Many women do not access free assisted reproductive technology treatment in France

Key takeaways:

• Two-thirds of women with infertility did not access cost-free IVF/ICSI.
• Women with infertility aged 18 to 25 years or 40 to 43 years and those socially disadvantaged were less likely to access IVF/ICSI.

Among women with infertility who used clomiphene citrate and/or gonadotropins, 65.4% did not access IVF even though the technology was available without cost, according to results of a cohort study conducted in France.

“The study reveals that despite full health insurance coverage, a high proportion of women [with infertility] do not access IVF/intracytoplasmic sperm injection (ICSI). Notably, nonaccess is more prevalent among younger and older women, as well as those living below the poverty line or in areas of higher deprivation,” Khaoula Ben Messaoud, MPH, PhD, epidemiologist and researcher at NYU Langone Health, told Healio. “This suggests that factors beyond financial capability, such as age, social status and possibly perceived success rates and social acceptance, play a crucial role in accessing these treatments.”

Messaoud and colleagues utilized French national health insurance databases and conducted a population-based nationwide cohort study with 20,240 women (median age, 34 years) aged 18 to 43 years in France who underwent unsuccessful assisted reproductive technology (ART) treatment with clomiphene citrate and/or gonadotropins from January to August 2016. Researchers evaluated factors linked to nonaccess to IVF/ICSI.

The primary outcome was nonaccess to IVF/ICSI during 24 months of infertility care.

According to the researchers, 14% of the women were socially disadvantaged and 11.6% lived at least 1 hour from the closest fertility center.

Overall, 65.4% of women did not access IVF/ICSI treatment in France. Women aged 18 to 25 years (OR = 2.17; 95% CI, 1.85-2.54) and women aged 40 to 43 years (OR = 3.6; 95% CI, 3.25-3.98) had higher odds of not accessing IVF/ICSI treatment compared with women aged 30 to 34 years (P < .001) in the multivariable analysis. In addition, women who were socially disadvantaged (OR = 3.76; 95% CI, 3.34-4.23) had higher odds of not accessing IVF/ICSI treatment compared with women who were not socially disadvantaged.

Researchers observed a significant upward trend in nonaccess to IVF/ICSI treatment with increasing deprivation of place of residence.

Distance to the closest fertility center was not significantly associated with not accessing IVF/ICSI treatment in France.

According to Messaoud, these findings indicate a need for personalized counseling and support strategies in infertility care, especially for younger and older women and those from socioeconomically disadvantaged backgrounds.

“Future research should focus on exploring the decision-making process in IVF/ICSI for different age groups, understanding the social and psychological barriers faced by women from disadvantaged backgrounds and investigating potential biases in the treatment approach by assisted reproduction technology specialists,” Messaoud said. “This research is essential for developing more inclusive and effective health care policies and practices in infertility care, ensuring that access to IVF/ICSI is equitable and based on medical needs.”

For more information:

Khaoula Ben Messaoud, MPH, PhD, can be reached at khaoula.ben.messaoud@gmail.com.