Three points that gripe about assisted reproduction for all, back to the Assembly

• The bioethics law returns to the National Assembly from Monday after a passage in February before the senators, who had profoundly changed the project.
• Many points remain unresolved, which worries associations and infertility specialists.
• They hope that this second reading will make it possible to make progress in particular on three important points: reimbursement of assisted reproduction for all, post-mortem assisted reproduction and the opening up to the private sector of the conservation of gametes.

"A missed opportunity". This is how Virginie Rio, founder of the Bamp collective, which supports couples affected by infertility, summarizes the debate on assisted reproduction (medically assisted procreation, also called AMP, medically assisted procreation). “In 2020, it is as if the PMA was still a red rag, a taboo in France. "

After procrastination and a delay due to the coronavirus, then to the reshuffle, the bioethics bill, which includes in particular the opening of the PMA to single women and lesbians, is back at second reading in the National Assembly. An express passage, since the Prime Minister wants the vote to be taken before the end of July, which risks being tense. In February, the senators had significantly revised the copy of the deputies. And the project must go back to the Senate in the fall. From June 29 to July 2, the committee added a number of amendments that shifted the lines.

Bill relating to bioethics | ✔️ Adopted last night by the special committee, after 37 hours of examination and debate.
See the debates ▶ ️ https://t.co/UYRS1ahsI3
Find out more ▶ ️ https://t.co/dh9wu6QvC3#DirectAN pic.twitter.com/QthMhr1dhc

Associations and doctors are worried about the fact that the heated debates and the long legislative course only give birth to a theoretical right. In particular for three essential points, on which 20 Minutes comes back.

• PMA reimbursement for all

If several members of the government (precedent of the blow) had pronounced in favor of a reimbursement of the assisted reproduction for all, the Senate reintroduced the medical criterion, which in fact excludes future mothers. But after going to committee, the project reopens this possibility of reimbursement. Indeed, it stipulates that “medically assisted procreation is intended to respond to a parental project. Any couple made up of a man and a woman or of two women or any unmarried woman have access to medically assisted procreation ”. And the first article insists on equality: “this access cannot be the subject of any difference of treatment, in particular with regard to the marital status or the sexual orientation of the applicants. "Complicated, then, to reimburse heterosexual couples and not others ... If this version is finally adopted in the Assembly, then in the Senate in the fall (less certain), this right would become effective. Knowing that some opponents of the law argue that in a context where Social Security will collapse under the cost of the coronavirus, there is more urgent need than to reimburse these new AMPs.

The amendment by Aurore Bergé (LREM) restoring the wording of the first reading is adopted. It removes the pathological criterion reintroduced by the Senate, and therefore opens the way to reimbursement of the assisted reproduction for couples of women and single women.

The associations have planned to step up to the plate so that this new right does not remain accessible only to the wealthiest. "If we do not reimburse, what interest do women have in having their examinations in hospitals in France? Asks Virginie Rio. They will continue to go to Spain, to Belgium, to look for a donor on the Internet, to have a child with the next door neighbor… It is as if we were saying for AIDS "we do not reimburse homosexual people"! "

“Just because you're a solo or a lesbian doesn't mean you're healthy. I had endometriosis for example, adds Marie Nozain, co-founder of the Mam'ensolo association, and who had a son in 1998 thanks to a assisted reproduction in Belgium. What world do lawmakers live in? We do not judge people who choose to have 15 children, we contribute with our taxes. We don't understand why we would be rejected. "

A subject that divides gynecologists. A questionnaire sent to members of the French National College of Gynecologists and Obstetricians (CNGOF) in early 2020 showed that 60% of practitioners were in favor of taking care of female couples. On the other hand, only 37.2% of them say yes to its reimbursement, against 44% who are opposed to it.

• Post-mortem PMA

Deputies and senators, then the commission, rejected post-mortem ART. Clearly, the ban on the recovery of embryos in the event of the death of one of the parents (heterosexual or homosexual) would be maintained. An exceptional case (fortunately), but which plunges the widow in a situation which is at least inhuman. Since she would therefore not have the right to continue IVF with the frozen embryos.

“But you can give them in a generous gesture to another couple concerned by infertility!” Virginie Rio quips. And then have access to a sperm donation. This does not concern many people, but it is symptomatic of the law. For Marie Nozain also, this provision of the text must absolutely change. “We treat this woman like a minor, as long as she is married, she had access to her frozen embryos, but she was not a widow. The deputies have not taken the opinion of any expert in countries where this is done. "

The CNGOF offers an alternative: “the possibility, for a woman who has become a widow, to obtain the transfer of embryos from a previous parental project is desired by 50.6% of practitioners, by supervising this possibility over time between 6 months and 18 months after the death of the spouse ”. For her part, Silvia Alvarez, gynecologist and member of the board of the Collective of French AMP Private Centers, recalls that in Spain, the AMP centers have settled the issue by asking the couple to give their permission (or not) to use gametes in the event of death from the start of the journey.

Disappointing and unfair vote. Infantilization of women and their parental project. Men's vote, patriarchal vote: a man who loses his wife will not have children. Is that conjugal love? @EmmanuelMacron @EPhilippePM @olivierveran @AdrienTaquet @NBelloubet @Defenseurdroits https://t.co/sDyWr12MGZ

• The private sector excluded for the conservation of gametes

According to the current project, reviewed by the committee, “only public or private non-profit establishments authorized for this purpose can keep the embryos intended for reception and implement the reception procedure. An amendment that risks significantly limiting access to autoconservation of gametes, now limited to medical reasons, but that the law should extend to women wishing to freeze their oocytes for later. But also to assisted reproduction for all future parents, whoever they are.

"Heterosexual couples will always have access to private centers, but if there is a need to collect and store embryos, this amendment says that this will only be done in the public sector," explains Virginie Rio. However, in France, more than half of IVF is carried out in the private sector, and there are fourteen departments that do not have a public offer of AMP. We cannot consider that we are opening new rights if there is no mechanism behind it to make it effective. “Because the activity will obviously increase with the arrival of new patients, which will further lengthen the delays in the public. To exclude the private sector from the conservation of gametes, "that would be going against what is done in Europe," insists Silvia Alvarez.

And the CNGOF underlines that another form of discrimination risks setting itself up: “These centers will rightly favor women with cancer whose preservation is urgent, and they will only be able to take care of very few women who wish conservation without medical reason ”. For many, the caricature made of the private during the debates is far from reality. "Doctors do the same studies, they are authorized, controlled by the same authorities, they have said they are ready to maintain precise prices so as not to be in the liberal approach", recalls Virginie Rio. Who concludes, bitter: “We have the experience of what is happening in AMP today in France [for heterosexual couples]: lack of means, lack of tools to improve results, too long delays… This law does not will solve nothing. "

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The DPIA, the return?

Another subject that promises great tensions: the committee authorized pre-implantation diagnosis with research for aneuploidy (DPIA) for in vitro fertilization. To learn more about this very controversial issue, here are some details in this article on DPIA. 

• Senate
• Olivier Véran
• National Assembly
• Women's health
• Society
• Bioethics law
• PMA
• Health