The desire for a child in the face of the too little known causes of infertility

“Few subjects have so many individual and collective implications in French society.“, wrote in February Professor Samir Hamamah, in the preamble to a report submitted to the government.

As an extension of the bioethics law of August 2021 which provided for the establishment of a national plan to combat infertility, this report listed the causes for the first time.

“Its aim was not to make people feel guilty or worried, but to provide information to as many people as possible about the risk factors or the limits of medically assisted procreation (MAP)“, explains to AFP Professor Hamamah, head of the human reproduction and fertility department at the Montpellier University Hospital.

“For us, this is a public health problem that must be given visibility.“, notes Virginie Rio, founder of the Bamp collective, which organizes the 8th week of awareness of infertility, from October 31 to November 6.

Today in France, as in most developed countries, one in four couples wishing to have children fails to achieve pregnancy after 12 months of trying, a period corresponding to the definition of infertility by the Organization World Health Organization (WHO).

Pregnancy at 30.8 years on average

Over the past few decades, the frequency of male and female infertility has steadily increased. And some 3.3 million French people would be directly affected today. The main cause is the decline in the age of childbearing.

In 2020, French women had their first child at the age of 30.8 on average, compared to 24-25 years in 1977. However, female fertility declines from the age of 30, and this fall accelerates significantly from the age of 35.

In 2020, around 190,000 children, or a quarter of the total number of births, were born to mothers aged 35 or over.

In addition, the public places excessive trust in medically assisted procreation (123,000 “attempts” in France in 2020) to counterbalance the effects of age, specialists point out. Gold “it’s not a magic wand“, warns Joëlle Belaisch-Allart, president of the national college of gynecologists and obstetricians.

In French ART centres, the live birth rate per attempt only reaches 20% on average.

And after 38 years, the results of in vitro fertilization are unsatisfactory.

Other causes of infertility include medical causes (such as endometriosis or polycystic ovary syndrome in women), lifestyle factors (tobacco, alcohol, obesity, etc.) but also decline in sperm quality.

Information deficit

The environment is singled out. Numerous studies have described a link between exposure to certain families of chemical substances and fertility disorders.

A meta-analysis published in 2017 revealed that the concentration of spermatozoa in semen has decreased by more than 50% in less than forty years (1973 -2011) in Western men.

“We are now facing a major challenge, but we can take a number of simple measures that are not necessarily costly.“, argues Professor Hamamah.

The subject suffers in particular from a lack of information. “Too many women try to have a first child at 40 but don’t understand why they can’t“, points out Dr. Belaisch-Allart.

Among its recommendations, the report thus proposed to inform the public regularly, from secondary school, on the physiology of reproduction and the decline of fertility with age.

Another idea: establish targeted consultations, so that young men and women can identify potential factors affecting their fertility.

For the moment, the government has not launched such a project. “There is no agenda in this area”, regrets Virginie Rio.

The bioethics law has certainly opened up the possibility of freezing gametes (oocytes or spermatozoa) without medical reason. But “the activity has not been opened up to private centres, it remains concentrated in public centres. But demand is exploding“, regrets Virginie Rio. And the delays to obtain an appointment generally vary from three to six months. So much time wasted in the face of a desire for a child, she laments.