Taboo, ego, betrayal: The many shades of male infertility in Kashmir

It was a dream wedding that brought Inayat Mir and Saima (names changed) together in 2017. Apart from drummed up festivities and lavish spending, the quintessential Kashmiri marriage forged new family ties and brought togetherness. But five years later, the memories of the wedding gala have all but faded and the ties are on the brink of collapse. The two families are at loggerheads as the marriage has failed to ‘bear any fruits’.

A software engineer by profession, Mir filed for divorce after Saima came to know about his deepest secret as she chanced upon his fake ‘fertility reports’.

In a traditional society like Kashmir, male infertility issues are a taboo subject around which there are no discussions. But male infertility, aggravated by the silence around it, is now casting a shadow on ‘happy marriages’.

When Saima couldn’t conceive for a year after her marriage, she consulted her gynaecologist who recommended a few tests and scans. When the repeated medical examinations and tests were normal, Saima was asked to get her husband’s semen analysis report.

“My husband was very reluctant about it,” Saima recalls. “But for my sake, he somehow agreed. The report he got showed everything as normal and this left me partly confused and partly relieved.”

Upon seeing Mir’s test reports, Saima’s gynaecologist put her on an ovulation induction treatment, but still there was no good news. Saima was growing increasingly worried. Constant questions from relatives about “any good news” were adding to her anxieties.
Back home, her endless pleadings to seek appointment with an infertility specialist were repeatedly shrugged off by her husband. “He would simply bat for homeopathic treatment,” Saima tells The Federal. “He would call it very effective.”

With no other option in sight, Saima agreed to visit the homeopathy doctor in Srinagar with Mir. The doctor saw Mir’s semen analysis reports and grew suspicious. He asked the couple to take another test, but this time at a prominent laboratory in Kashmir. Mir neither got the test done, nor visited the doctor again.

“But seven months later, he [Mir] visited me again,” the homeopathy doctor told The Federal on the condition of anonymity. “He thought I wouldn’t recognise him and showed me the same test report with a different lab name.”

In an attempt to understand the reality of the reports, the doctor told Mir that his reports were normal and that he should visit the clinic with his wife.

“When the couple visited me,” the doctor said, “I told Saima to get her husband’s semen-analysis test done again from Dr Qadri’s Hematology Center and Clinical Laboratory and collect the report herself. This is how the real issue came to the fore.”

Mir’s report showed azoospermia (male infertility) and it came to light that Mir had been fooling his wife with a fake report.

By the time Saima found out the real reason for not being able to conceive, she had passed through endless medical tests, medication and social alienation. Everyone raised fingers at her for not being able to mother a child. Despite knowing what Saima was facing, Mir never acknowledged his medical condition.

Dr Syed Sajjad Nazir, head of Urology Department at Srinagar’s Shri Maharaja Hari Singh Hospital and an andrologist who has been treating male infertility for the last 25 years, says that male infertility is an unreported reality in Kashmir. “A sense of taboo, male ego and improper diagnoses have escalated this health crisis in the Valley today,” Dr Nazir told The Federal.

The andrologist argues that women are made to undergo the tests when the gynaecologists should right at the beginning seek initial semen-analysis reports of the husbands. Doctors generally recommend a semen-analysis test only after years of treating the women. “This delayed medical test men is creating the whole problem,” Dr Nazir said.

“I’ve seen patients with undersized testes. They can’t have kids due to a primary testicular failure. The only option they have is adoption, but here in Kashmir majority of these patients get married and the unfortunate part is that they don’t understand the scientific problem.”

Dr Nazir said while men with obstructive azoospermia have the options of in-vitro fertilisation (IVF) for a biological child, they “unfortunately visit dermatologists and sexologists to fix their issue.”

“It’s a sign of unawareness. How can a sexologist treat infertility when it is not even a branch of medical science?”

Many studies back Dr Nazir’s claims. Lack of awareness leads to stigma, shadowing and silencing such cases in Kashmir.

“Most patients rarely visit any specialists before marriage due to the taboo in Kashmir,” Dr Umar Salim, an andrologist working in Kashmir, told The Federal. “They mainly try to treat their problem through some ‘secret’ drugs from local pharmacists,” he added.

Patients facing low-sperm count, low-motility and semen-morphology issues visit specialists only after marriages. “Since most of these patients are referred by either physicians or gynaecologists, the attitude behind not visiting specialists at the initial stage only adds to the problem for infertile men. Their issues remain untreated and undocumented in Kashmir.”

A 2018 study published by the North Asian International Research Journal of Multidisciplinary on Perception Among Married Couples Towards Causes and Treatment of Infertility, notes 15.7 per cent rise in infertility in the Valley over the last two decades.

The study mentions that there is extensive unawareness and misconception among Kashmiri Muslims regarding ART (Assisted Reproductive Techniques) treatments largely due to social and economic reasons.

“Many patients are reluctant about the failure of treatment as there is no guarantee given to the patient about the complete success rate of treatment,” the study notes.

The study also reveals that in Kashmir, 75 per cent men and 66 per cent women are unaware of medication for infertile men. “Also around 84 per cent men and 86 per cent women are unaware of the surgical procedures available for the treatment of infertile men,” it said.

The study also observed that the majority of respondents have heard or read about infertility but have poor knowledge about its treatment. Furthermore, about 43 per cent male respondents and 57 per cent of female respondents believe that infertility is the most common reason for gynaecological consultation.

The awareness rate of infertility recorded in this study is worrisome considering the fact that infertility is increasing in Kashmir due to the protracted conflict with a prevalence rate as high as 15.7 per cent.

The study recommended that there is a need to encourage education programmes to increase the level of knowledge and change the attitudes regarding infertility among people. Also, it suggests setting up IVF centres in Kashmir to save people from taking arduous journeys outside the state.

The study also bats for the peaceful solution of Kashmir problem as “it is one of the major causes of infertility in Kashmir”.

Experts believe that the disturbed political situation has impacted male infertility. “The impact of political uncertainty has only added to the problems of late marriages, stress, unemployment and burden of families on men which adversely impacted their fertility issues,” Dr Salim said.

The Ministry of Statistics and Programme Implementation’s ‘Youth in India 2022’ study states that Jammu and Kashmir has the highest proportion of unmarried persons—29%—within the age bracket of 15 to 29 years among all states and Union Territories.

Some of these unmarried men end up facing issues like erectile dysfunction.

A stone-cutter from Baramulla, Asif Khan, faced this issue and yet consented to marriage. He hesitated sharing his problem with his parents, but told his best friend about it. The friend gave him a native faith-healer’s address for remedy. On the faith-healer’s instructions, Asif threw a big feast before the marriage ceremony to cure his problem.

“The faith-healer told me that a djinn had possessed me at the age of 8,” Asif recalls. “As per him, that evil soul had created this erectile issue after I had peed below a tree where he was sleeping.”

Despite the big feats, Asif’s problem persisted. “I was lucky enough my wife was supportive,” he said. “She did not just find a sexual partner in me but a good friend, so she hid my problem from everyone and we tried to work together to find a solution.”

Unfortunately, not everyone is so lucky to find a partner like Asif. Many happy weddings are ending on a bad note. Despite the distressing situation, many experts believe that male infertility cases could wane in future.

Dr Abrar Wani, a homeopathy doctor treating infertile men, told The Federal that delay in consulting specialists is creating a major problem for now. “It becomes difficult for us to treat such problems in later stages. But in the future, we could see fewer infertility cases among men. The reason is during a baby boy’s birth these days, doctors check whether he has any physical problem and start treatment which fixes the issue till he reaches his marriageable age.”

None of this matters to Saima, who’s now staring at separation. Her husband’s inability to visit the specialist in time and faking the reports, have left her traumatised.

“It’s not my fault,” she lamented. “And yet, it’s my fault only. That’s how I was made to feel about my husband’s problem and betrayal.”