[LUM#4] Fertility at risk
Is having a baby easy? Not always... More and more couples are finding it difficult to have a baby. In the face of infertility, reproductive biology specialist Samir Hamamah has one watchword: prevention.
1 in 6. This is the proportion of couples who are unable to have a child without medical assistance. A worrying figure, " and one that's rising all the time ", warns Professor Samir Hamamah, Head of the Reproductive Biology Department at Montpellier University Hospital. For the specialist, in some cases infertility is directly attributable to our lifestyle. Alcohol, tobacco, drugs? He's not referring to these well-known scourges. But to others, as discreet as they are omnipresent: the chemicals we are confronted with every day from birth... and even long before. " The fetus is already exposed to these products in the womb, which can affect the fertility of the unborn child ", explains the director of Inserm Unit U1203. Endocrine and environmental disruptors, pesticides, volatile organic compounds - these are just some of the dangerous substances that lurk in even the most innocuous everyday products.
" If you put on lipstick, you're coating yourself with glycol ether; when you heat a frozen dish in the microwave, you're ingesting phthalates. In all, there are more than a hundred molecules toxic to "reproductive health" that we handle every day, often without realizing it. Reproductive health is very fragile," warns Samir Hamamah,"and we need to take care of it as soon as possible, otherwise we'll have to foot the bill for several generations. We need to make infertility a national cause! We need to alert young people to the consequences of these exposures, and tell them from an early age that their lifestyle may compromise their future plans for children ".
Prevent
All the more so as fertility is also being challenged by the evolution of our societies. On average, women now have their first child around the age of 30. " A woman's age is a major risk factor for infertility, as the quality of her oocytes, the female reproductive cells, declines over time ". At 20, 1 in 2 oocytes carries genetic abnormalities that may be incompatible with pregnancy. By the age of 40, 9 out of 10 oocytes are out of order.
How can we get around this major difficulty, given that the age of childbearing is steadily falling? For Samir Hamamah, the answer is obvious: " all young women who do not yet have a parental project should be offered the possibility of freezing their oocytes, so that they can use them later if necessary . If they ever have difficulty getting pregnant, they could then use these "young" oocytes for in vitro fertilization, thereby optimizing their chances of having a baby. For the specialist, this "preservation of fertility through freezing" is a real necessity, " today in France, women of childbearing age do not have this option, whereas men can benefit from it if they wish ", explains the practitioner.
3D to the rescue of fertility
All the more so as the success rate of assisted reproduction techniques remains relatively low, with only 20% of IVF cases being successful. Samir Hamamah's team has made considerable progress in this field. The latest revolution - and a world first - is Embryoscan, a three-dimensional modeling of embryos to increase IVF success. " To carry out IVF, several oocytes are harvested from the future mother and fertilized with sperm. On average, we obtain 5 embryos, not all of equal quality ", explains Samir Hamamah.
How do you choose which one to implant in the mother-to-be's uterus? That's where 3D comes in. " We scan the embryo from every angle, then use software to reconstruct a three-dimensional image, which is then materialized using a 3D printer. As a result, the practitioner can examine the embryo from every angle to detect any defects that would make pregnancy impossible. These are details that cannot be seen under a 2D microscope. " This is a revolutionary non-invasive procedure for improving embryo selection, while fully respecting ethical rules ", enthuses Samir Hamamah.
The reproductive biologist now has another major objective: to create an institute in Montpellier dedicated to human fertility. " Infertility requires transdisciplinary care: gynecologists, reproductive biologists, geneticists, andrologists, urologists, endocrinologists and reproductive researchers, as well as psychologists and sexologists. We need to offer couples a place where all these skills can be brought together, to give them the chance to enter this circuit with a parental project, and to come out with a baby ".
Relieve your guilt
"Infertility is too often seen as a shameful disease, couples who have difficulty conceiving experience it as a failure, and women in particular feel terribly guilty about their difficulties in having a child," testifies Samir Hamamah. To change the way infertility is viewed, the reproductive biologist advocates treating it as an illness, and points out that there are a variety of reasons why couples fail to have children. " In a third of cases, the problem is the woman's, in a third of cases it's the man's, and in the final third it's cofactors that explain the inability to conceive without medical help ".
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