Who does not have a person in his entourage affected by medically assisted procreation (PMA)? If the subject begins to emerge from the silence, the questions remain multiple. For Infertile generation?*, three journalists, concerned, investigated the experience of infertility thanks to around fifty testimonies. They also questioned the causes of this social phenomenon with interviews with doctors and researchers, but also on a side that we know less: the flourishing business of infertility. On the occasion of its publication, this Wednesday, 20 Minutes interviewed co-authors Pauline Pellissier and Estelle Dautry.
You are both affected by PMA…
Estelle Dautry : I had two miscarriages and an ectopic pregnancy, then we were taken care of in PMA with my partner in Paris. I have endometriosis and polycystic ovaries…like many women. We did IVF and we managed to have a child, four years after the start of the journey.
Pauline Pellissier : We tried with my spouse to have a child. After a year, we went to see a fertility specialist. I have irregular ovulation, so it’s hard to know the right window and my spouse didn’t have a great spermogram. We started with stimulation, then after four failures, we switched to IVF. And we were lucky because the first one worked. It took two years.
What surprised you the most during your investigation?
Estelle : We thought that the effect of age on infertility could be compensated by this medical support, but in fact not really. Despite all that we manage to do, the success rate in IVF is only 40%. More than half of the couples who enter it will not have children eight years later. We are not at all on a miracle solution! However, the general public is not aware of this.
Pauline : I was impressed by the business side of PMA. I was a little hallucinated by the fact that everything is declined: herbal teas, food supplements, box… PMA is a vein exploited by people who are aware that there are more and more infertile people… who have a certain purchasing power.
Is there really a rise in infertility, or are advances in science giving more people the ability to seek medical help?
Estelle : Indeed, there is better access to MAP than before. But there is also an increase in infertility. With several factors: we start having children later. There is also a strong effect of endocrine disruptors. Finally, various pathologies, endometriosis, polycystic ovaries, can explain it.
Pauline : Metadata show a real drop in the quantity and quality of sperm in Western countries… Which does not bode well for the future.
How would you define France’s place on the PMA side?
Estelle : There are two points of view: according to the NGO Fertility Europe, which brings together patients, access is good in France. Compared to other countries where everything is paid, all straight couples, and couples of women and single women recentlycan make a PMA while being reimbursed [jusqu’à 43 ans et en partie]. On the other hand, we are behind on the research part.
Pauline : France also has a special place on the donation of gametes: like all donations, they are not remunerated, which makes it very complicated for French couples to have access to them due to extremely long delays. Neighboring countries have opted for remunerated donations. As a result, couples who cannot afford to wait three, four, five years go abroad. However, this raises the question of commodification when 25-year-old Spanish women donate their eggs to pay for their studies…
Infertility has therefore become a business, especially on the side of alternative medicine…
Estelle : In the testimonies collected, it is much reassembled: there are excesses on alternative medicine. This becomes new injunctions, making you feel guilty and with a slightly “performance” side: you should do acupuncture, fertility yoga… But many women say “I found someone who listens to me”. This shows that there are deficiencies in the classical accompaniment. Abroad, there are certain clinics that offer “all inclusive”: egg donation, spa, psychological support… They have understood that women are looking for complementary medicine.
Precisely, clinics in Spain, the Czech Republic, Belgium have become popular with infertile couples and single women wishing to have a child…
Estelle : In Spain, assisted reproduction is the second industry after tourism! That’s why the laws are so open: women are taken care of until they are 50 or even 55 years old. But it is very difficult to obtain the figures of French women who go to Spain for a PMA…
Pauline : Today, there are more French people who use egg donation abroad than in France! And Social Security partially reimburses these donations abroad. It’s very good that we help couples who go abroad, but it’s still very hypocritical. And this shows that our system does not work: we reimburse people who seek treatment elsewhere.
On February 21, the government received a report on fertility, and Olivier Véran announced a strategy to fight all causes of infertility for the spring of 2022. Is it finally moving?
Estelle : The problem is how much money is there for this strategy? For the moment, there is neither timetable nor means on the table. Same with endometriosis…
Pauline : This is a first step, we ask for concretization. Will things change between now and the presidential election? I have a little trouble believing that. While at least 3.3 million French people are affected by infertility, this is not a minor issue. And beyond infertility, we talk about environmental health, endocrine disruptors that have an impact on cancer, the state of public hospitals…
Among your five ways to improve things, you talk about a free fertility checkup offered to all women. Why is it urgent?
Estelle : Everyone has a child if they want and when they want. To have all the keys in hand, the easiest way is to know, at 30, where your fertility is. Rather than making everyone feel guilty, it would be interesting to detect the women for whom it could be difficult, to talk about the egg freezing.
Pauline : Especially since there are fairly young infertility. On the endometriosisa lot of women find out about their illness when they can’t get pregnant.
Your essay is co-written with >Victor Point. And among your five leads, you suggest giving more space to men. How to do ?
Pauline : A desire for a child is lived by two, but all the treatments are undergone by the woman. It would be important to include men in all appointments, and even to make their presence compulsory. It would also be necessary to change the look of caregivers, who very often only address women.
Estelle : At the level of the law, and this is recent, women can take time off without loss of pay during their PMA course. One could imagine a change in the law to authorize the man to accompany the woman to appointments. This inequality in the PMA is quite difficult to live with for the women of our generation, who seek equality in the couple.
Pauline : We realized that there was even more of a taboo on male infertility. We made a questionnaire: out of 500 returns, less than 10 men answered. Men are as concerned as women by infertility, some are very involved in the course of PMA. But they talk about it even less than the women around them.
* “Infertile generation? “, Victor Point, Estelle Dautry and Pauline Pellissier, Otherwise, March 9, 2022, 20 euros.