Getting pregnant is not easy for all women: in France, according to the Report on the causes of infertility submitted to the government in 2022, approximately 1 in 5 couples encounter difficulties in conceiving a child.
“The World Health Organization (WHO) considers that there is a fertility disorder when no pregnancy has occurred after 12 months regular sexual intercourse (2 to 3 times a week with penetration) without contraceptionexplains Dr. Nadia Kazdar, medical biologist specializing in medically assisted procreation (MAP). But this definition depends of course on the age of the woman: this period must be reduced to 6 months for women over 35-36 years old.“
Contrary to popular belief that is still well anchored, fertility disorders are not necessarily to be blamed on the woman. “In 30% of cases, the cause is actually to be found on the woman’s side, but there are also 20% of cases where the problem comes from the man, and 30% from mixed causes!” notes Dr. Nadia Kardar. Finally, in about 20% of cases, there is no identified cause: the medical check-ups do not show any abnormality.
I can’t get pregnant: first, check-ups and additional tests
“If you are unable to conceive a baby after 1 year of trying (or 6 months, depending on your age), see a gynecologist first” advises the doctor. Preferably, make an appointment with a gynecologist specialized in medically assisted procreation (MAP) or in Medically assisted procreation (PMA) – it’s the same thing.
“After a thorough questioning on the couple’s history and lifestyle (do both partners smoke? Are they exposed to toxic substances or endocrine disruptors?), the gynecologist will prescribe a battery of examinations to the man as well as to wife.“
For the woman, it will initially be a question of carrying out a hormonal assessment in the laboratory (blood test) in order in particular to estimate its ovarian reserve. In addition, there will be a pelvic ultrasound (performed intravaginally) in order to “count the number of follicles: this is another marker of ovarian reserve“says the specialist.
For the man, it will be a question of making a spermogram : it is a laboratory sperm analysis that allows to evaluate the concentration of spermatozoa, their mobility, their vitality and the percentage of “normal” spermatozoa, in addition to the volume of sperm and its pH.
To know. After these initial tests, additional examinations may be prescribed by the gynecologist in order to clarify certain abnormalities – examination of the tubes (hysterosalpingography) or pelvic MRI in women, for example, ultrasound of the testicles and/or hormonal assessment in men, assessment genetics (karyotype) in men and/or women…
I can’t get pregnant: the most common (medical) causes
In the woman, fertility problems are often linked to ovulation disorders. “Either there is no ovulation, or it is of poor quality: it may be a question of a polycystic ovary syndrome (PCOS) with absence of regular ovulation, or even premature ovarian failure with women who may have very short cycles which may be a sign of premature aging of the ovaries” develops Dr. Nadia Kazdar.
Another possible cause: tubal infertility. “The woman’s tubes are blocked, which prevents the egg from reaching the fertilization site. This can occur especially after a sexually transmitted infection (chlamydia, for example).“
Finally, the difficulty in getting pregnant can be linked to a endometriosis : this gynecological disease affects about 1 in 10 French women. According to the EndoFrance association, 30% to 40% of women suffering from endometriosis face fertility problems.
In man, “it is often a question of abnormalities in the spermogram, which can be of obstructive origin (sexually transmitted infection, malformation,,,), non-obstructive (genetic, hormonal, etc.) or even environmental (bad lifestyle habits: smoking, cannabis use…)remarks Dr. Nadia Kazdar.
I can’t get pregnant: then, artificial insemination or IVF
“Depending on the case and the woman’s age, the gynecologist may then suggest intrauterine insemination (also called “artificial insemination”) or in vitro fertilization (IVF)“explains Dr. Nadia Kazdar.
I’intrauterine insemination involves giving hormonal treatment (in the form of injections) to the woman during the first part of her cycle in order to stimulate the activity of her ovaries. “Once we have obtained mature follicles, her companion will take a sperm sample (which will be prepared in the laboratory) and the latter will be inseminated into the woman’s uterus.“develops the medical biologist.
There in vitro fertilization can be proposed in particular when the woman has (for example) an obstructed fallopian tube. “Again, it starts with hormonal stimulation for 10-15 days. Then, the mature oocytes are removed, the partner’s sperm is removed, and an embryo is created in vitro. This is then re-implanted into the woman’s uterus after a few days of culture.“explains the specialist.
I can’t get pregnant: the doctor’s advice
- Don’t wait too long to make an appointment with a professional, especially if you’ve been trying to conceive for several months already! “On average and depending on the case, a PMA course can last from 1 to 7-8 yearsremarks Dr. Nadia Kazdar.
- Beware of grandma’s tricks that will only delay your medical care. “For example, there is absolutely no point in doing a handstand after sex: it does not increase the mobility of ejaculated sperm.“
- “There bioethics law of 2021 allows women to freeze their eggs if they have no imminent parental plansnotes the specialist. If you are under 35, consider this solution which can greatly facilitate a PMA course around 38-40 years old. It’s a way to put the odds on your side by freezing time!“
- “Pay attention to endocrine disruptors which are partly responsible for today’s growing fertility problems! Choose eco-labeled household products, choose your cosmetics carefully and pay attention to the plastic particles that can end up in your food (when you heat your coffee in the microwave in a plastic cup, for example): these are good habits which allow you to preserve your oocyte quality as much as possible.”
Thank you to Dr. Nadia Kazdar, medical biologist in Medically Assisted Procreation (Unilabs France).
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