[Medically assisted procreation in France; current situation and future prospects]

Infertility treatment has improved greatly with the advent of biological and medical technologies allowing gamete maturation, fertilization and embryo culture before implantation. The ethical, social and medical issues raised by assisted reproductive technologies (ART) led French legislators in 1994 to define the conditions of ART access and realization. These regulatory measures were recently bolstered by the creation of an Agence de la Biomédecine. In 2005, 123,000 ART treatment cycles were performed in France, all techniques included. They resulted in the birth of 19,026 children. The clinical pregnancy rate ranged from 11 to 24.4% per attempt and the multiple pregnancy rate from 11 to 21%, depending on the technique used. Nowadays, the first priority is to improve the quality of the results, which means controlling the risks and constraints as far as possible, while preserving the best chances for pregnancy and birth. A better evaluation of embryo characteristics and of the woman's fertility can reduce the required number of transferred embryos and the multiple pregnancy rate, without reducing the chances of procreation. The main improvements that are likely to occur in the near future are the use of milder hormone treatments to stimulate ovarian function, better selection of functional gametes, and refinement of fertilization and embryo culture conditions. Furthermore, micromethods to measure the embryo's metabolic and developmental capacities should significantly improve the results of ART and infertility treatment.