[LUM#4] Fertility at Risk
Is having a baby easy? Not always… More and more couples are having trouble conceiving. When it comes to infertility, reproductive biologist Samir Hamamah has one key message: prevention.
1 in 6. That’s the proportion of couples who are unable to conceive without medical assistance. It’s an alarming figure,“and one that continues to rise,” warns Professor Samir Hamamah, head of the Department of Reproductive Biology at Montpellier University Hospital. According to the specialist, in some cases infertility is directly attributable to our lifestyle. Alcohol, tobacco, drugs? He isn’t referring to these well-known scourges. Rather, he’s pointing to others—as subtle as they are ubiquitous: the chemicals we’re exposed to every day from the moment we’re born… and even long before that. “The fetus is already exposed to these substances in the womb, which can impair the fertility of the unborn child,” explains the director of the Inserm U1203 unit. Endocrine and environmental disruptors, pesticides, and volatile organic compounds—all of these dangerous substances lurk even in the most innocuous everyday products.
“If you put on lipstick, you’re coating yourself with glycol ether; when you heat up a frozen meal in the microwave, you’re ingesting phthalates.” In total, there are more than a hundred molecules toxic to “reproductive health” that we handle every day, often without even knowing it.“Reproductive health is very fragile, ”warns Samir Hamamah. “We must take care of it as early as possible; otherwise, we’ll be paying the price for several generations. We must make infertility a national priority!” For the specialist,it is urgent to implement a genuine prevention strategy:“We must alert young people to the consequences of this exposure and tell them from a very young age that their lifestyle could jeopardize their future plans to have children.”
Prevent
This is especially true given that fertility is also being undermined by changes in our societies. On average, women now have their first child around age 30.“A woman’s age is a major risk factor for infertility because the quality of her oocytes—the female reproductive cells—declines over time.” At age 20, 1 in 2 oocytes carries genetic abnormalities that are sometimes incompatible with pregnancy. At age 40, 9 out of 10 oocytes are non-viable.
How can we overcome this major challenge, given that the age at which women become mothers is steadily increasing? For Samir Hamamah, the answer is clear:“We should encourage all young women who do not yet plan to have children to freeze their eggs so they can use them later if necessary.” If they ever have trouble getting pregnant, they can use these “young” eggs for in vitro fertilization, thereby maximizing their chances of having a baby. For the specialist, this “fertility preservation through freezing” is a real necessity.“Today in France, women of childbearing age do not have this option, whereas men can take advantage of it if they wish,” the doctor explains.
3D Technology to the Rescue of Fertility
This is especially true given that the success rate of assisted reproductive technologies remains relatively low, with only 20% of IVF cycles resulting in a successful pregnancy. In this field, Samir Hamamah’s team has been responsible for considerable progress. The latest breakthrough—and a world first—is Embryoscan, a three-dimensional modeling technique for embryos designed to increase the success rate of IVF.“To perform IVF, several oocytes are retrieved from the prospective mother and fertilized with sperm. On average, five embryos are obtained, but they are not all of equal quality,” explains Samir Hamamah.
How do we choose which one will be implanted in the future mother’s uterus? That’s where 3D technology comes in.“We scan the embryo from all angles, and then software reconstructs a three-dimensional image that is subsequently produced using a 3D printer.” The result: the physician can examine the embryo from every angle to detect any defects that would make pregnancy impossible. These are details that aren’t visible under a 2D microscope.“It’s a revolutionary, non-invasive process for improving embryo selection while fully adhering to ethical guidelines,” says Samir Hamamah.
The reproductive biologist now has another major goal: to establish an institute in Montpellier dedicated to human fertility.“Infertility requires a multidisciplinary approach involving gynecologists, reproductive biologists, geneticists, andrologists, urologists, endocrinologists, and reproductive researchers, as well as psychologists and sexologists. We need to provide couples with a place where all these expertise are brought together, giving them the chance to enter this process with a plan to start a family and come out of it with a baby.”
To relieve guilt
“Infertility is all too often viewed as a shameful condition; couples who struggle to conceive see it as a failure, and women in particular feel terrible guilt over their difficulties in having a child,” says Samir Hamamah. To change perceptions of infertility, the reproductive biologist advocates for it to be recognized as a medical condition and points out that there are various reasons why a couple may be unable to conceive.“In one-third of cases, the problem lies with the woman; in another third, it lies with the man; and in the remaining third, it is due to cofactors that explain the inability to conceive without medical assistance.”
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