Since France’s first live IVF birth in 1982, on average 1 in 100 French babies are now born via IVF. France’s social security policy on assisted fertility treatments is recognised as being more generous than the UK or the USA. The news gets better: France even has higher success rates than its UK neighbours.
Approximately 60 000 couples undergo infertility treatment each year in France. Of those, nearly 90 percent will eventually have a positive outcome – a baby. IVF (FIV) is covered 100 percent by the French social security system for female residents up until their forty-third birthday.
Not only that, the sécu will even cover all costs for a maximum of four IVF attempts (this includes ‘ICSI’ (the more advanced IVF) and six IUI’s (the frequent first step in fertility treatment).
You are eligible for free IVF treatment in France as long as you qualify for a carte vitale and, most importantly, sterility in either the man or woman can be established. This confirmation has to be made by your gynecologist, (in some cases) your GP or andrologue (in the case of male sterility), and – be warned – is usually only made after a barrage of tests. The numerous examinations both husband and wife/partners will have to undergo before fertility treatment can commence are lengthy. Once sterility has been established, your consultant will then prepare the necessary paperwork for the social security system to grant ‘100 percent prise en charge’. Make a note of how long this is validated for, and ensure you renew the necessary paperwork well in advance. The attestation for ‘100 percent prise en charge’ must be carried with you at all times. Expect your pharmacist to verify that drugs issued to you are, in fact, for fertility purposes (and therefore free of charge). You will need to budget for transport costs and hotel stays, as these aren’t covered by the ‘100 percent prise en charge’ status. Many hospitals and clinics are based in France’s regional main cities, meaning that you can expect a regular commute of hundreds of kilometres for, in some cases, a simple thirty minute consultation. Before any fertility treatment can take place, you will also be asked to prove you have been married or together as a couple for a minimum of two years. Don’t take it personally, this is a requirement by French law in order to be eligible for funded fertility treatment. Un livret de famille or marriage certificate (translated) must be supplied, as well as photocopies of your proof of identity. If you aren’t married, then bills and bank accounts, at your shared address, and in joint names, will usually suffice. But they must verify you have been together, ‘la vie en commune’ for a minimum of two years. Unfortunately France doesn’t recognise same sex couples or single women as eligible for IVF within the social security system. If you’re clinically obese (a BMI of 40 or over) you’ll also be refused treatment. In fact, in some areas of France, doctors are refusing women with a BMI of 35 plus.
WHERE TO START In an ideal scenario, before you even attempt to conceive, it’s worth visit- ing your gynaecologist. Blood tests for STIs, toxoplasmosis and hormone levels can be run at this stage (your gynaecologist can also issue an ordonnance (prescription) for your partner/husband’s tests too). If you have been trying to conceive for at least a year, make an appointment with your gynaecologist (it’s worth doing this as soon as you can – it’s not unusual to wait 3 months in France for a gynaecological appointment). She/he will organise a spermocyclogramme for your partner/husband and blood tests (at this stage checking hormone func- tion). They will also organise a blood test for you to track hormone levels on a specified day, an ultrasound to confirm egg release at ovulation and a hysterosalpingogramme (take someone with you for this appointment) – an x-ray with injections of dye into your uterus. This, although unpleasant, verifies if the uterus and fallopian tubes are clear. While most medical staff speak English, it’s worth familiarising yourself with French medical terms too. Once sterility is proven in either one or both of you, you will then be referred to a fertility unit. At this stage your gynaecologist/GP/andrologue will also prepare the necessary paperwork stating you are eligible for ‘prise en charge 100 percent’.
WHAT TO EXPECT AT THE FERTILITY HOSPITAL/CLINIC
Before fertility treatment can begin, you must officially be accepted by the clinic’s/hospital’s medical board. Even at this stage a board can ask for further tests to be carried out or reject your application. On acceptance, you’ll both be requested to sign a contract agree- ing to support each other, and the cen- tre, throughout the duration of your fertility treatment. Every IVF team includes a clinical team (gynaecologists specialising in infertility) and a biological team (biologists specialising in reproduction and specialist laboratory technicians). Don’t forget, take your entire medical history (test results, X-rays, ultra-sounds) relating to your fertility status for every appointment. In France, fertility treatments (including IVF, IVF-ICSI and IUI) are strictly governed by the bioethical laws of 1994, 2004 and 2010. There are currently 103 centres in France who have official approval (centres agréés). They are legally obliged to keep records of their success rates. Advice and opinion is mixed about the most ‘successful’ centres, but the general perception is that the greater the number of procedures performed by a clinic or hospital – the better your chances will be.
THE PROCESS The IVF process in France follows the traditional procedures. However, legally, your husband/partner must be present on two occasions: the ‘puncture’ and the ‘transfer’. In most cases, a maximum of two embryos are transferred. Other viable embryos can also be frozen (confirm with your consultant for exactly how long) and then used for another attempt. It’s worth thinking about how many embryos you want transferred. However, there is no chance of an ‘Octomom’ ever birthing 8 children in France! Depending on your clinic or hospital policy you will be asked to ‘selectively reduce’ if it’s discovered you are carrying more than three embryos. Ensure you discuss all eventualities with your team before your treatment starts. It’s worth stating that the risk of multiple pregnancy is inherent in IVF. For every 3 embryos transferred: on average 72 percent of pregnancies are unique, 20 percent are twins, and the remainder are triplets. Other risks exist, such as ectopic preg- nancies or miscarriages, but they are of the same level as a natural pregnancy. Finally, while your IVF pregnancy will be followed under normal procedures (except for special circumstances), there is a greater risk of premature birth among IVF babies.
IF YOU DON’T QUALIFY Even if you don’t qualify for IVF within France’s social security system, an average round of IVF costs € 2500 which is still less expensive than the UK at £2,771 per cycle and $14,500 in the US. Fertility message boards are full of advice about where to buy your drugs too – in France it really pays to shop around. A clinic or hospital will also store and freeze embryos for you (although if you move to another part of the country you will need to return to the original clinic for further treatment).
Further information: www.fivfrance.com (in French)
www.agence-biomedecine.fr (in French)
This article, by Samantha Brick, first appeared in theFrenchPaper