hearings should help to refine things. "In particular the duration of the transitional phase. We want to wait for the reconstitution of equivalent stocks of gametes before destroying the old reserves, "says Aurore Bergé. Same story from the cabinet of Agnès Buzyn: "There will be destruction only when the stock will be restored, we promise. And so an intermediate period that could last a year or more. Nobody can say it today. But this period can also create a destabilizing blur for potential donors. According to some associations, questions are already pouring in on donations of gametes and the lifting of anonymity.

Can the Cecos afford to cope with the influx?

Even if, if this stock was not destroyed, some associations and doctors warn that this new right may remain theoretical if the law does not address other practical details. Especially on the management of gamete donation, which would remain in the hands of 29 Cecos. Many are surprised that couples have to wait until two years today while sperm glitter was not lacking in 2016 … "If we do not change this organization, in practice, it will still be difficult to access the sperm donation, and perhaps even more difficult for couples currently in care, insists Nathalie Massin, president of the Society Reproductive Medicine. We can not bring more people in the same door without increasing the means! "

A concern shared by the Cecos. "Without change and additional resources, it will be difficult to meet the current demand and the one that looms," warns Catherine Guillemain. Especially since these same Cecos will also have to cope with the influx of women and men who wish to freeze their oocytes and sperm, since the law of bioethics would allow everyone, with age limits, to keep its gametes for a possible PMA. "We add to a slow system an additional activity," says Nathalie Massin.

It is not the bill that will decide this budget issue, but the Social Security Financing Bill (PLFSS) discussed in the Assembly two months later. "It seems to me intelligent that we begin by seeing if there is a need for expansion of means and to what extent," ensures Aurore Bergé. And the member to recall that, on the organization side, the text would allow an improvement through a national registry of donors, where today they are regional registers (which require recipients to address only the Cecos of their territory ).

Should we open to private centers?

Faced with these challenges,
, 350 MPA professionals request via a
petition that the law allows other public centers, but also private centers, to manage gamete donations and self-preservation. "If the current system does not change, women who can afford it will continue to go abroad," warns Virginie Rio.

But this proposal to open to the private sector is not to everyone's taste. "Personally, I am not opposed to private centers being able to manage the demand for gamete conservation," says the vice president of the Federation of Cecos. On the other hand, if we are considering giving authorizations to manage the donation to private centers, we will have to look closely at what is happening. For the PMA not to become a lucrative business to which only the better-off would have access. "I am very reserved to the idea that we extend to other centers that Cecos this management of gamete donation, confesses Aurore Bergé. To open it to private centers, with possible overruns, would be contradictory with our wish that the PMA becomes accessible to all … They have the necessary expertise, which is reassuring for the receivers. Above all, this possible opening up to the private sector would not solve the crucial problem. "We do not think that the multiplication of centers would increase the number of donations," said the vice president of the Federation of Cecos. We are not besieged by the nominations! "

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