PMA: medically assisted procreation techniques

Medically Assisted Reproduction (PMA) is framed by the bioethics law of July 1994, modified in July 2011. It is indicated when the couple is facing a ” medically proven infertility Or to prevent the transmission of a serious illness to the child or to one of the members of the couple. She was extended in July 2021 to single women and female couples, who have access to assisted reproduction under the same conditions as heterosexual couples.

Ovarian stimulation: the first step

La ovarian stimulation is the simplest and often the first proposal made to a couple who is experiencing fertility problems, particularly in cases ofabsence d’ovulation (anovulation) or rare and / or poor quality ovulation (dysovulation). Ovarian stimulation consists in increasing the production by the ovaries of the number of mature follicles, and thus obtain a quality ovulation.

The doctor will first prescribe oral treatment (clomiphene citrate) which will promote the production and development of an oocyte. These tablets are taken between the second and sixth day of the cycle. If there is no result after several cycles, thehormone injection is then proposed. During ovarian stimulation treatment, medical monitoring is recommended with examinations such as ultrasound scans and hormone assays to monitor the results and possibly readjust the dosages (to avoid any risk of hyperstimulation, and therefore undesirable side effects. ).

Artificial insemination: the oldest technique of assisted reproduction

THEartificial insemination is the oldest method of medically assisted procreation but also the most used, in particular for the problems of male infertility and ovulation disorders. Artificial insemination consists of depositing sperm in the woman’s womb. Simple and painless, this operation does not require hospitalization and can be repeated over several cycles. Artificial insemination is very often preceded by stimulation of ovulation.

• IVF: fertilization outside the human body

La in vitro fertilization (IVF) is recommended in cases of ovulation disturbance, tubal obstruction or, in men, if the motile sperm are insufficient. This involves bringing oocytes (ova) and spermatozoa into contact outside the female body, in an environment favorable to their survival (in the laboratory), with a view to fertilization. Three days after the eggs are collected, the embryo thus obtained is placed in the uterus of the mother-to-be.

The success rate is around 25%. The advantage of this technique: it makes it possible to “select” the best quality spermatozoa and ova, thanks to a preparation of the spermatozoa and possibly ovarian stimulation. And this, in order to increase the chances of fertilization. This treatment sometimes results in multiple pregnancies, due to the number of embryos (two or three) deposited in the uterus.

• Intracytoplasmic sperm injection (ICSI): another form of IVF

Another technique for in vitro fertilization is intracytoplasmic sperm injection (ICSI). It consists of microinjection of a sperm in the cytoplasm of a mature oocyte using a micro-pipette. This technique may be indicated in the event of failure of in vitro fertilization (IVF) or when a sample from the testis is necessary to gain access to sperm. Its success rate is around 30%.

The reception of embryos: a technique rarely used

This method of assisted reproduction involves implanting in the uterus an embryo from donor parents. In order to benefit from this transfer of frozen embryos donated anonymously by a couple who themselves have undergone ART, the couple generally suffers from double infertility or risks of transmission of a known genetic disease. Also, the more usual attempts at medically assisted procreation have already been tried and failed.