DOC // New rules for in vitro fertilization in the Republic of Moldova

The Regulation on the provision of in vitro fertilization (IVF) medical services within the system of compulsory health insurance (AOAM) has been published in the Official Journal and has entered into force. The document sets out who can benefit from the free procedure, the eligibility criteria, the medical conditions and the services that will be covered by the state.

According to the new provisions, the program will be available to couples and single women diagnosed with infertility, citizens of the Republic of Moldova who are insured persons in the AOAM system and meet the medical criteria established by the Regulation.

The authorities specify that the new rules aim to facilitate access to modern assisted reproduction services and to reduce the financial burden for people facing infertility.

A major focus is placed on the eligibility and selection criteria for beneficiaries. The Regulation stipulates that women can be included in the program only if they are a maximum of 40 years old at the date of initiating the IVF cycle. According to the document, after this age the success rate of the procedure decreases significantly, while medical and obstetrical risks increase.

Another mandatory criterion concerns ovarian reserve. To be included in the program, the patient must have an anti-Müllerian hormone level of at least 1.1 ng/ml or an ovarian reserve of at least five bilateral follicles.

The Regulation also sets conditions regarding the condition of the female reproductive system. Beneficiaries must have an endometrium compatible with embryo implantation and must not present severe uterine pathologies that could prevent the pregnancy from progressing. In the case of conditions such as uterine fibroids, endometrial polyps, adhesions or active infections, access to the program may be postponed until treatment is completed.

The new rules also include criteria for male infertility. The program can be accessed if there is a possibility of obtaining viable spermatozoa for fertilization. In severe forms of male infertility, including azoospermia, the procedure may be carried out only using donor sperm and with the written consent of the beneficiaries.

The document also establishes a list of contraindications. Persons with serious diseases incompatible with pregnancy, acute infections, certain uterine malformations or active malignant neoplasms will not be able to benefit from the program.

The Regulation describes the pathway beneficiaries must follow. In the first stage, the family doctor or obstetrician-gynecologist will inform patients about the program and direct them to one of the IVF service providers contracted by the National Health Insurance Company (CNAM). Subsequently, specialized clinics will carry out the initial evaluation free of charge and establish eligibility for inclusion in the program.

According to estimated data, in the Republic of Moldova approximately 140,000 couples (20%) suffer from one form or another of infertility. At the same time, in recent years there has been a continuous downward trend in the total fertility rate of the population.