In Morocco, more than 900,000 couples are affected by infertility. Unfortunately, very often, they are unable to benefit from medically assisted procreation, the price of which remains prohibitive. But things could change…
As the saying goes, better late than never: the National Health Insurance Agency (ANAM) is working, in collaboration with learned medical societies and the Ministry of Health, on a therapeutic protocol for medically assisted procreation ( LDCs). “We have accelerated the pace of work in order to set up this system during this year”, says Dr. Laila Ibn Makhlouf of ANAM. There is, in fact, urgency insofar as this protocol will allow management of PMA, for which only drug treatment is currently covered for AMO policyholders by the CNSS and the CNOPS. The decision to reimburse nine hormonal treatments was taken, it should be remembered, by the Ministry of Health on a proposal from the National Health Insurance Agency.
900,000 couples concerned
Effective since January 2021, this measure, which had aroused great hope both within the scientific community and among patients affected by infertility, has not had the desired effect. And for good reason, it is only a partial support for medically assisted procreation since, as explained by Aziza Ghanam, president of the Moroccan Association of Aspirants to Paternity and Maternity (AMAPM), ” the medical act itself is not covered, nor are the biological analyses. Overall, it is a cost varying between 30,000 and 50,000 dirhams depending on the case to be treated”. A high cost for the approximately 900,000 couples who are, according to statistics from the Ministry of Health, unable to give birth. The result is not guaranteed, very often, the couple must make several attempts. “Which requires a substantial budget which patients often do not have. To finance it, they have to resort to family solidarity or else to call on bank loans”, regrets the president of the AMAPM. Since 2019, infertility has been recognized as a pathology, and because of the economic and social problems it poses, public authorities are now aware that it is a public health issue. Proof of this is that reproductive health is one of the Sustainable Development Goals (the 3rd goal). For 40 years, Morocco has mainly endeavored to develop a family planning program but only from the perspective of contraception policy, while infertility has been relegated to the background. A reorientation is necessary today, in the opinion of professionals, because of the needs of the population. According to estimates by practitioners, 15% of couples of childbearing age are affected by infertility.
4,000 PMA per year in Morocco!
The cost of alternative procreation solutions remains dissuasive. This explains the low number of LDCs identified annually in Morocco. Barely 4,000 operations are carried out in the 14 assisted reproduction centres, of which only four are public. The president of the AMAPM calls for “the opening of other public centers, because they will allow, by their tariffs, to treat a greater number of couples. The cost practiced in the public sector is indeed 15% lower than in the private sector”. Just as it calls for support from private insurance companies. “A file that is not on the agenda at our level,” replies a source from the Moroccan Federation of Insurance and Reinsurance Companies (FMSAR).
Morocco thus remains, unfortunately, far behind neighboring countries which have tackled this problem head-on.
For example, in Tunisia, the costs of the PMA, whose price varies between 1,300 and 1,800 euros, are fully supported by the state. In France, it is fully covered for those under 43 with a limit of 6 attempts at artificial insemination and 4 IVF. In Belgium, social security also covers PMA under the same conditions as its neighbour. However, the patient must pay a co-payment of 50 euros covering consultations, ultrasounds, as well as blood tests. In both countries, the price of IVF is 1,800 euros. We are therefore a long way from the prices charged under our skies. What discourage the majority of couples, especially since the success rate does not exceed 30%.
Protocols and costs
Infertile couples can resort to artificial insemination or in vitro fertilization practiced in the 14 public and private assisted reproduction centres. Artificial insemination with spouse’s sperm is the oldest technique. This natural fertilization costs around 3,000 DH.
In case of failure, we resort to in vitro fertilization (IVF) which is envisaged to reproduce in a test tube what happens naturally in vivo. After a stimulation treatment, the practitioner artificially fertilizes the oocytes before transferring them into the uterine cavity. The cost invoiced by the private centers varies from 20,000 to 30,000 DH of which almost 80% cover only the injections of hormones which are supposed to stimulate the ovaries. IVF ICSI (Intracytoplasmic Sperm Injection) is similar to IVF, to which is added the management of sperm morphological defects. This technique is done at the same price as conventional IVF. The cost of an IVF is around 15,000 dirhams and that of an IVF ICSI is 18,000 dirhams.