At the Human Reproduction Department of the "Danilo I" Hospital in Cetinje, in 2022, the number of medically assisted fertilization (MPO) procedures is almost a third lower than before the start of the coronavirus epidemic.
Mayor Željko Lazović He told "Vijesta" that the reason was that "Montefarm" did not regularly supply them with medicines.
The Budva private clinic "Humana reproduction" says that the problem is even more complex - that the registration for the procurement of some drugs used in sterility treatment procedures has expired, and they add that the procurement problem is present on a global level.
"Montefarm" did not respond to the newsroom's inquiry.
In the past months, women and couples who are going through medically assisted fertilization have addressed the "News" several times, with the claim that the procedure that would allow them to become parents cannot begin as they planned, but with certain delays.
Thus, the only state health institution where the procedures are carried out, General Hospital "Danilo I" in Cetinje, when asked by the editorial staff, said in April that for a new group of patients they are waiting for the completion of the public procurement procedure, which was supposed to provide the necessary drugs and consumables.
A few days ago, "Vijesti" was contacted again by a reader who expected the procedure to begin in the same hospital during November.
"I am one of the women who are waiting for the in vitro fertilization process, specifically this month I came to the VTO procedure in Cetinje with all the properly collected findings. However, I was told that they cannot accept me at the moment, because there are 30 women ahead of me waiting for their turn, and to call back in January. I accepted it, even though I was visibly disappointed, because I was told to come with all the collected findings of myself and my partner, and it was only necessary to start the procedure", she stated in a letter to the editors, adding that the reason for the delay in the procedure is because the Hospital "Danilo I" in Cetinje does not have enough drugs for the MPO procedure, as well as that he knows other patients, among whom is a woman who, as she said, "was already being sent back for the second month... but only this month they told her that they didn't have everything medicines".
The interlocutor of "Vijesti" says that she is satisfied with the doctors at the Cetinje Hospital, but she wants answers from the authorities as to why there are no medicines.
"Every delay shortens the opportunity for women to fulfill their role as parents," she said.
Lazović: Bigger delays are possible next year
The head of the Department of Human Reproduction of the "Danilo I" hospital does not deny that they have problems in the procurement of medicines. If the situation does not normalize in 2023, Lazović told "Vijesta", couples will wait even longer than now.
"During the whole of 2022, we had a problem with the regular supply by the pharmacy institution 'Montefarm' of the necessary drugs for MPO procedures. This problem was particularly pronounced in the second half of the year. So the number of procedures we performed this year is 30 percent less than in the period before the coronavirus epidemic. Because of this, it was not possible for all couples to have the procedure done immediately after receiving the instructions, but for most of them the procedure was done within the stipulated six-month period, so that so far no couple has lost the right to the MPO procedure. If the situation does not normalize in the next year, I am sure that couples will wait longer for the procedure, because we already have about 30 couples waiting for the procedure," said Lazović to "Vijesta".
There is no "estrophem", "pregnyl" is hard to come by
They claim that they did not have any supply problems in the private clinic "Moj Lab".
"Vijesti" sent questions to other clinics where MPO procedures are performed. The answers were not submitted by "Life" and "Ars Medica", and "Humane reproduction" from Budva says that the problem with the drugs used for MPO is "not so simple".
"There are medicines that are necessary for us, but their registration in Montenegro has expired and the companies that produce them do not want to do re-registration, because the costs of registering the medicine are higher than the earnings they will have as long as the registration lasts. It is for example 'estrophem' for stimulation of the endometrium. It is a big problem for us, both for us and for the patients," she told "Vijesta" Tatjana Motrenko Simic from the "Human Reproduction" clinic, also coordinator of the European Community for Human Reproduction and Embryology (ESHRE).
According to her, there are medicines whose production on the world level is smaller, "and companies driven by interest first reject the smaller markets".
"So that the stop injection on the territory of Montenegro can only be a recombined preparation, others of the type of naturally isolated preparations 'pregnyl' or 'choriomon' cannot be obtained or there are very big problems with procurement, and they are often more reliable. There is still a worldwide shortage of 'cetrotide', but thanks to Merck (drug manufacturer, ed.) we are well supplied, unlike the environment, as I can see from my contact with other colleagues from the Mediterranean region", said Motrenko Simić.
How much money, how much medicine
As the third problem in supply, the doctor of the Budva clinic cites the financial limitations of the Health Insurance Fund (FZO). He explains that because of this, it is more difficult for some centers where MPO procedures are performed to obtain the stimulation drugs that are available on the market.
"Private centers can take, because until now they have paid relatively regularly, the payment term is 60 days, which is just right if the Fund pays for the service performed on time (we have to order before the start of the stimulation, then in the next month we send an invoice to the Fund and, if everything is fine and there are funds, we are waiting a month for the payment). However, last year we did not have five months of payment in the second half of the year, until the New Year, at least my center. It was partially paid only after the New Year and the adoption of the new budget, and then we were able to pay the suppliers who until then regularly reminded us of our obligations... We had to pay part of it from other funds and manage," said Montrenko. Simic.
This means that, as she said, they did a service, ordered medicines and consumables...
"They got into debt with all the suppliers and then we were left to agree on how and when we will pay the debts. With all suppliers, as customers, all centers have promissory notes and bank guarantees. In this difficult situation, the question is when wholesale pharmacies will activate it, if we do not pay, and settle the debts. Now the question arises as to how much we are allowed to go into debt, because if there is no payment from the Fund, and the situation is difficult, our centers will be pushed into debt", she told "Vijesta".
She also said that they had already spoken with the director of the FZO Vuk Kadić, "but what to do when there is no money in the cash register":
"Everyone should understand that one fund of the Fund meets all the health needs - including children's vaccines, their treatment, and pregnant women, cancer treatment, surgical and cardiovascular patients, salaries of health workers... We gave greater rights than richer countries, and then canceled the financing of the Fund . And the rest between heaven and earth. We have bravely done over 40 pairs. So we'll see...”
MPO procedures in Montenegro, apart from the state hospital "Danilo I", are performed by the private clinics "Life", "Ars medica", "Moj lab" and "Kodra" in Podgorica and "Humana reproduction" in Budva. All health institutions, except "Kodra", with which the contract was not renewed in January, provide this type of service at the expense of the FZO.
At the state clinic, as Lazović said, the price of the medical service procedure is 1.130 euros, without the drugs included in the MPO procedure.
From the "Moj Lab" clinic, they said that their commercial price of MPO is 2.000 euros. They did not specify which specific procedure was involved, or whether it included medication.
According to the FZO price list from 2021, folliculometry (follicle monitoring) costs 111,52 euros, follicle aspiration is 135,65 euros. Anesthesia, according to the Fund's price list, costs EUR 49,30, the laboratory in the IVF procedure costs EUR 588,90, and ICSI costs EUR 761,46. Embryo transfer, i.e. the return of an embryo to a woman's uterus, according to the FZO price list, costs 73,46 euros.
On the list of other in vitro fertilization services, FZO defined the prices for the first gynecological examination - 8,34 euros, spermogram - 18,07 and ultrasound examination of a woman - 16,68 euros.
The Law on MPO and the Law on Compulsory Health Insurance, which partly deals with the field of sterility treatment, were adopted at the end of 2021. Although it was announced for June, as the law provides, in the meantime no by-laws have been adopted that would enable the realization of some of the rights provided for by the new regulations.
According to data released on the occasion of European Infertility Week, which is celebrated from November 7 to 13, 25 million people across Europe struggle with some form of infertility.
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