- Confinement interrupted all PMAs in progress for patients followed in France or abroad.
- Since deconfinement, the protocols have gradually resumed.
- Patients fear additional waiting times before resuming their journey.
Want to become a mother. Go through medically assisted procreation (PMA) and accept the wait, stress, appointments, injections, samples and other exams that mark this adventure. Because, without question, the reward is worth the effort made. And see everything stop overnight. Among other collateral effects, the Covid-19 crisis put an end to all ongoing LDC projects.
The pandemic in France has caused all medical procedures considered non-urgent to be put on hold, and the PMA centers have therefore closed their doors. Like most MAP clinics in Europe, anyway inaccessible due to the closing of borders. While the deconfinement and the ebb of the epidemic allow a progressive resumption of LDCs, many women fear to have to wait longer before being able to resume their maternity project.
"The gynecologist called me to tell me that everything was over"
"Treatments, ovarian stimulation, embryo transfers: we had to stop everything when confinement was announced and warn each of our patients," says Professor Jean-Marc Ayoubi, head of the obstetrics and gynecology department of the PMA center. Foch hospital in Suresnes (Hauts-de-Seine). “It was the evening when President Macron made the announcement, remembers Marie *, 34, followed in France for her PMA journey started almost a year ago with her companion. The gynecologist called me to tell me that everything was over. And advised me not to start an ovarian stimulation cycle to prepare for insemination, since we had no visibility on the calendar. ”
Same scenario in Spain, "hard hit by the epidemic. We called our patients to tell them that we were interrupting all the treatments in progress, ”says Dr. Clara Colomé, medical director of the Eugin Clinic in Barcelona, where many French patients are followed. Noémie Trillaud, almost 40 years old, received this call. For the young woman, who has been leading this solo project in Spain for two years and is expecting a double donation from gametes, “the confinement could not have come at a worse time. An oocyte donor had been found, and in the process, the embryo transfer had to be scheduled. But it all stopped, with no idea when it could resume. A psychologically very difficult moment ”.
Additional stress for patients
When you embark on an LDC, "the time factor is decisive," recognizes Dr. Colomé. “At each cycle, when my period arrives, I tell myself that it's a lost month, says Marie. And there, I am told that everything stops: I am prevented from having a baby, my marriage in April is canceled, and I have to confine myself! It was too much to take in one go. ”
The first month, Noémie “put things into perspective. What mattered was that my loved ones were in good health. Then I understood that it would last, that we should live with this virus. When the Spanish clinics reopened in late April, I was impatient, but it was impossible until the borders were reopened. A journey of PMA is already long and painful, but there, to the stress inherent in PMA has been added the stress of confinement, the epidemic and uncertainty about the date of resumption. I contacted associations of PMA patients, but there was no information, no communication. ” So Noémie launched a petition on Change.org in May to appeal to Minister of Health Olivier Véran, "so that French women can continue their LDC in Europe during the Covid-19 pandemic". “The petition has given us the support of a few parliamentarians, but no return from the minister. I spoke with other women in my situation, and all of them felt as destitute as I did. With the PMA for All bill constantly postponed, we who have to do our PMA abroad have the feeling of being second-class patients. ”
Maintain contact
It is true, "a path of PMA is already stressful and uncertain," confirms Professor Ayoubi. And this health crisis has created additional stress. This is why it was essential to maintain contact with our patients. Shortly after the start of confinement, we contacted them all and set up a teleconsultation system, so that they do not feel abandoned, that they keep hope and are assured of being taken care of as a priority. reopening ”.
Significant support for Marie, who was able to count on listening to her gynecologist. “When I had my period in April, with the blues that comes with each month, I needed to know more and I sent her several emails. Each time, I had a return in less than five minutes, says the young woman. Even if at first she had no visibility, having a very human doctor listening to me comforted me. She explained to me that this postponement of procedures was also intended not to create new risk situations for patients, and that helped me to be patient. Finally, I would not have seen myself getting pregnant during confinement. ”
Ditto for Noémie: "I was in regular contact with the clinic, and despite the vagueness, the staff couldn't do enough". It must be said that in Spain, "we are used to working with our patients from abroad, remote monitoring is already natural," says Dr Colomé.
A gradual recovery and strict health rules
For the moment, only "donations of gametes - oocytes and sperm - cannot yet be made," says the Biomedicine Agency, which instructed the regional health agencies (ARS) "to authorize or not the resumption medical activities according to the local conditions of circulation of the virus ”. Thus, “as soon as we had the green light from the ARS, the LDCs resumed, explains Professor Jean-Marc Ayoubi, with a very strict health protocol. We ensure that patients have no symptoms of the coronavirus. We favor teleconsultation as much as possible ”. Measures that allow recovery to 50%, "by favoring the use of local anesthesia rather than general, to limit the presence of staff, intervention times and the use of anesthetic products in tension". With a normal monthly capacity of 150 patients, Pr Ayoubi's service can now "only take care of 75 patients, while we have about 230 whose PMA has been suspended," details the doctor. We will try to purge this activity during the summer period, by shortening the next holidays ”.
At the Eugin clinic in Barcelona, “some French patients were able to return in May. We have provided them with certificates justifying their compelling medical trip, ”says Dr. Colomé. There, the health protection protocol is strictly respected: "in addition to wearing a mask and physical distance measures, we take temperature readings and ask patients to perform a PCR screening test beforehand". And no additional waiting to deplore, "our premises are very large and organized to quickly absorb these closed weeks". However, for patients with "risk factors for Covid-19, such as overweight, diabetes or hypertension, we recommend that they wait," says Dr. Colomé. A report also recommended in France by the Biomedicine Agency for these patients at risk.
"I was too happy to return to the clinic"
As with every new cycle, Marie contacted her gynecologist in mid-May. "The clinic had just reopened and planned a resumption of PMA in early June, says the young woman. I was one of the first to call, and one of the first to schedule an appointment. I filled out a Covid questionnaire to make sure I had no symptoms or contact cases around me. ” And the resumption of his PMA journey was done without thinking of the coronavirus. “I was too happy to return to the clinic and not stressed about the Covid-19. I passed a good part of the preliminary medical examinations - the results must be less than 3 months for some - and I was able to start my ovarian stimulation a few days later. Then my ovulation was triggered, and my insemination took place a few days ago, ”says Marie, for whom we cross our fingers.
After long weeks of uncertainty, Noémie also begins to see the light at the end of the tunnel. And 'hope for a next test in early July. Finally, if there is no second wave! Because there are still many uncertainties for all those who, like me, are doing their LDC in Europe. Will the borders be reopened? Will I find a plane ticket to Spain at the last minute? On the other hand, for women who planned to start an LDC journey at the time of confinement, the wait may be longer, ”feared Noémie.
A difficult wait also for the women followed in France and who will have blown out their forty-third candle - age limit for taking charge of PMA by Health Insurance - during confinement. To date, no postponement of care has been clearly announced for them.
* The first name has been changed.
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