Fraeeha never had an issue with her blood pressure in her 27 years of life, but things changed after she got married. She has been married for a year and it was her parent’s choice with whom she’ll spend the rest of her life.

She always visited a homeopathic doctor for any medical issues before her marriage and continued to do so till the physician told her to get her husband tested for infertility issue. Her husband got tested in June 2023 and that’s when everything changed for her.

Faizan’s sperm count was low, so the doctor recommended they take medicines. Even before a month passed, her periods got delayed. “I took the test, it was negative. There was nothing in the ultrasound, but the doctor still gave me medicines for growth,” she said while lamenting how this made her hypertensive and she never recovered from it. She was taken to the emergency room in a nearby hospital as her blood pressure was high. She fainted once she reached there.

As much as medical science has advanced, there is still a lot to be researched and taken into consideration regarding women’s bodies and the impact of different medications on them. Her husband ordered her not to tell anyone about his fertility issues and Fareeha was the one who took the brunt of its impact. She and her brother got married in the same month. When the other couple got pregnant within a month, everyone started asking her why she wasn’t pregnant yet.

Male infertility is characterized by a man’s inability to initiate a pregnancy with his female partner. Various factors can contribute to male infertility, such as insufficient sperm production or the presence of unhealthy sperm. Genetic issues, like cystic fibrosis, or a blockage in the genital tract, may also be underlying causes.

Certain predisposing factors, such as a history of genital infections, testicular injuries, or experiencing early or late puberty, may increase the likelihood of male infertility.

Treatment strategies are tailored to address the specific cause of infertility. Options may include artificial insemination, the use of medications, or surgical interventions, depending on the identified factors contributing to the fertility challenges.

Doctor Zarina Ashraf, a gynecologist by profession, recommends that a couple should wait for two years at least before starting medicines in case there is no issue of fertility in one of them. But this case was different. Fareeha and Faizan’s case was not something she hadn’t dealt with before but she still felt upset when she got to know that Faizan was not taking the medicines properly.

Fareeha said, “I sometimes have to treat him like a child. I must convince him to take medicines. He sometimes needs extra pampering to keep taking the pills. It is exhausting but I keep my spirits high.”

She is still among the ‘lucky ones’ whose spouse got tested and believes in treatment. Alina was not that lucky. She was married to Salman for nine years and she terms them a ‘nightmare’.

“Salman used to beat me up, he told me multiple times that I am a useless woman since I can’t bear a child. All my tests were normal while he never agreed to get tested as he believed that fertility can never be a problem for men,” she stated in a shaking voice with tears in her eyes.

Unlike Fareeha, who only got the chance to get an education till the intermediate level, Aleena got a master’s degree before getting married. She succeeded in her career but gave in to family pressure on marriage and still regrets it.

“I have forgotten the number of medicines I’ve taken. Doctors always said that there was no issue with me, but my husband forced them to give me medicines. He used to beat me black and blue if I ever missed a pill and, in the end, all I am left with is hypertension, irregular periods, body fat, trauma, and a divorce,” she said.

Aleena’s husband remarried and due to the wealthy background and influence of the girl’s family, he eventually got tested and doctors declared that he was infertile. The girl took Khula and left him, but this hasn’t given Aleena any closure. She is just relieved that the world eventually got to know the truth but the marks on her body and mental trauma are still there for her to deal with.

“I have been practicing for more than 20 years and I have barely seen men who are easily convinced to get tested let alone seek treatment in case of infertility,” explains Zarina. She further added that societal pressure is also usually on women and men easily get away with it. She has now set a rule that in case of infertility treatment, the couple must sit together in her office and get counseling. Zarina believes that this has helped in changing the dynamics a bit but there is still a long way to go.

Doctor Mehboob ur Rehman Asif runs a hospital in Lahore and often sees men with fertility issues. “They usually go for Hakims first instead of a professional doctor. Along with fertility issues we also see patients who have erectile dysfunction (ED), but they come to us after they have tried things like salajeet or other herbs,” he said.

He further stated that a lot of such men usually know inherently that the fault lies in them but barely acknowledge it in from of their wives. Her life partner, Doctor Rabia Nisa, who is also a gynecologist by profession, makes sure to recommend such patients to her in case the husband refuses to get tested or seek treatment.

The couple has been treating and counseling such cases for years but Rabia still thinks that in the end women are impacted more in such situations. “We see mothers-in-law and other family members verbally or even sometimes physically abusing the woman for not being pregnant. When we initially tell the patient that their husband needs to get tested, the first reaction is a no and that is primarily out of fear,” she said.

Asif also agrees that such behavior exists adding that sometimes the husbands get aggressive too. “In most of the cases, their immediate reaction is anger or denial. Even if they know before their marriage that they have ED or any other issue, men rarely admit immediately that they have an issue. Mostly it is their ego and sometimes shame which become a reason behind this behavior,” he adds.

Male Infertility in Pakistan

According to a study conducted by the Pakistan Journal of Public Health, approximately 21% of couples in Pakistan face infertility issues. Furthermore, the same study found that male factors contributed to infertility in 37% of cases, female factors in 51%, and both male and female factors in 12% of cases.

According to a study, “Prevalence of Infertility in a Cross Section of Pakistani Population” by Riffat Shaheen, Fazli Subhan, Sikandar Sultan, Khaula Subhan, and Faheem Tahir from the Department of Obstetrics and Gynaecology, Federal Government Services Hospital, Islamabad, Pakistan (RS), and Department of Reproductive Physiology/Health, Public Health Laboratories Division, National Institute of Health, Islamabad, Pakistan, during the three years of their research out of 534 women presented for inability to conceive, indicating frequency of infertility in this population as 7%.

A standard protocol of investigations revealed several causes for fertility deprivation.

In the examined study, conducted at a public sector tertiary care hospital in the capital, it was observed that, over a three-year period, only 534 patients sought consultation with a history of infertility.

This pattern reflects the prevailing socio-cultural dynamics in Pakistan, where individuals with financial means typically opt for private medical practitioners, leaving public facilities mainly utilized by the economically middle and lower classes.

Despite being a significant portion of the Pakistani population, this demographic lacks awareness regarding available health facilities for investigating and treating infertility.

The study states, that to address this issue, there is a need to raise awareness among this segment of the population, leveraging the network of lady health workers. By facilitating referrals to major hospitals equipped with units for managing infertility cases, couples can undergo investigation and receive necessary treatment or counseling.

The data generated from these interactions could contribute to a consolidated national database by integrating it into the existing Health Management Information System (HMIS). This integration would enable the government to estimate the prevalence of both primary and secondary infertility cases, facilitating the development of targeted strategies for the welfare of individuals affected by infertility.

How is male infertility diagnosed?

Diagnosing male infertility involves a comprehensive approach by your healthcare provider.

The process typically includes a review of your health history and a physical examination. Various tests are conducted, such as:

1. Sperm Count (Semen Analysis): Your provider will collect at least two semen samples on different days to assess several factors. This includes the volume and uniformity of the semen, its acidity, as well as the quantity, motility, and morphology (shape) of the sperm.
2. Blood Tests: Hormone levels are evaluated through blood tests to identify any abnormalities and rule out other potential issues contributing to infertility.
3. Other Tests: Additional tests are performed to pinpoint the cause of sperm defects or reproductive system health problems. Imaging tests, like ultrasound, may be employed to examine the testicles, blood vessels, and structures within the scrotum.
4. Testicular Biopsy: If the semen analysis indicates a low sperm count or absence of sperm, your healthcare provider may conduct a testicular biopsy. This involves the removal of a small tissue sample from each testicle, which is then examined under a microscope to determine the root cause of the fertility issues.

Asif recommends that mandatory sex education in the early years of a child and constant sensitization among the public can change things. “The government needs to take a lead on this. Our society needs to stop shaming men for infertility and till the time men don’t stop making it an ego issue, this is not going to get better. We, as a society, need to be more accepting and at the same time be kinder and more empathetic towards women,” he adds.