There is this unfeigned embarrassment to talk about it. In a low voice, eyes lowered, Souleymane unfolds his story of an infertile man with difficulty. He is 36 years old, including eight years of marriage. “People make fun of me and my wife because we don’t have children,” he said. We first thought that the problem came from her. But she doesn’t suffer from anything. Then I thought I had to get tested. The result comes in: bilateral varicocele. An often asymptomatic pathology that causes dilation of the veins in the spermatic cord, the channel that connects the testicles to the urethra.
“Souleymane’s case is no longer isolated,” notes Racine Kane, a Senegalese urologist trained at the Val de Grâce hospital in Paris, who received him that day for consultation in his Dakar office. 75% of my consultations in town now concern male infertility problems. I see a lot of men under 30 who suffer from testicles that are non-functioning or produce little or no sperm. »
For these young patients, infertility is all the more difficult to accept as it is traditionally associated with women. “When asked to do a spermogram, many refuse. They will first marry a second or a third wife before accepting that the problem comes from them”, observes the urologist. In Senegal, infertility is confused with impotence. Of a man who has no children, they say he is not a real man. Some of my patients in great pain have needed psychological support. »
This reluctance delays medical care, often slowed down by years of care from traditional healers. For them, infertility is a lucrative market. For distraught couples, they offer affordable rates even for the less well-off and consultations without waiting times. “My wife pushed me to meet a traditional healer after a few years of marriage. He assured me that he could treat me and that no operation was necessary. “But, for lack of results, Souleymane ended up having surgery on both testicles. An operation that cost 560,000 CFA francs (853 euros) to this employee of a construction company.
Pollution, stress, tobacco and alcohol
Of her husband’s infertility, Estelle* now speaks with a laugh. “I called him ‘Mr. 1%’ because only 1% of his sperm were viable. They were generally slow and poorly formed,” she laughs between feedings. An extreme case that pushed the couple to follow a medically assisted procreation program (PMA). At each attempt, Estelle faced physical pain in her lower abdomen caused by the hormone injections. Her body suffered a major weight gain and her face became covered in acne. Cost of the two in vitro fertilizations, treatment and hospitalization included: 15,200 euros. “We put all our savings into it and our standard of living suddenly dropped, which surprised our relatives from whom we hid our problem. We were the only ones to carry this burden. »
After two failures, the couple resigns. Estelle rummages on the Net, digs up improbable recipes to “help” her husband. “I was putting ice on his testicles to cool his sperm, because it was one of the symptoms of his pathology. I also made him drink potions of cola nuts, coffee, juice. In short, I tried everything. »
For his part, her husband drastically changes his lifestyle. Stop alcohol and tobacco. Then, one evening in December 2021, the umpteenth pregnancy test of the year draws a small cross. Estelle got pregnant naturally. Eight months later, in July 2022, she gives birth to their child. “Our doctor is convinced that my husband’s new lifestyle has contributed to this pregnancy. This opinion is in line with recent studies according to which male infertility results, in addition to untreated sexually transmitted infections, from environmental factors, such as pollution, stress and the consumption of alcohol or tobacco.
The quality of male semen has also plummeted all over the world in recent decades. Thus, the average concentration of gametes in sperm has fallen from 101 million per milliliter (M/ml) in 1973 to 49 M/ml in 2018 according to work published in November 2022. And the trend could well accelerate.
Form of adultery
It is in this worrying context that the PMA is discreetly establishing itself on the African continent. Several centers have opened in recent years in major cities. But the practice remains reserved for the wealthiest, due to a lack of commitment from the public authorities and international donors.
“Faced with malaria, maternal and infant mortality or food insecurity that still kills, infertility is considered a luxury by our States. Donors are wondering why they should help Africans have more children when they are struggling to feed the living”, regrets Doctor Djédi Kaba Diakité, pioneer of PMA in West Africa, at the head of one of the few fertility clinics in Mali.
Difficulties are all the greater in Senegal as the donation of sperm, apart from that of the spouse, remains prohibited for religious reasons. This is likened to a form of adultery. Moreover, the option of adoption also arouses strong reluctance from couples. “When all avenues are exhausted, we offer them to adopt but the refusal is categorical. There is the idea that filiation is not respected, ”regrets obstetrician-gynecologist Rokhaya Ba Thiam.
