Four questions about infertility, the “scourge” that Emmanuel Macron wants to tackle

During his press conference on Tuesday evening, the Head of State promised “a major plan to fight” against “male and female” infertility with a view to a “demographic rearmament” of France, including the birth rate is falling.

The problem affects more than 3 million French people. Emmanuel Macron promised the launch of a “big plan” against infertility “masculine and feminine”which he described as “scourge” and of “taboo of the century”, during his press conference at the Elysée, Tuesday January 16. This plan, already provided for by the bioethics law of 2021, is part of an ambition to revive the French birth rate, which fell significantly in 2023 according to INSEE, and thus enable the “demographic rearmament” wanted by the head of state. But what exactly are we talking about, and how can we fight infertility? Franceinfo takes stock in four questions.

1 What are we talking about ?

First of all, it is important not to confuse infertility, sterility and reduced fertility. Health Insurance thus defines infertility as “the absence of pregnancy after 12 to 24 months of complete, regular sexual intercourse (two to three times a week) and without contraception”. However, this infertility does not have the “irreversible character” of sterility which, in turn, refers to a “total inability of a heterosexual couple to have a child”.

As for fertility, it is a demographic parameter, which relates the number of births to the number of women aged 15 to 50, according to the National Institute of Demographic Studies (INED). It is thus conditioned by the capacity of couples to have a child, but also takes into account a broader set of social behaviors, such as individual lifestyle choices, contraception, birth rate policy or even the influence of religions.

2 Who is concerned ?

Worldwide, about one in six people suffer from infertility, according to a World Health Organization (WHO) report in April. “And this, regardless of where they live and the resources they have”, specifies its general director, Doctor Tedros Adhanom Ghebreyesus. According to the WHO, this is a “major health problem”which affects 17.8% of the adult population of rich countries and 16.5% of inhabitants of low- and middle-income countries.

Today, in France as in most developed countries, between 18 and 24% of couples wanting children fail to achieve pregnancy after twelve months of trying, according to Public Health France (SPF), which specifies that this rate falls to 8% to 11% after 24 months. One in seven heterosexual couples consult during their lifetime for a problem of reduced fertility, and one in ten couples undergo treatment to remedy it, according to Health Insurance. In total, 3.3 million French people would be affected, according to a report submitted to the government in February 2022 (PDF file) and co-led by Professor Samir Hamamah, head of the reproductive biology department at Montpellier University Hospital.

3 How to explain this phenomenon ?

Over the past few decades, the incidence of male and female infertility has continued to rise. The cause: the increase in the age at which couples seek to conceive, which has a negative impact on fertility. Thus, the average age at which women give birth to their first child was 31 years in 2022 and 2023, then compared to 30.7 years in 2019, 29.3 years in 1999, and between 24 and 25 years in 1977, notes the Health Insurance.

Medical problems, such as ovarian or testicular failure, endometriosis or even undergoing chemotherapy, are also causes of infertility, adds the National Institute of Health and Medical Research (Inserm).

There are also environmental factors favoring infertility, such as smoking, exposure to sources of high heat (oven, welding stations, computers) which increase the temperature in the testicles, or certain eating disorders (anorexia, obesity ) continues Inserm. Finally, exposure to certain pesticides, solvents or heavy metals has proven consequences on fertility, points out the institute, which adds that suspicions weigh on other polluting substances or endocrine disruptors, on which science does not provide still no definitive answers.

4 What could be done to fix it ?

When infertility is due to medical factors, hormonal treatments can remedy it, and medically assisted procreation (MAP) is a potential solution. In France, according to INED, 3.7% of children were born following PMA in 2019, even before it was opened to all women.

More broadly, the authors of the report on infertility submitted to the government in 2022 put forward several avenues to remedy it, such as informing young adults more widely about the phenomenon, establishing dedicated medical consultations so that they can “identify potential

They also recommend setting up a “national research strategy on human reproduction and infertility”as well as the creation of a National Fertility Institute, which would allow “to lead and coordinate research, infertility prevention actions and patient care”. Tuesday evening, Emmanuel Macron did not detail the measures he intended to implement or the planned timetable.