[What is the validity limit of patient reimbursement? Is age a criterion for refusal? Yes....].
Selection is probably necessary for women undergoing ART (Assisted Reproductive Therapy), since cost of technique is very important. Furthermore, the right to try to achieve a pregnancy is a debatable issue, since the delivery rates are very low for ageing women. Success rates decrease strongly for women over 40, and women must be informed of it. Women 40 years or older are significantly less likely to achieve pregnancy with IUI as compared to women under age 35. The older women are also significantly less likely to achieve pregnancy with in vitro fertilization (IVF and IVF-ICSI). Costs per cycle were similar, however, for both groups. Moreover, older women utilizing assisted reproductive techniques are four to five times less likely to achieve normal delivery than the younger group, since pregnancy loss rate is greater. This poor prognosis for success in older women adds significantly to the mean cost per pregnancy as compared to younger women. Now, public institutions advocate and impose an age limit upon women who which to undergo ART. Ovulation induction should not be administrated for women over 45 years old (AFSSAPS, 2003). One should recommend not to propose to women over 42 years old and to men over 59 years old (Guidelines, 2004). Moreover, ART techniques cannot be reimbursed for women over 43 years old (CCAM, 2005).
Belaisch-Allart
J
J
Service de Gynécologie Obstétrique, Hôpital de Sèvres, France.
D000328:Adult; D000367:Age Factors; D005260:Female; D005602:France; D006801:Humans; D007246:Infertility / Q000628:therapy; D007349:Insurance, Health, Reimbursement; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D018579:Patient Selection; D011247:Pregnancy; D018873:Pregnancy Rate; D016079:Refusal to Treat; D027724:Reproductive Techniques, Assisted / Q000191:economics* / Q000592:standards / Q000706:statistics & numerical data