Not having children for ecological reasons: this is the new line followed by part of Generation Z, born in the early 2000s in developed countries. A break with the 25-30 age group, who, on the contrary, have a significant fear that coexists with their desire for parenthood: infertility. “I have the impression of not having a body healthy enough to accommodate life”, thus sums up Adèle *, producer in Paris. The young woman, who has just celebrated her 29th birthday, has a priori no reason to worry from a medical point of view. Her fears, she lists them on the fly: “hygiene and the rhythm of life, smoking, alcohol and food…”.
Bertrand*, 30, joins her in her analysis, and extends the list “to lack of sleep, and even porn consumption. I ended up telling myself that it could be harmful, and impact sperm production. Besides that, I ride the motorbike every day, I have my nose in diesel all the time. I know that there is a relationship between my quality of life and my fertility”. Like Adèle, he is far from having surveyed all the studies, public health reports and other articles available on the subject. “But it’s a conviction,” he asserts.
Gabin*, a 27-year-old actor, was particularly marked by the series The Scarlet Maid, adaptation of the eponymous science fiction novel by Margaret Atwood, in which global pollution has been right in the birth rate. “We project ourselves quite well into this type of society today. And I know that the problems of fertility and demography are a reality in other countries. It is becoming a collective, societal and political problem. It is quite frightening “. Compared to previous generations, having a child naturally today seems much more uncertain.
“You can feel his body leaving”
Melissa Benkaci has been working as a liberal midwife for nearly seven years in the 20th arrondissement of Paris. In her daily practice, questions about fertility have come out of the bosom of gynecological pathology – patients with endometriosis or polycystic ovary syndrome – to win over “young women without a partner or short-term child project”. The reflection then unfolds in concentric circles: “Disorders of the menstrual cycle will quickly be attributed to a hormonal disturbance, itself attributed to poor diet, stress or lack of sport, details the midwife. in a way, you feel your body leaving, as if it were out of balance.”
These concerns, although sometimes confused and unbridled, are not without foundation: male, female or mixed fertility disorders are progressing at a dizzying rate. Taken together, the results of numerous studies, the most significant of which have been published in the journal Human Reproduction Update in 2022, reveal that the concentration of sperm in semen has been halved in 50 years globally. At the beginning of April, the WHO published a report which indicates that infertility today affects 1 in 6 people in the world, with small disparities depending on the region.
In France, the report on the causes of infertility published within the framework of the bioethics law of 2021 reveals a prevalence of one in four couples, i.e. 3.3 people concerned. “I think there is an awareness of the reality of infertility, and it is an area that is part of the general state of health. However, today, we fear that our bodies are degraded or soiled by external elements that we do not control, by a cocktail effect of all the pollutants that surround us”, analyzes Karine Mayer, psychologist specializing in infertility and perinatality in Boulogne-Billancourt.
Younger and younger patients
Alongside substances whose toxicity has been proven, such as tobacco, alcohol or drugs, new studies are now working to highlight the impact of environmental pollution on our ability to reproduce. “The repercussions that this can have on fertility, the impact of endocrine disruptors which we talk a lot about… These are stress factors today”, notes Gabin.
Although the conditional is often used, pesticides, heavy metals, solvents and more recently air pollution are suspected. “It’s a reality, but the causal link is difficult to establish in women, because the oocyte cells cannot be analyzed unless they are removed during in vitro fertilization. All that what we know is that in the course of assisted procreation, we have increasingly young patients, with an embryonic quality which is in some cases disappointing compared to their young age”, explains Julien Lepage , obstetrician-gynecologist at the American Hospital of Paris.
The development of research on endometriosis and other gynecological pathologies now allows earlier treatment of women who wish to have a child. Still, for the reproduction doctor, “it is clear that the main factor of fertility in women is age”. However, since the mid-1970s, the average age of first childbearing has increased from 24 to 31 years according to INSEE. “And that can easily go up to 34 in urban areas,” adds Julien Lepage. If lifestyle and fertility are intimately linked, “the important thing, if you have a pregnancy project, is above all not to think about it too late”, underlines Julien Lepage, who specifies that “solutions exist today to help couples in a situation of infertility, from simple procreation aid to egg donation”. The report on the causes of infertility in France, however, warns against excessive confidence in medically assisted procreation techniques. For example, the transfer of frozen embryos in the context of in vitro fertilization (IVF) offers only a 15 to 20% chance of success per attempt.
A child, right now
For Mélissa Benkaci, the anxiety of infertility which is observed today can also be understood as the antechamber of a more general malaise: “This is linked to many other apprehensions concerning our current lifestyles, the consumer society in which we evolve. Today you have to be able to have everything, right away. But you don’t get pregnant like you order online”, observes the midwife.
In consultation, Julien Lepage sometimes receives couples in their thirties three or six months after stopping contraception. Much earlier than the recommendations of the WHO, which defines infertility by the absence of pregnancy after 12 months of unprotected and regular sexual intercourse. “Obviously there is impatience with pregnancy”, agrees the gynecologist, “but we worry more quickly today if it does not happen immediately, a little in a dynamic of control. If we come consulting too early is also a need for reassurance. You have to give yourself time, and not panic without reason”. Among these reasons, we can cite those who worry about never having had an unwanted pregnancy, despite unprotected intercourse. “It is unfounded, it does not allow a diagnosis of infertility”, slice Julien Lepage.
Far from being fully elucidated, the mysteries of female and male fertility are today the subject of much research. In France, 20 to 30% of infertility is said to be “unexplained”. On the other hand, there are stories like that of Asma*, a 30-year-old former chef. Suffering from various gynecological pathologies, she went through five grueling assisted reproduction protocols that left her bloodless. “It was dramatic, I was made to understand that it was going to be very difficult to have a child without medical help. My body was nothing more than a failing machine, I felt broken. I stopped everything, I I regained possession of my body. Then I got pregnant, naturally”, rewinds the young woman.
Without being on the verge of a birth rate crisis, the situation remains worrying. Organizations, scientists and professionals in the sector are sounding the alarm: we must prioritize research, improve diagnosis and care, train caregivers and raise public awareness of this public health issue.
*Names have been changed