Birth rate and infertility: Ethics void at the CCNE
On 3rd April 2025, the CCNE (National Consultative Ethics Committee) for human sciences and health published a new report on the falling birth rate and fertility. It follows a claim by the Minister in charge of Health and Prevention, asking the Committee to provide recommendations aimed at a “Major plan to combat infertility”.
Indeed, the birth rate is falling in France and infertility is on the increase. Even though the two phenomena are not totally correlated and obey different dynamics, the CCNE has covered them in a joint report.
What has the CCNE discovered?
On the reasons for the falling birth rate?
The CCNE confirms the facts which are not new, and are linked to socio-economic, cultural and societal reasons. It also confirms that the delaying of the age of motherhood is a determining phenomenon in the falling birth rate. At the end of its report, it therefore recommends that “Doctors make their female patients aware of the existence of increased risks of complications or of maternal or infant death with late pregnancies, in particular for primipara pregnancies.“
It also notes the double increase: that of women and couples who wilfully wish to remain “childfree”, and that of those who regret not having any, due to external factors (medical or economic), so-called “childless”.
The CCNE further mentions the changing place of women in society, the lowering of sexuality and the general trend of “voluntary celibacy” (increasing rates of celibacy). In “modern society, relationships are not only less frequent, they are also ever more fragile”[1]
On the rise in infertility?
There also, the CCNE repeats the existing knowledge on the causes of the fall in fertility: life styles, obesity, environmental impact, in particular endocrine disruptors. On that theme, the CCNE recalls the existence of a trans-generational dimension of the problem. Studies have shown a link between exposure to endocrine disruptors during pregnancy and reproductive difficulties in their descendants, due to hereditary epigenetic modifications.
On the limitations of medically assisted procreation (ART)
The CCNE considers that the rise in infertility is due also to the poor results achieved in ART. It recalls that “ART is not a solution for everything: it does not enable all couples and all women to achieve their wanted child”. The committee even considers that “The true results, as provided by the Biomedecine Agency (ABM), should be better relayed to the general public”.
The CCNE states that “the latest figures show the achievement of a19 % median of childbirths following an IVF/ICSI[2]“. In fact, at each attempt, there is an average chance of 1 in 5 to achieve a childbirth… But the information on this statistic is limited and the French public are insufficiently aware of it, as the CCNE further deplores. “The mistaken attribution of virtually magical powers to medicine is followed by a period of painful disillusionment”: trying ART procedures, frequent failures, long waiting times, worry, disappointment, consequences on the sex life and relationships in couples, loss of sex drive, intrusion of the medical technique in the intimacy of their sex life, tensions, narcissistic wounds etc…
Moreover, the CCNE recognises that the conception mode may not be innocuous and recommends that parents should be encouraged to inform their children of their conception mode.
However, these statements do not prevent the authors from concluding on the need to encourage an increase in ART (assisted reproductive technology) activity in order to achieve an effect, even if limited, on the birth rate.
What are the CCNE recommendations?
On the falling birth rate?
The CCNE recognises that the responses to the falling birth rate, currently being experienced in France, are essentially political (in the sense of public policies); its determinants being essentially cultural, as well as economic and social.
The principal recommendation concerns support for infants and the different modes of childcare, at costs which are affordable by parents. But also child benefits, tax alleviations and access to accommodation compatible with parenthood, the improvement of the trade-off between family life and professional duties (family holidays and other support) and the establishment of a better distribution of tasks between men and women.
The CCNE is also appealing for respect for “reproductive autonomy” for people and recalls that it would be unethical to exercise any pressure, even if implicit, by any technique whatsoever and for whatever claimed reasons, on men and women who do not want children, to have them.
Concerning the increase in infertility?
The CCNE is calling for an intensification of the information provided to the general public on fertility, its determinants (eating habits, external factors, endocrine disruptors etc.), its temporality: all the information must be provided positively without any intention to accuse nor to incite women and/or couples to have children. It encourages the avoidance of reverting to injunction to have children as in that of responding without limits to any desire for a child.
It proposes to encourage the development of the PREVENIR (Prevention Environment Reproduction) platforms. These structures are dedicated to the evaluation of environmental exposure of patients being treated for reproductive disorders (fertility problems, pregnancy-linked pathologies, congenital malformations).
It recommends the creation of a “repro-toxic product” logo (presence of pesticides, endocrine disruptors etc.) on consumer products.
Concerning AMP and the health of unborn children
The CCNE is calling for intensification of the information provided to the general public on the self-preservation of oocytes and the different AMP techniques, their successes and their limits: the complexity of the procedures, the non-guaranteed results, the associated suffering.
It recommends providing clear, objective information, and as precise as possible to be delivered to those who wish to become parents whilst resorting to AMP on the uncertainties which subsist, on the risks associated with ART techniques on the health of the child to be, even if the vast majority of AMP children are in good physical and psychological health.
The paradoxes of the CCNE, and its lines which are neither clear, nor durable
On the subject of self-preservation of oocytes
The CCNE recognises the numerous limits, risks, and the pointlessness of the process since less than 10% of women have any real need to subsequently use their preserved oocytes and conceive naturally, as well as the high rate of failure: “There is no absolute guarantee of subsequent pregnancy”. It repeats its statement from 2017, from its report 126: “The proposed self-preservation of oocytes for all young women who so wish in view of a hypothetical future use appears difficult to defend”.
However, after stating these negative aspects, the CCNE wonders: “whether the self-preservation of oocytes should be offered to all women aged 30 or more and who cannot achieve an intended pregnancy due to the lack of a partner or of favourable conditions?”… and balances such suggestion as follows: “However, this proposal appears unrealistic in the current circumstances, in view of the long queues inherent in the rush of applications.”
This is in agreement with the statements by President Macron in Elle magazine, on the subject of “Demographic revival”. He announced “We are going to open private oocyte self-preservation centres. The procedure was previously restricted to hospitals” and the organisation of “Campaigns to promote the self-preservation of oocytes for women who wish to have children later on”.
On the protection of non-marketing of the human body
The CCNE is favourable to the opening of private ART centres, therefore clearly for profit, but claims to wish to protect the non-marketing, and non-contracting of human reproduction … the CCNE even considers the need to demand minimum quotas for self-preservation centres in their activity! Nevertheless, the CCNE recalls that it remains attached to the principles which govern it today, namely: respect for dignity, which means non-patrimoniality of the human body, gratuitous donations in order to guarantee non-marketing, non-contracting of human reproduction … The CCNE appears to have adopted the “as well as” reasoning which is becoming so widespread nowadays…
Moreover, the CCNE recommends further reinforcing information campaigns on sperm donation in an attempt at increasing the number of donors… whereas they have already several times shown their ineffectiveness, despite their exorbitant cost to public funds…
On the subject of resorting to foreign gamete banks
The CCNE recalls the risks involved in legally opening up access to foreign sperm banks but in its Advice omits to maintain its prohibition…
Indeed, according to the CCNE, since ART is now available to single women or female couples, by the use of sperm donations, the CCNE recommends reinforcing the human and material means in the centres to better meet the demand. The committee therefore wonders whether clear access should be granted to foreign sperm banks. Since “such banks already ship to France, orders placed on line by women and since certain doctors accept to use such sperm straws”.
Note the simplicity of the argument… Since “it happens”, let’s allow it…
On the age for resorting to ART
Additionally, the CCNE wonders whether there should be a minimum age to be eligible for ART, in particular for young women, who are not infertile, but no decision has been made.
The difficulty in reasoning in depth on the best interests of the child
Even if the importance of the best interests of the child is recalled on numerous occasions, the subject is not covered generally, whether in this advice or in current society and policies. The CCNE assures that it is not possible to question the different stakes relative to procreation without affording priority attention to the best interests of the child to be. It specifies that although such interests are in effect quite complex, and their appreciation must not be limited to the wishes of those who see them exclusively through their parental project. “In terms of medically assisted procreation for example, it can be divisive to claim that the best interests of the child are necessarily the same as for those who “conceived” the birth project”.
The child’s right to know its origins, although modified through the 2021 bioethics law, remains complex and has not considered the very cause of the problem: namely, access to anonymous gamete donations. Such measures are by definition contrary to the best interests of the child.
On the question of autonomy
On the one hand, the idea of autonomy is fundamental in the text. On the other hand, the limits, risks and failures of ART are clearly stated. However, the CCNE is favourable for all men and women to be able to benefit if they wish to preserve their fertility with no reason other than age (self-preservation of oocytes or sperm). This technique however means that the women and couples have to rely on technology to have children (thus relinquishing their autonomy for procreating alone).
On the question of post-mortem ART
The CCNE begins by recalling that “Giving birth to an orphan child is far from innocuous”. Yet, at the same time, since the law in France now authorises single women to use sperm donations, should such a prohibition be maintained? The CCNE proposes that the matter should be subject to an evaluation during the next bioethics convention.
On the so-called “ROPA” method (receipt of an oocyte from a female partner)
The current law does not authorise this technique, which consists in the donation of an oocyte from a woman to her female partner who then bears the child conceived from that oocyte and an anonymous sperm donation. But, since ART is now possible for female couples and the law recognises two mothers in civil status, why not authorise an umpteenth procreative construction? Here, the CCNE completely omits to mention the major risks of pregnancies when the child shares none of the genetic heritage with its mother.
Finally, although this new advice raises important points, its recommendations show a marked lack of consistency.
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