The High Authority of Health Publishes Groundbreaking Recommendations on Pre-conception Health and Fertility

The High Authority of Health (HAS) has taken a significant step forward in addressing reproductive health in France by jointly releasing the first two parts of its comprehensive recommendation on pre-conception health on July 17, 2026. This initiative, stemming from a request by the Directorate General for Health, aligns with the broader national strategy to combat infertility, first announced in 2024. The HAS underscores that "parenthood is a fundamental and universal right of the human being," emphasizing the importance of considering the "diversity of individuals and couples concerned."

This landmark publication aims to provide healthcare professionals with evidence-based guidelines to improve the quality of care for individuals and couples seeking to conceive. The recommendations are divided into distinct but interconnected parts, with the initial releases focusing on foundational aspects of reproductive well-being and the initial steps in investigating infertility.

Understanding the Two Pillars: Fertility and Global Health, and First-Line Infertility Assessment

The first component, titled "Fertility and Global Health," meticulously outlines how reproductive health should be integrated into routine consultations. This section emphasizes a proactive approach, encouraging healthcare providers to initiate conversations about reproductive intentions with all individuals of reproductive age. The HAS advocates for the use of a simple, yet powerful, key question: "Do you think you might want children at some point?" This seemingly straightforward inquiry serves as a crucial gateway, opening the door for further discussion and tailored support.

Crucially, the HAS clarifies that within the scope of a "Fertility and Global Health" consultation, "no examination is required." This stance applies regardless of whether the examination would be clinical, gynecological, andrological, involve medical biology, or medical imaging. The emphasis here is on dialogue, education, and risk assessment, rather than immediate diagnostic procedures. The goal is to empower individuals with knowledge about their reproductive health, potential influencing factors, and how to optimize their well-being prior to conception.

The second part of the recommendation addresses "Infertility and First-Line Assessment." This section delves into the diagnostic and management pathways for couples experiencing difficulties in conceiving. It provides clear definitions and outlines the essential steps for primary care physicians and midwives to undertake when a couple presents with concerns about infertility. The HAS stresses that the exploration of infertility should be initiated within primary care settings, emphasizing early detection and intervention by general practitioners and midwives before referral to specialized reproductive medicine practitioners or teams.

A third volume, dedicated to the specific content of the pre-conception consultation itself, is currently under development and will be released at a later date. This forthcoming publication is expected to further detail the practical implementation of pre-conception care, providing a more granular guide for healthcare professionals.

Defining Infertility and the Importance of a Dual Approach

For the purposes of these recommendations, infertility is defined as "the absence of pregnancy after 12 months of regular, unprotected sexual intercourse, ensuring that intercourse has occurred during the period when the woman is expected to be most fertile." This definition aligns with international standards and provides a clear benchmark for initiating investigations.

A pivotal aspect of the HAS’s recommendations on infertility is the unequivocal insistence that the assessment must involve "both partners." This is based on the understanding that infertility can originate from male factors, female factors, or a combination of both. The publication explicitly states that the investigation "concerns both partners, because infertility can have a male cause, a female cause, or both." This holistic approach is critical for accurate diagnosis and effective treatment.

The exploration of infertility is to be initiated by primary care physicians and midwives, who are tasked with early identification and referral. This strategy aims to streamline the diagnostic process, reduce potential delays, and ensure that couples receive appropriate guidance without undue waiting periods.

Key Components of the Initial Fertility Assessment

The HAS outlines that the initial consultation for suspected infertility involves a detailed interview with each partner. These interviews are designed to gather comprehensive information that can inform the diagnostic process. The areas explored include:

• Couple’s History: Understanding the dynamics and journey of the couple.
• Individual Medical and Surgical History: Identifying any pre-existing conditions or past interventions that might impact fertility.
• Frequency and Context of Sexual Intercourse: Assessing the regularity and timing of intercourse in relation to the woman’s fertile window.
• Behaviors and Factors Potentially Affecting Fertility: Discussing lifestyle choices, environmental exposures, and other elements that could influence reproductive capacity.

Following these interviews, personalized advice and guidance are provided to the couple.

Specific Investigations for Each Partner

The recommendations detail specific examinations for both men and women when infertility is suspected.

For men, the primary recommended examination is the spermogram. This analysis assesses the quantity, motility, and morphology of sperm, providing crucial insights into male reproductive potential. The HAS emphasizes the importance of this test as the initial step in the male fertility workup.

For women, the recommended examinations, as illustrated by the HAS decision tree, include:

• Gynecological Examination: A clinical assessment to evaluate the reproductive organs.
• Transvaginal Ultrasound: An imaging technique to visualize the uterus, ovaries, and fallopian tubes, identifying potential structural abnormalities.
• Hormonal Assessment: Blood tests to measure key reproductive hormones, such as follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, and progesterone, to assess ovarian function and ovulation.
• Chlamydial Screening: Testing for Chlamydia infection, as this sexually transmitted infection can lead to tubal damage and infertility.

The Crucial Role of Communication: Announcing Results

A significant emphasis is placed on the manner in which results are communicated to couples. The HAS strongly recommends that "results are ideally announced in the presence of both partners." This approach acknowledges the emotional and psychological impact of infertility investigations and ensures that both individuals are informed and can discuss the findings together. This shared experience can foster mutual support and facilitate joint decision-making regarding subsequent steps.

Background and Context: A National Commitment to Reproductive Health

The release of these recommendations is not an isolated event but part of a larger, concerted effort by the French government to prioritize reproductive health and address the growing concern of infertility. The "Plan national de lutte contre l’infertilité" (National Plan to Combat Infertility), announced in 2024, signaled a significant commitment to improving access to care, funding research, and raising public awareness.

The increasing prevalence of infertility, affecting an estimated 15% of couples of reproductive age in developed countries, has become a major public health issue. Factors contributing to this trend are multifaceted, including delayed childbearing, lifestyle choices, environmental factors, and a rise in certain medical conditions. France, like many other nations, has witnessed a gradual decline in its birth rate, making fertility a key area of focus for demographic and societal well-being.

The HAS, as the independent public health authority responsible for evaluating health products and services and developing guidelines, plays a crucial role in shaping clinical practice. Its recommendations are based on rigorous scientific evidence and are intended to standardize and improve the quality of care provided across the healthcare system. The collaborative nature of this publication, involving the Directorate General for Health, underscores the coordinated approach to tackling this complex issue.

Analysis of Implications: Towards Enhanced Patient-Centered Care

The implications of these HAS recommendations are far-reaching. Firstly, they promote a shift towards more proactive and preventative reproductive healthcare. By encouraging early discussions about conception, the HAS aims to empower individuals to make informed choices and optimize their health before pregnancy. This preventative approach has the potential to reduce the incidence of infertility-related issues and improve pregnancy outcomes.

Secondly, the clear guidelines for infertility assessment, particularly the emphasis on a comprehensive evaluation of both partners, are expected to lead to more accurate diagnoses and effective treatment plans. By standardizing the first-line approach, the HAS aims to reduce diagnostic delays and ensure that couples receive timely access to specialized care when needed.

Thirdly, the explicit recommendation for joint consultation and result disclosure underscores a commitment to patient-centered care. Infertility can be a deeply distressing experience, and supporting couples as a unit is crucial for their emotional well-being and their ability to navigate the challenges ahead.

Finally, the ongoing development of the third volume on the pre-conception consultation signals a commitment to continuous improvement and adaptation of reproductive health services. This suggests a long-term vision for integrating pre-conception care as a routine and essential component of healthcare.

Looking Ahead: A Comprehensive Framework for Reproductive Well-being

The joint publication of these two key components of the HAS’s recommendation on pre-conception health marks a significant milestone in France’s commitment to reproductive well-being. By providing clear, evidence-based guidance for healthcare professionals, these recommendations aim to enhance the quality of care, promote proactive health behaviors, and offer better support for individuals and couples facing fertility challenges. As the third volume is released, a more complete picture of this comprehensive framework for reproductive health will emerge, further solidifying France’s position as a leader in this critical area of public health. The ultimate goal is to ensure that the journey towards parenthood is as informed, supported, and successful as possible for all.