Infertility (Aulad Na Hona) in Pakistan: Causes, Tests for Both Partners, and Treatment

Infertility is discussed constantly in Pakistani families and almost never accurately. The reference figures come from the Pakistan Reproductive Health and Family Planning Survey, cited in a study in BMC Public Health: the prevalence of infertility in Pakistan is 21.9%, of which primary infertility (never having conceived) is 3.9% and secondary infertility (difficulty conceiving after a previous pregnancy) is 18.0%.

Two caveats, stated plainly: that survey is from 2001, so it is dated, and definitions of infertility vary between studies. But the internal proportion is the part that matters and it is consistent across the literature — secondary infertility is roughly four to five times more common than primary infertility here. That single fact contradicts the assumption doing the most damage in practice, which is that a couple without a child must have a permanently "infertile" wife. Globally, WHO estimates that around 1 in 6 people of reproductive age experience infertility at some point.

At a glance

• Infertility prevalence in Pakistan: 21.9% — primary 3.9%, secondary 18.0% (Pakistan Reproductive Health and Family Planning Survey)
• Secondary infertility is far more common than primary — most affected couples have conceived before
• WHO: roughly 1 in 6 people worldwide experience infertility during their reproductive life
• A male factor is involved in a large share of cases, and semen analysis is the cheapest, fastest test available
• Investigation is for the couple, not the wife — testing only one partner wastes months

Kab test karwana chahiye, aur kis ka?

Tibbi tor par "infertility" ka matlab hai: ek saal tak baghair kisi zarya-e-inseraf ke koshish ke baawajood hamal na therna. Agar biwi ki umar 35 saal se zyada hai, to chhe mahine baad hi doctor se rujoo karna chahiye — intezar barhane se aasaan ilaj mushkil ho jata hai.

Sab se ahem baat jo aksar nazar-andaz hoti hai: test dono miyan biwi ke hone chahiyen. Mard ka test — semen analysis — sab se sasta, sab se asaan aur sab se jaldi natija dene wala test hai. Ise aakhir mein chhorna, jab biwi ke kai mahine ke test aur dawaiyan ho chuki hon, na sirf waqt zaya karta hai balke ghair-zaroori taqleef bhi. Mard mein kami hona koi "ayb" nahi — yeh ek tibbi masla hai, aur aksar qabil-e-ilaj hota hai.

Doosri baat: is mulk mein sab se aam waja secondary infertility hai — yani un joron mein jinke pehle se bache hain. Iski aam wajohat mein infection, pehli delivery ki pechidgian, PCOS, thyroid, aur umar shamil hain — yeh sab dekhi ja sakti hain aur kai qabil-e-ilaj hain.

Causes in women

• Ovulation disorders, most commonly polycystic ovary syndrome — see our guide to PCOS, one of the most treatable causes
• Thyroid disease, which disrupts cycles and is easily tested and corrected — see hypothyroidism
• Blocked fallopian tubes, often after pelvic infection, or following complications of a previous delivery or miscarriage — a leading contributor to secondary infertility
• Endometriosis, frequently under-diagnosed, and often presenting as severely painful periods
• Fibroids or uterine abnormalities, depending on size and position
• Age, particularly after 35, which affects both egg quantity and quality
• Raised prolactin and other hormonal causes
• Significant underweight or obesity, both of which disturb ovulation

Causes in men

• Low sperm count, poor motility or abnormal morphology
• Varicocele — dilated scrotal veins, common and often surgically correctable
• Previous infections, including mumps orchitis after puberty
• Hormonal problems, including low testosterone and thyroid disease
• Heat, smoking, heavy tobacco or drug use, and certain occupational exposures
• Diabetes and its effects on erectile and ejaculatory function
• Undescended testis in childhood, and previous groin or testicular surgery
• Anabolic steroid use for bodybuilding, which suppresses sperm production, sometimes for many months after stopping

How it's investigated

A first assessment covers both partners together: cycle history, previous pregnancies, surgeries and infections, medications, weight and smoking. Then, typically:

• Semen analysis — first, because it is inexpensive, non-invasive and answers a large question quickly; an abnormal result is usually repeated before conclusions are drawn
• Ovulation assessment — cycle tracking and mid-luteal progesterone
• Hormone profile — thyroid, prolactin, and PCOS-related tests where indicated
• Pelvic ultrasound, and tubal assessment (HSG or laparoscopy) where tubal blockage is suspected
• Blood sugar and general health screening, since diabetes and obesity affect both partners' fertility

A gynaecologist usually coordinates this; male-factor findings are managed with a urologist or andrologist. A urologist handles varicocele and obstructive causes.

Treatment

• Treat the identified cause — thyroid correction, PCOS management, weight optimisation, stopping smoking and steroids. A meaningful number of couples conceive at this stage alone
• Ovulation induction with tablets such as letrozole or clomifene, with monitoring
• Surgery for tubal disease, fibroids, endometriosis or varicocele in selected cases
• Intrauterine insemination (IUI) for mild male factor or unexplained infertility
• IVF or ICSI for tubal blockage, severe male factor, or where other treatment has failed — effective but expensive in Pakistan, and worth understanding the realistic per-cycle success rate for your age before committing
• Timing and expectations — even with everything normal, conception is a monthly probability, not a switch

Be cautious with treatments sold without a diagnosis. Any clinic offering a cure before completing the basic tests on both partners is selling hope, not medicine.

When to see a doctor

• Twelve months of regular unprotected intercourse without conception — or six months if the woman is over 35
• Immediately, without waiting, if there are irregular or absent periods, severe period pain, known PCOS or thyroid disease, previous pelvic surgery or infection, or a previous ectopic pregnancy
• Two or more miscarriages
• Known male-factor risk: undescended testis, previous mumps after puberty, varicocele, testicular injury or steroid use
• When the strain is affecting mental health — this is common and legitimate; see our guide to depression and anxiety

Frequently asked questions

Kya kami hamesha aurat mein hoti hai?

Bilkul nahi. Bohot se kesson mein waja mard mein hoti hai, ya dono mein. Isi liye semen analysis sab se pehle karwana chahiye — yeh sasta, asaan hai aur bohot waqt bacha deta hai.

How long should a couple try before testing?

One year of regular unprotected intercourse, or six months if the woman is over 35 — and sooner if there are known risk factors such as irregular periods or previous pelvic infection.

Does stress cause infertility?

Severe stress can disturb cycles, but stress is far more often a consequence of infertility than its cause. "Just relax" is not a treatment plan, and it delays testing.

Is IVF the only option?

No. Many couples conceive after treating an identified cause, with ovulation induction, or with surgery. IVF is one option among several, chosen for specific indications.

Sources

• "Knowledge, perceptions and myths regarding infertility among selected adult population in Pakistan: a cross-sectional study," BMC Public Health (PMC) — citing the Pakistan Reproductive Health and Family Planning Survey (National Institute of Population Studies)
• WHO — Infertility fact sheet
• "Risk Factors for Secondary Infertility among Women in Karachi, Pakistan," PLOS ONE

For practitioners: if you're a gynaecologist, fertility specialist or urologist in Pakistan, list your practice free on DoctorOS and start taking bookings from patients who are searching for exactly this kind of care.