PMA (medically assisted procreation) or AMP (medically assisted procreation) refers to all the techniques used to reproduce in the laboratory part of the natural processes of fertilization and early embryonic development. They make it possible to compensate for medically established infertility or to prevent the transmission of certain serious diseases.

The first step in the assisted reproduction process is to carry out an infertility assessment in order to detect the possible cause (s) of infertility in men and / or women.

At the couple level, the Hühner test (or post-coital test) is the basic examination. It consists of taking cervical mucus 6 to 12 hours after intercourse at the time of ovulation and analyzing it to ensure its quality.

In women, the basic assessment includes:

• a temperature curve to analyze the duration and regularity of the cycle as well as the presence of ovulation
• a clinical specimen examination to detect any abnormalities of the genital tract
• a hormonal assessment by blood test to assess the quality of ovulation
• medical imaging examinations to observe the different genitals (uterus, tubes, ovaries). Ultrasound is the first-line examination, but it can be supplemented by other techniques (MRI, laparoscopy, hysteroscopy, hysterosalpingography, hysterosonography) for more extensive explorations.
• a clinical examination to detect the presence of a varicocele, cysts, nodules and other abnormalities on the various channels
• semen analyzes: a spermogram (analysis of the number, mobility and appearance of sperm), a sperm culture (search for infection) and a sperm migration and survival test.

Other examinations such as a karyotype or an endometrial biopsy may be performed in certain situations.

In men, the infertility assessment includes:

 Depending on the results, other tests may be prescribed: hormone assays, ultrasound, karyotype, genetic examinations. 

Depending on the cause (s) of infertility found, different assisted reproduction techniques will be offered to the couple:

• simple ovarian stimulation to induce better quality ovulation
• Insemination with partner’s sperm (COI) involves injecting previously prepared sperm into the uterine cavity on the day of ovulation. It is often preceded by ovarian stimulation in order to obtain quality oocytes. It is offered in cases of unexplained infertility, failure of ovarian stimulation, viral risk, female cervicalo-ovulatory infertility or moderate male infertility.
• in vitro fertilization (IVF) consists of reproducing the fertilization process in a test tube. After hormonal stimulation and the onset of ovulation, several follicles are punctured. The oocytes and spermatozoa are then prepared in the laboratory and then fertilized in a culture dish. If successful, one to two embryos are then transferred to the uterus. IVF is offered in cases of unexplained infertility, insemination failure, mixed infertility, advanced maternal age, blocked uterine tubes, sperm abnormalities.
• ICSI (intracytoplasmic injection) is a variant of IVF. Fertilization is forced there: the crown of cells surrounding the oocyte is removed in order to directly inject a previously selected sperm into the cytoplasm of the egg. The micro-injected oocytes are then placed in a culture dish. This technique is offered in cases of severe male infertility.

These different techniques can be performed with a donation of gametes.

• sperm donation can be offered in the event of definitive male infertility in the context of artificial insemination with donor sperm (IAD), IVF or ICSI.
• oocyte donation may be offered in the event of ovarian failure, an abnormality in the quality or quantity of oocytes or the risk of disease transmission. It requires IVF.
• embryo reception consists in transferring one or more frozen embryos from a couple who no longer have a parental project, but who wish to donate their embryo. This donation can be considered in the event of double infertility or a double risk of transmission of genetic anomaly.

In France, assisted reproduction is regulated by the bioethics law n ° 2011-814 of July 7, 2011 (1). It lays down the following main principles:

• AMP is reserved for couples made up of a man and a woman, of childbearing age, married or able to prove that they have lived together for at least two years
• gamete donation is anonymous and free
• the use of a “surrogate mother” or a double gamete donation is prohibited.

Health Insurance covers assisted reproduction under certain conditions:

• 
  the woman must be under 43 years of age;
• coverage is limited to 4 IVF and 6 inseminations. In the event of the birth of a child, this counter is reset to zero.

In Quebec, assisted reproduction is governed by the Federal Law on Procreation of 20042 which lays down the following principles

• infertile couples, single people, lesbian, gay or trans people can benefit from assisted reproduction
• gamete donation is free and anonymous
• surrogacy is not recognized by the civil code. The person giving birth automatically becomes the mother of the child and applicants must go through an adoption procedure to become the legal parents.

The Quebec Assisted Procreation Program, which came into force in August 2010, has been amended since the adoption, in 2015, of the health law known as Law 20. This law puts an end to the free access to the assisted procreation program and replaces it with a low income family tax credit system. Free access is now only maintained when fertility is compromised (for example following chemotherapy) and for artificial inseminations.