Infertility: The Other Side Of the Story in Pakistan

Karachi: Sitting on a bench, legs crossed, fingers of his right hand tightly intertwined with that of left one, Asfandyar Saleem* frequently frowns while explaining that as per his medical reports he has fertility issues, which he claims is not true. His speech is interrupted by small pauses as he shares his story. 

“This is the 10th year of my childless marriage, my wife has been visiting different doctors for treatment since last 8 years but it has been of no use. She has talked to me about visiting a doctor every time she had an appointment and [each time] I told her that she is the one responsible for our unhappy life, not me,” he said. 

Saleem secretly went for a test and found out that his sperm count is below 10 million while the normal range for sperm count is 20 million to 300 million per milliliter. He is yet to accept this result. “My father has always told me that Punjab is a fertile land and so are the men here. I believe that the test results were wrong because the doctor wanted to make some money. You know these treatments are expensive and it is easier to make more money if they put the blame on men. It is really easy for them to give medicines and then ask for tests every month which has zero results. This happened with my friend too and I believe that they are playing the same games with me,” he said.

 When asked about why he never told his wife about these reports he said, “First of all I don’t believe in any such thing like male infertility. Woman is responsible for giving birth to a child so how can a man be responsible for this and secondly, you cannot really give any such point of humiliation to your wife because then they won’t obey you at all. The only reason we are not blessed is because my wife does not offer Namaz regularly and Allah is punishing her for disobeying Him. I have planned to marry a pious woman now because I know I will have a child if my wife offers her prayers regularly.”

Dr Nusrat Rehman, who is a Women Medical Officer (WMO) at Tehsil Headquarter Hospital Chowk Sarwar Shaheed and has been working as a gynecologist since last 22 years, argues that she encounters such cases every day in her practice. “Men usually don’t accept that there is any issue in them. Social pressure is usually on females and they are the ones who suffer the most. Husbands of most patients don’t even bother to accompany them during their visit and even if we force them to bring their partners for consultation and tests, it is of no use. Only one in 100 men bother to visit us and go through proper checkup and medication. Others simply refuse and usually go for second marriage if their wife is unable to give them a child,” she said. It frustrates her when all her efforts go in vain just because male partners don’t agree to undergo tests and even if they somehow agree to it and reports don’t go in their favour then either they reject it completely or go for treatment from Hakeems instead of proper medical treatment.

Kashaf Mansoor, a student of MPhil in social sciences, has been married since 7 years and is unable to conceive. “I started visiting doctors after 2 years of my marriage [and] all reports were normal. It was really hard for me to convince my husband that he should go for tests too. He finally agreed after almost one year and findings were not in his favour. He didn’t agree for any treatment and since past two years he is suffering from erectile dysfunction as well. I even tried to convince him for IVF (In vitro Fertilization) treatment but it was of no use. The burden of infertility in the eyes of society is on me and this sexless life has led to depression,” she said. She is unable to focus on her studies and goes for psychiatric treatment every month because her anxiety attacks are increasing day by day. She thought of divorce once but her family never supported this decision and now she has no option other than to live with her husband in same condition forever.

In case of male infertility, health care providers might suggest semen analysis to determine the number and quality of sperm, blood test to check infections or hormone problems or physical examination of penis, scrotum, and prostate to assess male infertility. Treatment options include semen production supplements, artificial insemination, In-vitro Fertilization (IVF) and in case of zero sperm count “donor sperm” can be used too.

However, the treatment for male infertility can be quite costly. Usually it falls within the bracket of 30,000 rupees to 10 lacs and at times it even exceeds this range.  

Some of the common causes of male infertility are Varicocele, a swelling of the veins that drain the testicle, infection, ejaculation issues due to diabetes, injury, surgery, antibodies that attack sperms, undescended testicles, hormone imbalances, chromosome defects and certain medications like long term anabolic steroid use. Routine life habits and issues like emotional stress, depression, obesity, drug and alcohol use can also lead to infertility in men.

Dr Khaleeq, an Andro-urologist from Lahore, is a surgeon and usually treats surgical disorders associated with male infertility. He argues that patients who approach him for treatment are the ones who have already accepted their infertility issues and need counseling for their surgery only. “It doesn’t matter whether they are educated or not, 99 percent of patients who visit me for their surgeries have already gone through the process of initial diagnosis and treatment. This makes my task easier as I have to counsel them regarding their surgeries only and don’t have to face any ego or stigma issues from their side,” he said. He further added that trends are changing and due to increasing awareness more people are coming for treatment as compared to last twenty years.

Nina Kumar and Anit Kant Singh suggest in their research article “Trends of male factor infertility, an important cause of infertility: A review of literature”, published in Journal of Human Reproductive Sciences, that more research should be conducted on male infertility in order to dig out the causes and cures as well as to reduce the stigma surrounding this issue.

 Scientists worldwide believe that there is a lot more to be explored regarding this issue and now the world needs to focus on men regarding infertility issues instead of women for better results and treatment options, which currently are more women oriented.

*Name has been changed to maintain confidentiality