The “taboo of the century”.

These are the terms used by Emmanuel Macron during his announcement, Tuesday January 16, of a “major plan” to fight against infertility with a view to a “demographic rearmament” of France, whose birth rate is falling ( see box).

An announcement which is not really one since this plan was expected and provided for by the bioethics law of 2021. 

According to a report submitted to the government in February 2022 as an extension of this law, in France, approximately one in four couples wanting children do not manage to conceive naturally after 12 months of trying or more, a period corresponding to the definition of infertility by WHO.

The equivalent of 3.3 million people. 

Virginie Rio is one of them.

After several years of unsuccessful attempts, she finally managed to become pregnant through PMA.

But his journey was strewn with pitfalls, notably due to the lack of consideration on the part of the medical profession.

“I was told that women had psychological problems, that I needed to relax,” she says.

Virginie Rio denounces paternalism which contributes to the stigmatization of infertile couples.

“It’s a speech that makes women feel very guilty. We make them understand that it’s their fault if they can’t have children.”

President and co-founder of the Collectif Bamp!, an association which supports affected couples, she calls for better treatment of infertility. 

See also Infertility: a major societal challenge that raises concern

Societal, environmental and medical causes 

Better management of infertility requires understanding its origins.

Studies show that the likelihood of achieving pregnancy decreases with age.

Under 30, a woman has an 85% chance of becoming pregnant within the following year, according to a study published in May 2020 in the Upsala Journal of Medical Sciences.

At age 30, the chances drop to 75%.

They are 66% at 35 years old and 44% at 40 years old. 

But this argument can reinforce the feeling of guilt.

“The stigma according to which women are considered the only ones responsible for infertility is very anchored in the popular imagination, underlines Élise de La Rochebrochard, researcher at the National Institute of Demographic Studies (INED). We must not reinforce this representation which assigns women to reproduction, when it is also an issue which concerns men."  

This decline in the age of motherhood is linked to a multitude of societal factors.

Sociologists cite the generalization of female work and access to contraceptive techniques.

The decline in the desire to have children among younger generations, the search for professional and emotional stability before having a child, or even the difficulty in reconciling family and professional life can also contribute.

However, the later the request for support for infertile couples is made, the lower the chances of success.

Medical causes, such as endometriosis, polycystic ovary syndrome (PCOS) or disorders of sperm production, can also cause infertility. 

Furthermore, a meta-analysis carried out in 2017 showed that the average concentration of gametes in sperm fell by 50% between 1973 and 2011. Several reasons are put forward to explain this drop: smoking, alcohol and even obesity.

Pollution and regular exposure to endocrine disruptors are also singled out. 

"The decline in sperm quality is a worrying subject, but we must not panic, wants to reassure Micheline Misrahi-Abadou, professor and hospital practitioner at Paris-Saclay University. Current concentrations of 40 or 50 million gametes per milliliter, even if they are lower than in the past, are still largely sufficient for fertility."  

What could be done to fix it ? 

When infertility is linked to medical causes, hormonal treatments can promote pregnancy.

PMA (medically assisted procreation), also called AMP (medically assisted procreation) – accessible to all women since 2021, without medical criteria for infertility – constitutes a way out for many infertile couples.

But professionals say it is not always necessary.

“A portion of the three million people estimated to be affected by infertility may be due to the fact that couples go directly to PMA,” points out Micheline Misrahi-Abadou, while understanding the impatience to become parents. Infertility is a terrible suffering, experienced as a tragedy, especially when we do not know the cause.

But PMA can be an additional suffering, with 40% failure on average." 

See alsoInfertility in Ivory Coast: an Ivorian clinic breaks the taboo

Many couples wanting to have a child go through tests and treatments that can be expensive and stressful.

Infertility is a challenge not only on a social level, but also on a professional level.  

“ART protocols are often time-consuming and not very successful, which can make it difficult to reconcile professional life and treatment,” explains Virginie Rio. Employers often expect employees to be productive and present, but ART treatments can require absences from work or lateness." 

In the report on infertility submitted to the government, the authors recommend better public information from middle school onwards, as well as the establishment of targeted consultations to identify factors affecting fertility.

They also underline the need to provide information on the phytoestrogen content of food products (likely to cause fertility disorders) and to strengthen the training of doctors and other health professionals. 

“A subject mistreated by society”

At the same time, researchers are working to better understand the factors and mechanisms that cause infertility.

“Identifying the causes of infertility is an essential condition for improving treatments,” insists Micheline Misrahi-Abadou, insisting on genetics as an essential tool.  

“When we cannot identify the cause of infertility, it is possible to use DNA analysis, as in all medical specialties, to search for it,” continues the person responsible for the first laboratory. reference for genetic infertility at Bicêtre hospital.

“The ultimate goal is to define targeted therapy with drugs that can act directly.”  

According to the experts interviewed by France 24, infertility is a public health problem that has not been sufficiently taken into account.

They hope that Emmanuel Macron's announcements will be followed by effects.

“Infertility remains a subject mistreated by society and mistreating for the people concerned,” denounces Virginie Rio who, with her association, has “the impression of being agitated in a desert for ten years.”

Micheline Misrahi-Abadou agrees.

“Infertility is not a fatal disease and is therefore considered less serious than other pathologies,” explains the professor. 

Will the “taboo of the century”, denounced by the president, finally be broken?

“Infertility is a taboo, but it is not the only reproductive health issue that is still difficult to address,” recalls Élise de La Rochebrochard.

“Menstruation and abortion are subjects that we still talk too little about.” 

Infertility, sterility and reduced fertility are three different concepts that must be distinguished.  

  • Infertility is the inability to have a child after 12 months of regular sexual intercourse without contraception, according to the WHO definition. 

  • Infertility is the complete inability to have a child, regardless of treatment.  

  • The decline in fertility is a reduction in the number of births per woman.

    In France, the fertility rate stood at 1.68 children per woman last year, compared to 1.79 in 2022, according to INSEE.

    It can be explained by the drop in the number of women aged 20 to 40, i.e. of childbearing age, but also to other factors such as individual lifestyle choices. 

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