Vers une stratégie nationale de lutte contre l’infertilité et le déclin de la fertilité.

With 3.3 million people directly affected in France, infertility has become a major public health issue, yet it has never been treated as such by the public authorities. In France, as in all industrialised countries, the rise in infertility is primarily the result of the decline in the age of childbirth. In four decades, this age has increased by five years. In 2019, French women had their first child at an average age of 29. As fertility gradually declines from the age of 30, so-called ‘late motherhood’ automatically increases the risk of infertility. This decline in the age of childbearing is the result of a number of societal factors. The spread of female labour and contraceptive techniques has contributed to this. Sociologists also identify other factors, such as a possible decline in the desire for children among the younger generations, the search for professional and emotional stability before embarking on a parental project, an economic crisis and the absence of a public policy facilitating the reconciliation of family and professional life. In addition, the ignorance of many couples about the reality of the decline in their fertility with age, combined with excessive confidence in the performance of assisted reproductive technology (ART), results in a demand for increasingly late medical support, thus limiting success rates. Environmental factors are also behind the rise in infertility. A meta-analysis carried out in 2017 showed a decline of more than 50% in sperm concentration in men in industrialised countries between and1973 probably 2011, continuing at the same rate since then. This phenomenon would be linked in particular to regular exposure to endocrine disruptors. Furthermore, recent studies show the negative impact of Western lifestyles on the fertility of men and women, particularly during the pre-conceptional period, i.e. the 6 months preceding pregnancy: smoking or cannabis consumption, obesity, eating disorders, etc. These behaviours could even have a trans-generational effect, with consequences on the health and reproductive function of the unborn child. Infertility is also very often linked to medical causes. In women, it can have a mechanical origin, such as endometriosis, a widespread but still poorly understood pathology that causes tubal obstruction. It can also be of hormonal origin. For example, polycystic ovary syndrome (PCOS) is the most common cause of menstrual cycle disorders and lack of ovulation. Infertility in men can be endocrine, testicular or related to genital tract damage. The most common cause is varicocele. Despite the multiplicity of these causes, which are themselves often combined, infertility has long remained a blind spot for public authorities. A first step was therefore to identify these causes and to formulate concrete ways of combating them. In this respect, the mission presents six areas for improvement forming the framework of an operational plan for the prevention of infertility (educate and inform with a collective and individual information, update and train health professionals in infertility prevention, better detection and diagnosis of the causes of infertility, establishment of a comprehensive and coordinated national research strategy on human reproduction and infertility and the creation of a ‘National Fertility Institute’, embodying the discipline, guaranteeing the coordination of actors in the prevention and treatment of infertility. [ABSTRACT FROM AUTHOR]