PMA: a complex organization for the Chaumontais forced to go to Dijon 52
More and more couples are forced to go through Medically Assisted Procreation (PMA) to conceive a child. The Chaumont residents concerned must go to the Dijon university hospital center throughout their journey. A significant organization is needed. Met.
In France, 1 child in 30 is conceived through medically assisted procreation (PMA). This figure has been growing steadily for several years. In Chaumont, the couples concerned by this course must go to the Dijon University Hospital (CHU), the closest. For many, the organization of appointments becomes almost military.
Between the first medically assisted procreation appointment and a pregnancy, it can take several months or even a few years. This is the case of Alexandra who went through In Vitro Fertilization (IVF) to have her daughter Oïhana. “With my husband, we started our journey in 2017, our daughter was born in 2020.
It was a complicated period, especially for the first try, because I was working as a temporary worker at 8am and I hadn’t wanted to talk to my employer about it. I took my hormone injections in the company toilets. It ended up blocking and my position was not renewed. (See box for the law)
For the second and third attempts, it was easier, because Alexandra was able to talk to her superiors about it. “I had an absolutely brilliant chef, she pushed me to make my appointments and supported me enormously in our efforts. »
Coming back and forth between her place of residence and Dijon was tiring for Alexandra, but she knew that the Dijon University Hospital team was performing well. “I went there on my own initiative. I did not look for Chaumont at the time because the reputation of the Dijon University Hospital is excellent. So when we hit the road, we think it’s for a good thing. When you are confident, it helps to move forward. »
A feasible part in Chaumont
Note that in 2017, the Chaumont hospital did not offer follow-up in medically assisted procreation. Since the 1 year and a half and the arrival of Dr. Kimpamboudi, some examinations can be carried out. (See box) “At present, three doctors have graduated in reproductive medicine, Dr Sloukgi, Dr Kimpamboudi, and Dr Hellou. Nevertheless, a PMA center must be attached to a university hospital centre. Which is not the case in Chaumont”, specifies Camille Duquennoy, deputy director of the Chaumont Hospital Center.
In addition, an agreement has been signed between Chaumont and Dijon in the event of a gynecological emergency for women undergoing medically assisted procreation. If a Chaumontaise encounters a difficulty, she will automatically be sent to the Dijon University Hospital.
Floriane first went to the Chaumont hospital for the first examinations, but quickly made the decision to go to Dijon with the support of her attending physician. “It’s certainly further away, but over there I feel better framed. I had no disparaging remarks from them, unlike the person who received us at Chaumont. For appointments, as I work in 2/8 I manage to place them easily, but sometimes there is a lot of waiting between them. »
Fuel inflation
But with the inflation of gasoline prices, and the amount of motorway tickets, there is an additional budget to take into account because of the many appointments to be made. “As we live an hour away, the Dijon University Hospital offers to group appointments. For example, I was able to have interviews with the biologist and the anesthesiologist on the same day. Sometimes also on a video meeting, it is more practical and economical in some cases, ”explains Floriane.
Indeed, in some cases, it is necessary to wait several weeks or even a few months between two control appointments. This is explained by the strong demand from the Dijon University Hospital which carries out, on average, around thirty interventions per week.
“For round trips, I can benefit from transport vouchers (see box), because I am in “long-term illness” (ALD). Affected by endometriosis, Marie* did not hesitate for a moment to go to Dijon despite the distance and the price of fuel. “These vouchers are very practical. At the time of the oocyte retrieval, I will be covered 100% for my trip. The vouchers are nominative and I can have several, but I manage to do everything on the same day when possible. »
For her career in medically assisted procreation, Marie* was vague with her employers, because she is on a fixed-term contract. “I just talked about regular monitoring. For my spouse, it’s easier because he is entitled to days off so we never told him anything. »
Marie* nevertheless advises couples or people who do not have a serious pathology to go to the Chaumont hospital center for their baby tests. “We have to make this hospital live. He goes through many crises, of course, but he must continue to be treated at Chaumont. »
Sofia*, encounters more difficulty in her appointments, because she has very long hours. “I can start at 8:30 a.m. and finish at 10 p.m. In this context, I spoke to my boss and my colleagues about it. It’s complicated, because sometimes I know that I have an appointment the day before for the next day and the schedules are not necessarily flexible.
It is certain that if in Chaumont, I had an identical follow-up as in Dijon, I will go without hesitation. Unfortunately, it is not the case. I’m a little afraid of the start of the sessions with the hormone shots, I’m going to have to organize myself so as not to interfere with my work, even if it means going back and forth to my home several times. Sometimes I wonder how the other couples who live 2 hours away are doing. It’s even more complicated for them. »
Caroline M.Dermy
*Names have been changed at the request of the speakers
The Chaumont hospital carries out the first stages of medically assisted procreation
Few people are aware, but the Chaumont hospital center can carry out several examinations directly related to medically assisted procreation, as explained by Dr Kimpamboudi, head gynecologist of the obstetrics gynecology department at Chaumont.
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“Our team is already taking charge of the first paraclinical assessment after the examination and the clinical examination. Ovulation stimulation is also done (excluding IVF), with some encouraging results.
In practice, infertility is defined by the impossibility of conception after 12 months in a woman under 35 years old, we launch the balance sheet of the couple, and if it is strictly normal, we launch the stimulation phase of ovulation with ultrasound monitoring until ovulation is triggered. For a woman over 35, no waste of time.
If the assessment is doubtful, even bad, the orientation is made from the outset towards a specialized center, therefore in Dijon. If, on the other hand, the balance sheet is strictly normal, two to three maximum attempts can be made in the service, before sending it to Dijon. We also provide follow-up ovulation monitoring (ultrasound monitoring) for women elsewhere.
The real limit in this charge price is at the laboratory level. The dosages of E2 (estradiolemia), LH and FSH, essential for determining the period of ovulation triggering, are only made in Dijon. In addition, the spermogram, the spermocytogram, the sperm culture and the survival migration test can only be carried out by a laboratory with the necessary approval. Chaumont does not own it.
On the other hand, pelvic ultrasound, and hysterosalpingography (HSG), are generally done in radiology departments, in the city, or even at the hospital, for ultrasounds. Ovulation monitoring and antral follicle counting are organized in the department. »
Unrecognized transportation support
On the Améli site, all the procedures for taking charge of transport are explained. You must request the prior agreement of the Health Insurance to be reimbursed. Therefore, the doctor must give the patient a request for prior agreement, which is valid as a medical prescription for transport. This request for prior agreement must be sent to the medical adviser of the health insurance fund. After the sending, the absence of answer under 15 days is worth agreement. In case of refusal, a letter will be sent.
To be reimbursed, the prescribed mode of transport must be respected, unless the patient uses another mode of transport.
Various criteria must be met: a one-way trip of more than 150 km or serial transport (at least four of more than 50 km one-way, over a period of two months, for the same treatment).
What the law says
Some people do not dare to talk about their medically assisted procreation journey to their employer, but article L1225-16 of the labor code is very clear on this point. “The employee benefits from medically assisted procreation under the conditions provided for in chapter I of title IV of book I of the second part of the public health code benefits from a leave of absence for necessary medical procedures.
The salaried spouse benefits from medical assistance for procreation or the salaried person linked to her by a civil solidarity pact or living with her in a marital relationship also benefits from a leave of absence to go to three of these compulsory medical examinations or of these medical acts necessary for each protocol of the medical assistance path to the maximum. These absences do not entail any reduction in remuneration and are assimilated to a period of effective work for the determination of the duration of paid leave as well as for the legal or contractual rights acquired by the employee in respect of her seniority in the company. »