- When we talk about PMA, the eyes often turn to the woman, however in half of the cases, it is the man who is in question.
- Unfortunately, out of fear or lack of information, some men discover late that they will have difficulty procreating.
- But this woman-centered care is beginning to evolve.
And if it was him ? While one in seven couples in France has difficulty having a child, a big taboo sometimes delays or complicates the already difficult course of PMA, that surrounding male infertility. Denial or lack of information, many men do not feel concerned when talking about infertility. Yet studies show that contrary to prejudice, for 50% of couples in LDCs, it is the man who is the source of the couple's difficulties in conceiving.
"Many don't think about the guy dimension"
When Elodie * launched out with her companion, Nicolas, in the great adventure of parenthood at 40, she thought that all the lights were on. “I had a very high ovarian reserve, monitored regularly since I was 30 years old. What is crazy is that I never wondered if he was wrong ... ”And the doctors did not help her to question either. After two years of testing, the couple consults. And quickly discovers that Nicolas is sterile. “We are so put in mind the ticking of the biological clock that many women do not think about the guy dimension. Especially since men do not see a urologist regularly, unlike women followed by a gynecologist. "
For her, this taboo manifests itself in the embarrassed looks of friends when her companion talks about her sterility and in the looks of the doctors who target her. "Often, men have the impression of being transparent during medical consultations," adds Virginie Rio, co-founder of the Bamp collective, which supports people on PMA courses. "There is sexism on both sides: women are the designated culprits and men are poorly detected and poorly supported, they are more rarely offered psychological counseling than women, for example," concludes Elodie.
Why this taboo?
A taboo that has several explanations. For some men who already find it difficult to talk about their difficulties in life, detailing the poor quality of their sperm sounds like an admission of failure. “Quite a few men confuse virility and fertility, when it has nothing to do with it, says Marika Donadieu-Mallion, a doctor specializing in fertility. Some people refuse to make a spermogram or consider that it cannot come from them. "When we talk to them about abnormal spermograms, they have the impression that it makes them weak, that we talk about erectile dysfunction," adds Charlotte Methorst urologist at Foch hospital (Hauts-de-Seine). They are afraid to talk about it and to be stigmatized. "
If many of these men are silent about their sadness, it is often because they feel guilty. "Many of the members of the collective explain that they feel guilty because they" impose "treatments on their wives," adds Virginie Rio. Indeed, during IVF, even when the patient has no problem, it is she who will undergo hormone injections, blood tests, medical appointments, punctures and other joys ...
Another explanation, research side this time, "IVF with intracytoplasmic micro-injection (ICSI) revolutionized medical assistance in reproduction in the 1990s, because it suffices to inject a single sperm into the oocyte," reveals François Olivennes , gynecologist specializing in fertility. But this quick fix has put a stop to research on male infertility. "
Recent developments
Gradually, the veil is lifted on this question. "We have been interested in infertility in women for decades, but interest in men is much more recent, but exponential in publications," says Rachel Lévy, head of the reproductive biology of the Tenon hospital in Paris. Following in the footsteps of research, doctors are refining care. “For years, we treated women and not men, regrets François Olivennes. Fortunately, today, a male assessment is almost systematically prescribed in the course of PMA. "And the change would not come only from the medical profession ..." Overall, I have the impression that young men have less trouble talking about infertility ", nuance Virginie Rio, from the Bamp collective.
A drastic drop in sperm
So much the better, because the shortage of sperm is not a fantasy. A study published in Human Reproduction revealed in 2017 that the number of sperms decreased on average by half between 1973 and 2011, in the United States, Europe, Australia and New Zealand. It remains to be seen how to combat this vertiginous fall ... The causes are not clearly established, but the evolution of our lifestyle (at random tobacco, alcohol, sedentary lifestyle, obesity, junk food ....) and our environment (pollution, endocrine disruptors, stress, phone waves ...) regularly returns to the carpet. Hence the interest in breaking down this taboo to improve prevention.
"When there was military service, some men with testicular pathologies were detected very early," said Charlotte Methorst, urologist. But this is only a whole part of male infertility. Today, when we go to colleges to talk about sexuality, perhaps we should insist on the fact that tobacco, cannabis and alcohol are extremely harmful for spermatogenesis which takes place during adolescence. "
* First names have been changed.
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