Global fertility rates have been falling since the 1970s and are expected to drop below the replacement level by the mid-2050s. This is driven not just by social changes, but also by an increase in fertility issues across the globe. In this context, fertility has become a matter of national importance, rather than a problem for individuals or couples to manage – it affects demographic trends, economic outlook and healthcare priorities.
 
Certainly, the field of fertility treatment is rapidly expanding, with new technologies and approaches arriving every year – but there is still much to be done. Eugénie Vellieux, CEO and Co-Founder of HoliYou, discusses the current landscape and how her company seeks to help.

Fertility in the 21st century

According to the World Health Organization, one in six people will experience infertility in their lifetime – and it affects men and women equally.

There are a number of factors at play here. Both male and female fertility are affected by environmental influences like atmospheric pollutants and pesticides, as well as by lifestyle choices like smoking and diet. But the biological drivers of male and female fertility are different. In men, fertility is linked to the quality of sperm and the ability to create sperm. In women, by contrast, there’s a wider range of variables, including problems with the womb, fallopian tubes and ovaries that can result from common conditions like endometriosis and polycystic ovary syndrome. And, unlike men, women can’t produce any more reproductive cells – a baby girl builds her entire ovarian reserve in her mother’s womb, and she is born with all the eggs she’s going to have.

This ties into social factors. More and more people are opting to have children later in life, as they want to focus on their careers or their studies, or else make sure they’ve found the right partner to settle down with – often people seek stability in their personal and professional lives, which is itself linked to economic stability, before starting a family. As such, although the optimum age for a woman to conceive a child is between 25 and 29 years old, first-time parents often exceed this age bracket in the Western world. Indeed, according to Eurostat data from 2019, women in Switzerland on average have their first child at 31 – and this is only set to rise. Because of this, we often need some help to conceive.

Varied treatment options – but women nearly always carry the burden

I want to stress that infertility is not a women’s health issue, although people often put it in this box. That’s primarily because the female partner generally carries the burden of treatment – even when the issue lies with her male partner. As things stand, there is no treatment for male infertility, aside from taking vitamin supplements, which are supposed to improve the quality of sperm (though this has not been medically proven). More research is needed on this moving forward.

For women, however, there are a number of options, which range from less to more invasive and/or interventionist. Generally, you start with artificial insemination, which is on the lower end of the scale as you don’t have to take as many hormones. Then, moving up a level, you have in vitro fertilisation (IVF), using either sperm and an egg taken from the couple in question, or a donor egg and/or donor sperm. The egg is fertilised with sperm in a laboratory and returned to the female partner’s womb to grow and develop. You can go a level beyond this with intracytoplasmic sperm injection (ICSI), where the body of the egg is injected with sperm in a controlled lab setting before being implanted in the womb. Both options put strain on the female body, requiring hormone injections, internal examinations and specialist medical procedures.

Science is constantly advancing, so doctors can also analyse the DNA of the embryo before implantation to assess whether the pregnancy is viable. Or rather, doctors can do this under specific conditions in certain countries, including Switzerland and Spain; others don’t allow it due to ethical concerns. Certainly, we must be mindful of these ethical questions, but I see this as a positive step forward: analysing the embryo’s DNA can prevent women from undergoing more invasive treatments, with hormones and the like, if it’s clear that the embryo is not going to develop.

Barriers to treatment

On this note, regulation – and subsidisation – of treatment involving assisted reproductive technology (ART) really varies across Europe (and the world). What kind of treatment you can get, how many rounds and how much it costs is wildly different depending on the country – which leads to treatment tourism. We have seen a lot of same-sex female couples from Switzerland going to have IVF in Denmark or Spain, for example, because in those nations, all personal information related to the sperm donor can be retracted.

But then you have to weigh this up against cost. In France, for example, IVF is reimbursed by the state in full, as long as the couple (or single woman) meets certain criteria (such as being under 45 years of age). Surrogacy, however, remains illegal, which means that gay men cannot access much in the way of fertility treatment.

By contrast, in Switzerland, IVF treatment is 100% at the cost of the couple. And one round of IVF can range from CHF 7,000 to 30,000, depending on whether you opt for additional tests, never mind the cost of medication and further integrative medicine practices. It’s difficult to know at the start of the process how much it’s going to cost – either way, the financial burden of the IVF journey is huge.

With this in mind, there’s a lot riding on each IVF cycle, which puts an additional mental and emotional load on the couple or individual. Ironically, this makes it more difficult to conceive. According to several scientific studies, women undergoing fertility treatment generally feel high levels of stress, but this stress makes it up to 30% less likely that they will get pregnant.

Dismantling the taboo around ART and moving towards an empowered, holistic approach

We need to open up the conversation and challenge our assumptions around fertility. Many couples assume 1) that they’ll easily be able to conceive naturally and/or 2) that with ART, such as IVF, they’ll conceive quickly. But in reality, most couples who need ART undergo between three and five years of treatment before conceiving a child and, of these, 30% don’t conceive at all during this time. As a renowned fertility scientist told me when I went through fertility treatment myself, there is always an element of luck inherent in these procedures.

This is exactly why I set up HoliYou: we try to get luck on your side and give you the best possible chance of success (as symbolised by the lucky clover that we use in our logo). Trying to conceive via ART can be a very long, draining and disempowering process, made even worse by (misplaced) shame and stigma. But the whole idea behind HoliYou, the first personalised self-care app dedicated to those attempting to conceive via ART, is to put the power back in the hands of the couple or individual undergoing treatment. The app allows you to track your protocols, manage your appointments, access personalised advice and educational content and sign up for holistic sessions, such as yoga, meditation and hypnosis. All of this helps you to feel more confident, manage stress and therefore improve the outcome of treatment. After all, bringing the mind and body into alignment – a key tenet of integrative medicine – has been proven to increase not only wellbeing but also medical prognosis.

Admittedly, we still have a way to go before launching HoliYou. We’ve been working closely with three fertility clinics – in France, Spain and Switzerland – for the past year, incorporating feedback from both practitioners and patients. I don’t want to compromise on performance – it’s crucial that we develop the right tool to serve the needs of our users. All being well, I hope to roll our services out in October 2024, first in France and French-speaking countries in Europe. I believe that we can make a real difference to people going through this process, alongside other fertility tech and femtech companies working in this space, many of which are also led by and for women.

HoliYou has taken me on the most wonderful adventure – it has transformed my life. Having struggled to conceive myself, I have learned so much from my work with amazing doctors, midwives and biomedical scientists. I am now committed to helping other women and couples on their fertility journeys.