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Article Dans Une Revue BMC Women's Health Année : 2023

Strong social disparities in access to IVF/ICSI despite free cost of treatment: a French population-based nationwide cohort study

Résumé

Background: Access to IVF/ICSI is facilitated when the financial barrier is removed. In a national context where in vitro fertilisation (IVF)/intracytoplasmic sperm Injection (ICSI) treatment is cost-free, how many women do not access IVF/ICSI and what are the factors associated with non-access? Methods: Using French national health insurance databases, the cohort included 20,240 women aged 18–43 years living in France who underwent unsuccessful treatment (no pregnancy) with clomiphene citrate (CC) and/or gonadotropins with treatment started between January and August 2016. The outcome measure was non-access to IVF/ICSI during the 24-month following start of infertility care. Factors associated with non-access to IVF/ICSI were explored using mixed effects logistic regression. Results: In the cohort, 65.4% of women did not access IVF/ICSI. In multivariable analysis, non-access to IVF/ICSI was higher in younger women (18–25 years: (OR 2.17, 95% CI: 1.85–2.54) and in older women (40–43 years: (OR=3.60, 95% CI: 3.25–3.98)). Non-access was higher among women below the poverty line (OR=3.76, 95% CI: 3.34–4.23) and showed a significant upward trend with increasing deprivation of place of residence. Distance to the nearest fertility centre was not significantly associated with non-access to IVF/ICSI. Conclusions: In a national context of cost-free ART treatment, a large proportion of women did not access treatment, with a strong social gradient that raises important issues. We need to understand the underlying social mechanisms to develop an efficient and equitable health policy regarding infertility care.
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hal-04334521 , version 1 (22-12-2023)

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Khaoula Ben Messaoud, Juliette Guibert, Jean Bouyer, Elise de La Rochebrochard. Strong social disparities in access to IVF/ICSI despite free cost of treatment: a French population-based nationwide cohort study. BMC Women's Health, 2023, 23 (1), ⟨10.1186/s12905-023-02784-4⟩. ⟨hal-04334521⟩
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