The advice of Dr. Gilbert Sarrot, gynecologist-obstetrician.
What are the critical conditions for entering into a medically assisted procreation (ART) protocol, and IVF in particular?
The woman must be under 43, and be married or prove the existence of a life together for 2 years and not be homosexual.
Beside that, one must have carried out complete medical check-ups in both men and women. And concerning the particular case of IVF, the gynecologist must be able to perform a follicular puncture vaginally.
The spouse must have spermatozoa (examinations will be done: spermogram, spermocytogram and survival test survival), or it is necessary to use a sperm donation.
And more precisely, in women?
On the female side, one must make sure that the uterus is normal. The woman must have undergone a certain number of correct ovarian stimulations (6) without result, or a certain number of correctly performed inseminations, but without result (6). The correct stimulations are those which lead to the formation of mature follicles (between 18 and 20 mm).
A number of women have unsuccessful stimuli that are therefore incorrect. These stimulations are often the result of untimely prescriptions of treatment instituted over 6 months.
Why do we stop at 4 IVF reimbursed in France?
Because a number of doctors prescribing IVF consider that after 4 IVF, there is no chance. These same doctors most often engage couples very quickly to IVF, without having a complete assessment, and then refer these couples to gamete donations and / or adoption. A number of couples are insufficiently explored, insufficiently informed, in a hurry to have a child and "throw themselves" immoderately to IVF and find themselves after 4 attempts without children ...
Is it possible to have a 5th IVF?
An IVF attempt is counted only if embryos are transferred. It must be known that the success of an IVF attempt is multifactorial. It depends, among other things, on the onset of ovulation which is not codified according to computer determinism. The puncture of the follicles, like the transfer of embryos, depends in part on the gynecologist who practices them.
An IVF attempt should be initiated only when the balance sheets in both men and women have been well done, and all other alternatives (stimulation and / or inseminations) have failed. The result is a total absurdity of limiting attempts to 4, given the diversity of indications, conduct and factors inherent to each couple and each team.
This is valid for both IVF and ICSI (Intra cytoplasmic sperm injection).
There are, of course, derogations that it is imperative to ask Social Security. These derogations are requested by the practitioner and are only granted drop-wise and often randomly.
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Sources and notes
- Hervé Fernandez. The infertility. PUF. 128 pages. Que Sais-je collection, 2001.
- C. Humeau, F. Arnal. Reproductive medicines. Odile Jacob, 2009.