French women turning to infertility treatment at increasingly older ages
One couple in four in France cannot conceive after twelve months trying. Even in cases of male infertility, women are the ones treated. But in what proportions? Using data from the French national health insurance system now available to researchers, Khaoula Ben Messaoud, who has just defended her doctoral thesis, INED researcher Elise de La Rochebrochard, and INSERM epidemiologist Jean Bouyer were able to measure annual infertility treatment use in France. This is the first estimate in the world to take into account all types of infertility treatment for such a large population. Annually, from 2008 to 2017, 1.25% of women aged 20 to 49 in France were treated for infertility (over 150,000 women a year). In the last decade, women turned to infertility treatment at increasingly older ages: the above-cited rate increased by 24% among women aged 34 or over.
More than one women in ten in the French population is treated for infertility every year
Until now, use of infertility treatment throughout France was not well-known. Several medical treatments are used to help women conceive: ovulation induction, assisted reproductive technology (ART), and in-vitro fertilization with or without intra-cytoplasmic sperm injection (ICSI). We now know that every year from 2008 to 2017, 1.25% of women aged 20-49 were treated for infertility in France, or over 150,000 women per year. This unique study was possible because all cases of infertility treatment in France are covered by national health insurance and are therefore recorded in the system’s databases, and this information is now accessible to researchers. The study takes into account all types of infertility treatments: ART procedures, of course, but also ovulation induction, the first-line treatment and one we knew very little about. Moreover, thanks to how well the French health insurance system covers the population, these data enable us to measure long-term trends in infertility treatment use at very large scale.
Infertility treatment among women aged 34 or over has risen 24%
The rate of infertility treatment use by age over the last decade in France (Figure) shows two developments that would appear to be in opposite directions. Young women’s use of infertility treatment remained stable, albeit with a slight dip (Figure: the 2017 curve falls below the 2008 curve), whereas use by women age 34 or over jumped 24% in the same period (Figure: the 2017 curve is much higher than the 2008 curve). These observations are nonetheless entirely consistent with each other; they both reflect the fact that people in developed countries are becoming parents increasingly later in life, a trend that began in the early 1970s. Fewer young women try to have children and infertility at those ages is relatively infrequent so the effect of using it is low. Meanwhile, women over 34 try more frequently to have children and infertility rises sharply at those ages, accounting for the sharp increase (24%) in their use of infertility treatment.
Use of infertility treatment by women’s age in France in 2008 and 2017
Reading: The figure shows the trend in infertility treatment use by age of women in France in 2008 and 2017. Over that decade, the bell curve rose among women aged 34 or over.
An important public health issue
The observed increase in infertility treatment after age 34 raises important questions because treatment effectiveness falls sharply with age. The medical corps and public authorities should take into account this societal trend and its effects over the long term in order to better accompany couples seeking to conceive. If there was a system for monitoring infertility treatment use, public health policymakers could better orient national strategies for preventing and treating infertility, a health problem that looks increasingly serious in adulthood.
A Conseil d’État decree of 2016 (deliberation 2016-315 of October 13, 2016) granted INED permanent access to national health insurance data in conjunction with the Institute’s research mission. The present study was conducted using a “generalist sample of beneficiaries” (EGB): an extremely large sample representative of the general population that was set up in 2005 and covers 1% of all persons affiliated with the French health insurance system. It therefore covered women aged 20 to 49 over the period 2008-2017—more than 100,000 women in the sample per year. For each year of the period, women were defined as having received infertility treatment if they had been reimbursed for at least one infertility medication or procedure in the course of the year.
Khaoula Ben Messaoud, Jean Bouyer et Elise de La Rochebrochard, 2020, "Infertility Treatment in France, 2008–2017: A Challenge of Growing Treatment Needs at Older Ages", American Journal of Public Health 110: 1418-1420. Article librement accessible : doi.org/10.2105/AJPH.2020.305781
Online: January 2021