Male Infertility in Nigeria and South Africa: A Ten-Year Observational Study

Abstract

Abstract Background: Male infertility is a disease of public health relevance contributing to 50% of infertility cases globally. However, there is dearth of information on the prevalence of male-factor infertility in Sub-Saharan countries. Therefore, in this study we aimed at identifying the prevalence, and trends of male factor infertility in Nigeria and South Africa over a period of ten years between 2010 and 2019. Methods:A retrospective study of semen analyses of 17,292 men attending fertility hospitals in Nigeria and South Africa in 2010, 2015 and 2019. Patients who had undergone vasectomy and those who had a pH less than 5 or greater than 10 were excluded from this study. The following variables were assessed: ejaculate volume, sperm concentration, progressive motility, total progressively motile sperm count (TPMSC), total sperm count, and normal sperm morphology Results: Between 2010 and 2019, significant trends of decreasing values were observed in normal sperm morphology (-50%), progressive motility (-89%), TPMSC (-91%) and the ejaculatory volume (-7%), indicating a progressive deterioration of the values in both countries. In Nigeria, there were significant decreases in progressive motility (-87%), TPMSC (-78%), and sperm morphology (-50%) between 2015-2019 (p<0.0001). Spearman`s rank correlation revealed significant negative associations between age and morphology (ρ = -0.24, p<0.0001), progressive motility (ρ= - 0.31. p<0.0001), and TPMSC (ρ = -0.32, p<0.0001). Patients in South Africa were younger than those from Nigeria, with also a significantly higher sperm morphology, sperm concentration, progressive motility, total sperm count and TPMSC. Conclusion: Our findings provide a quantitative evidence of an alarming decreasing trend in semen parameters in Nigeria and South Africa from 2010 to 2019. It also proves that astheno- and teratozoospermia are the leading causes of male infertility in these regions. In addition to this, it also shows empirically that semen parameters decrease with advancement in age. These findings are the first report on male-factor infertility prevalence in Sub-Saharan countries, necessitating a thorough investigation on the underlying factors promoting this worrisome decline.