French President Emmanuel Macron vowed this week to tackle the country’s growing infertility problem as part of efforts to revive the country’s sluggish birth rate, describing the subject of infertility as “the taboo of the century”. More than three million people in France are said to suffer from the condition, making it a major public health issue – but one that has never been treated as such.
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Macron promised steps to boost France’s declining birth rate during a televised press conference on Tuesday, calling for a “demographic rearmament” of the country. The call came after France recorded its lowest annual birth rate since World War II, with 678,000 births registered in 2023 – a sharp 6.6 percent drop from the previous year.
France has long been proud of its comparatively high birth rate, described as a “French exception” in Europe. But recent trends have undermined the country’s status as the continent’s baby-making champion – and highlighted a growing fertility problem.
A 2022 report commissioned by the government showed that as many as one in every four French couples who have tried to conceive naturally for 12 months or longer are unable to do so. The World Health Organization (WHO) defines this as infertility – a condition that currently affects as many as 3.3 million people in France.
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Among them is Virginie Rio, the president and co-founder of the advocacy group Collectif Bamp!, which advocates better treatment for infertility.
After failing to conceive naturally for several years, Rio sought help through Medically Assisted Procreation (MAP), ultimately resulting in a pregnancy. But her long journey was fraught with challenges, not least because of what she described as a lack of understanding and compassion from doctors.
“I was told that women had psychological problems, and that I needed to relax more,” she said, pointing to sexist prejudice surrounding the issue of infertility. “The discourse makes women feel very guilty. They’re made to feel as if it’s their fault that they can’t have children,” Rio explained.
The underlying causes
Multiple studies have shown that a woman’s age plays a key role in her ability to conceive. A study published in the Upsala Journal of Medical Sciences in May 2020 showed that a woman under the age of 30 had an 85 percent chance of getting pregnant within a year, while a woman aged 30 had a 75 percent chance. At 35, chances dropped even further, to 66 percent, and at 40 to 44 percent.
But these types of statistics are guilt-tripping and hardly show the full picture.
“The stigma that women are the only ones responsible for infertility is deeply rooted in peoples’ minds,” said Élise de La Rochebrochard, a researcher at the French Institute for Demographic Studies (INED). “We shouldn’t reinforce this belief, making women the only ones responsible for reproduction – since it’s also an issue for men,” she said.
In recent decades, women have tended to wait until later in life before trying to have a child, for a variety of reasons. Sociologists point to women making up a much larger part of the workforce and to widespread access to contraceptives. Many young adults put their childbearing plans on hold as they seek professional and emotional stability. But the longer people wait to seek help for an infertility problem, the more difficult it gets for them.
Medical conditions, such as endometriosis, polycystic ovary syndrome (PCOS) and sperm production disorders, are also to blame for the uptick in infertility rates.
A meta-analysis published in 2017 showed that the average concentration of gametes in sperm had dropped by 50 percent between 1973 and 2011. Several reasons have been cited for the sharp reduction, including smoking, alcohol consumption and obesity, but also the exposure to pollution and endocrine disruptors, which can be found in many plastics and which interfere with the body’s hormones.
“The decline in sperm quality is a worrying issue, but there’s no need to panic,” said Micheline Misrahi-Abadou, a professor of biochemistry and molecular biology at the University of Paris-Saclay. She said today’s gamete concentration average of 40 to 50 million gametes per millilitre of sperm is still more than enough to impregnate a woman.
So what are the remedies?
When medical conditions stand in the way of a pregnancy, hormone treatments can help. In France, Medically Assisted Procreation, or MAP, has been available to all women since 2021 and no longer requires them to fulfil the medical criteria of infertility. But many doctors say hormonal treatments are not always necessary and, in some cases, not even the best route to pregnancy.
“A part of the three million people who are estimated to suffer from infertility may be due to couples going straight for MAP,” said Misrahi-Abadou, adding that she understood why some do not want to take the risk of waiting to become parents.
“Infertility causes terrible suffering, and is experienced as a tragedy, especially when the cause is unknown. But MAP can be an additional source of suffering, with an average failure rate of 40 percent,” she said.
Couples who choose MAP treatment have to undergo a multitude of tests and treatments that can be both expensive and stressful. But infertility is not only a social challenge, it is also a professional one.
“MAP protocols are often time-consuming and unsuccessful, which can make it difficult for people to reconcile their work with the treatment they are getting,” Rio explained. “Employers often expect their employees to be productive and present, but MAP treatments can require taking time off work.”
The authors of the 2022 infertility report recommended better public information, starting from secondary school, as well as targeted consultations in a bid to identify the factors affecting fertility. They also stressed the need to label food products containing phytoestrogens – which can cause infertility problems. Finally, they suggested more training on the issue for doctors and other health professionals.
Neglected issues
Meanwhile, researchers are trying to pin down the underlying factors of infertility.
“Identifying the causes of infertility is an essential prerequisite to improve treatments,” said Misrahi-Abadou, adding that genetics is an especially important tool to do so. “Like in all medical specialty fields, it’s possible to use DNA analysis to look for the causes of infertility,” she said. “The ultimate goal is to define a targeted therapy with medication that can act directly,” said Misrahi-Abadou, who heads the first reference laboratory for genetic infertility at the Bicêtre Hospital in Paris.
The experts interviewed by FRANCE 24 agreed that infertility has not been taken seriously enough in France. They hope Macron’s announcements will be followed up by action.
“Infertility is still an issue that is mistreated by society, and the people concerned are mistreated too,” said Rio, adding that her advocacy group’s calls for action have long been ignored. Misrahi-Abadou added: “Infertility is not a fatal disease and so it’s considered less serious than other pathologies.”
Taking Macron’s ambitions into account, does this mean that the “taboo of the century” will now finally be broken in France? The experts are not so sure. “Infertility is a taboo, but it’s not the only reproductive health issue that remains difficult to talk about,” de La Rochebrochard said. “Menstruation and abortion are both topics that are still not talked about enough.”
Infertility, sterility and reduced fertility are three different concepts.
The WHO defines infertility as the inability to conceive after one year or more of regular unprotected sex. Sterility is the total inability to conceive or impregnate, regardless if the woman or man undergoes treatment. Reduced fertility is a drop in the number of estimated births per woman. In France, the fertility rate came to 1.68 children per woman last year, compared with 1.79 in 2022, according to the national statistics office INSEE. This can partly be explained by a general drop in the number of women of child-bearing age (between 20 and 40 years old), but also other factors, including lifestyle choices.
This article was translated from the original in French.
