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When to carry out a medical assessment of infertility

When to carry out a medical assessment of infertility?

When a couple cannot conceive a child after 12 to 24 months of regular intercourse, it is necessary to consult a doctor. This may be a gynecologist or fertility practitioner, usually on the advice of the attending physician. Both members of the couple must be present during the consultation.

If the woman is over 35 (or if there is a known or suspected reproductive tract disease in either the male or the female), this consultation should take place earlier, after 6 months of trials unsuccessful.

During the consultation, a medical assessment of sterility is carried out, which then allows:

  • to confirm the diagnosis of infertility by its seniority;
  • find a simple cause of infertility that can be easily modified;
  • to consider, after a medical examination of the couple, the necessary additional examinations.

Infertility treatment

Following the medical assessment of infertility carried out by the specialist doctor or gynecologist, the chances of natural conception are studied by a team of doctors, who determine the time frame and specificities of the necessary treatment:

  • the advice was given to the couple, in particular on lifestyle, diet, physical activity, or the frequency of sexual intercourse;
  • medical treatment, such as ovulation induction with medication;
  • surgical treatment, when the cause of infertility is operable (uterine fibroid, obstruction of a fallopian tube, endometriosis, etc.).

Acts of medically assisted procreation (PMA)

When it is not possible to treat the couple’s infertility by traditional care, it is possible to have recourse to medically assisted procreation (MAP). ART is carried out in an approved center by a medical team specialized in the field.

3 different assisted reproduction techniques can be applied depending on the results of the additional examinations and the origin of the sterility (male, female, or couple):

  • Intrauterine artificial insemination (AI);
  • Classic in vitro fertilization (IVF);
  • In vitro fertilization by micro-injection or ICSI.

What supports for infertility by Social Security?

To benefit from 100% coverage (based on the conventional rate) of assessments and care for infertility by Social Security, it is important to respect the course of coordinated care by consulting the attending physician beforehand. The practitioner must indeed complete a care protocol that the couple must then submit to the Primary Health Insurance Fund (CPAM). This protocol can correspond to a supported request or renewal.

Manx Tip!

It is strongly advised to submit a request for reimbursement to Social Security before carrying out the most expensive examinations or treatments to ensure that you benefit from 100% reimbursement of these expenses.

Support for medically assisted procreation

Medically assisted procreation acts are 100% covered by Social Security, subject to validation of the treatment protocol, and only for women up to 43 years old.

  • Artificial insemination is covered up to one attempt per cycle, with a maximum of 6 to achieve pregnancy;
  • In vitro fertilization is covered for 4 attempts to achieve pregnancy.

Additional attempts cannot be refunded and will therefore be the sole responsibility of the couple. However, each successful pregnancy resets the support counter, making it easier to conceive several children through medically assisted procreation.

What reimbursement of infertility by the mutual?

Although Health Insurance covers 100% PMA, this reimbursement is based on the conventional Social Security rate and does not correspond to the actual costs of the couple. To benefit from a full refund, the intervention of mutual health insurance is necessary.

The mutual will thus take charge of excess fees (private clinics, gynecologists, etc.), drugs not reimbursed in normal times, the hospital package, accommodation costs beyond 12 days after childbirth, etc.

The quality of the coverage by the mutual will mainly depend on the reimbursement levels defined on the insurance contract taken out. Note that it is important to inquire with the mutual before incurring significant health costs. If the existing cover does not reimburse the expenses related to infertility well, it is necessary to compare the health mutuals on the market to find the cover best suited to the couple.