It is a global disease that affects 1 in 6 adults. In France, 3.3 million people are affected, men and women. Guadeloupe is no exception. Between 20% and 25% of couples fail to have a child. Most are followed by the Caribbean Center for Reproductive Medicine.
The plan announced by Emmanuel Macron at the start of the year to fight infertility has made progress, but still falls far short of urgent needs, Professor Samir Hamamah, co-author of the report, estimated last month. “on the causes of infertility: Towards a national strategy to combat infertility”, thus joining other specialists. According to Professor Hamamah, the president's announcements remained at the stage of declarative intentions.
According to the Ministry of Health, 3.3 million people are directly affected by infertility in France. It is therefore a major public health issue.
Last year, in Guadeloupe, the Caribbean Center for Reproductive Medicine (CCMR) recorded 600 new cases.
Between 20% and 25% of couples fail to have a child. They are considered infertile if they fail to achieve pregnancy after 12 months or more of trying.
The CCMR can support them in their desire to have a child. The territory has its own sperm and egg bank. This center, little known to Guadeloupeans, is detailed by Doctor Catherine Morinière, head of the PMA (Medically Assisted Reproduction) service in Guadeloupe at the CCMR.
One in 4 couples are affected by infertility in Guadeloupe. However, there are solutions to help heterosexual couples, female couples and single women realize their desire to have a child: PMA (medically assisted procreation) at the Caribbean Center for Reproductive Medicine in Jarry.
A center facing a shortage of donors. Only three donations per year are recorded at the CCMR.
Infertility will still affect one couple in five, or even one couple in four, so it’s really very common. And we still have the impression, in Guadeloupe, that it remains very taboo.
Dr Catherine Morinière, head of the PMA department, medically assisted procreation at the Caribbean Center for Reproductive Medicine
Very taboo, and yet we need to talk about it. Many Guadeloupeans are on the waiting list due to a lack of donors.
We don't have many sperm donors in our bank. So actually, we would need around twenty per year and on average, we have three per year.
Only three donors on average per year in Guadeloupe, while demand will increase.
It's really very complicated since the more women are aware of the new law, the more they will seek advice. And there, we already have a waiting list of around 80 women who are waiting for sperm donation to have their baby. Unfortunately, we put them on a waiting list of about two years because we have a shortage of donors.
This shortage therefore reduces the number of attempts at IVF, in vitro fertilization, and possible inseminations.
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Normally, we are allowed four IVF attempts and six inseminations. But as we do not have enough donors, we will reduce the possibilities of attempts to two IVF attempts and three inseminations. So indeed, it is still a loss of opportunity for the patients.
The shortage of West Indian donors forces recipients to accept donors who do not have the same physical characteristics as them.
The problem is that here, 90% of patients will be of West Indian origin while more than half of our donors are Caucasian. So, we do not have enough West Indian donors for the patients who would like them and we are forced to allocate Caucasian donors or to increase our waiting times, hoping that donors from the West Indies will come.
Dr Sandra Boyer Kacem, head of the laboratory and CECOS, the Center for the Study and Conservation of Human Eggs and Sperm
Sperm donation is voluntary, anonymous and free. PTo make a donation, you must be between 18 and 44 years old inclusive and in good health.
what a gift”is governed by bioethics laws. The number of births is limited to 10 per donor. And for those who are worried about the risk of inbreeding linked to insularity, here in Guadeloupe, we can also make exchanges“with France, explains the specialist.”We can send their donation, like that, the children resulting from the donation will be in France and we bring donors from France here“.
Since the new bioethics law of 2022, four babies have been born thanks to sperm donations in Guadeloupe, and 6 pregnancies are underway.
Donors cannot know the identity of the people who will receive their donation and vice versa. Since 2022, children born from sperm or egg donation have access, when they come of age, if they wish, to the identity of the donor. Consent is collected and information about the donor is collected before donation. In case of refusal, donation is not possible.
Since 2021, the PMA has been open to all women, single or in a relationship. If the department is facing a shortage of West Indian sperm donors, there is also a serious shortage of egg donors while the demand is increasingly strong.
However, the candidates do not have to go to France. They are followed at the Center for Reproductive Medicine in Jarry.
As with sperm donation, the number of egg donations is not sufficient to meet demand. On average, around fifteen women are ready to make a donation each year in Guadeloupe and opposite, around thirty couples and single women are on the waiting list.
There are fewer of them than those waiting for a sperm donation. But hey, in general when you have an egg donor, she donates for two, or even three patients maximum. While it is true that a sperm donor will give for 15/20 patients. So we need many more donors than male donors.
And here again, the profiles do not correspond to expectations. Like sperm donations, most egg donors “are of Caucasian origin and we have recipients who are of West Indian origin and therefore, it is not always easy to be able to respect their choice of morphological characteristics” specifies Dr Boyer Kacem.
Result, due to a lack of West Indian donors, heterosexual couples and female couples are turning abroad where the donation is remunerated for the donors. Single women often prefer to wait.
We are more like around 10, maybe 15 couples, but those who can, we ask them to go abroad because there is a minimum of four years of waiting. In truth, if we had more donors, we could reduce these delays but for the moment we cannot. And unfortunately, it is those who do not necessarily have the opportunity to go abroad who will wait the longest.
Abroad, egg or egg donation can be paid between €5,000 and €10,000.
Due to the shortage of oocytes, the AMP (medically assisted procreation) service in Guadeloupe allocates only five oocytes per woman. As with sperm donation, this reduces the number of possible attempts and therefore the chances of pregnancy.
Furthermore, egg donation is a little more restrictive.
Donors must be between 18 and 38 years old, so a little younger than male donors, but also in good health. The constraint of egg donation is that they will have to have follicular stimulation and a puncture in the operating room, which can slow things down. But in general, it goes very well and we support them throughout the journey. It's really something very altruistic, which is important to help all our waiting patients.
Costs are fully covered. Site and anonymous volunteer donations are free. The donation of gametes from a donor cannot lead to the birth of more than 10 children, the treatments linked to the donation do not reduce the donor's chances of subsequent pregnancy, nor do they advance the age of menopause. .
Donors cannot know the identity of the people who will receive their egg donation and vice versa. As with children born from sperm donation, those born from egg donation have access, upon reaching the age of majority if they wish, to the identity of the donor. Consent is collected and information about the donor is collected before donation. In case of refusal, donation is not possible.
There is no filiation between the child and the donor.
Woman, man, couple or single wanting a child but not being ready can freeze their gametes: oocytes or sperm. Self-preservation of gametes has been authorized since the 2021 bioethics law. A preventive approach to preserve fertility, subject to several criteria.
It is no longer necessary to carry out a medical assessment for infertility. This is a personal choice and not a medical indication.
This procedure carried out in Guadeloupe allows women to use their eggs later and therefore to consider pregnancy at a later age.
Women can freeze their eggs for their own use between the ages of 29 and 36 years and 12 months. And it's true that this can be of interest since either they will use them later if they have not achieved their pregnancy, or they will be able to donate them to fund the egg donation bank. And then men can also keep… For them, there is less interest, because we know that the man will have sperm almost until his death, but it can still be interesting to know.
To have your gametes preserved, you must therefore be between 29 and 37 years old for a woman and between 29 years old and 45 years old for a man. And a woman must use her own gametes before the age of 45, a man before the age of 60.
Why embark on this procedure? It is above all prevention for Dr Morinière, head of the PMA department at the Caribbean Center for Reproductive Medicine.
The key message is that basically fertility is correct up to 35 years old and after 35 years old, it will decline very significantly until, around 40 years old, there is a maximum pregnancy rate of 5%. With lots of miscarriages, lots of chromosomal abnormalities. So the key message is prevention. We should perhaps carry out awareness campaigns among the population to have children early or to freeze their eggs and avoid this decline in fertility after the age of 35 and 37.
By calling for the self-preservation of your gametes, you will have to indicate each year whether you wish to keep them, use them, donate them to people on the waiting list, make a donation to scientific research or end their use. conservation.
Those who do not respond to reminders will see their stock destroyed after 10 years,
If the collection or sampling is reimbursed, on the other hand, the costs of preserving the gametes are not covered by Health Insurance and therefore remain the responsibility of the patient. They are around forty euros per year.
For any information or appointment regarding medically assisted procreation, please contact: [email protected]
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This article was first published on February 12, 2024.
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