KATHMANDU, Dec 27: For five years after her marriage, Ujjwla Sharma (name changed), a 35-year-old woman from Rupandehi, waited for a pregnancy that never came. What came instead were relentless questions—from relatives, neighbours, and family gatherings—about why she had not yet become a mother.
Medical tests later revealed that it was her husband who was infertile. Yet, as is often the case in Nepali society, the weight of explanation and social scrutiny fell squarely on Ujjwla. The couple eventually sought help at an infertility centre, where doctors recommended in-vitro fertilisation (IVF).
Seven years into marriage, they finally welcomed twin babies. Today, the Sharma family says it has found long-awaited happiness—after years of quiet struggle.
A similar ordeal marked the life of Reena Thapa (name changed) from Pokhara, who became a mother only at the age of 42. For years, she endured constant questioning over her childlessness, even as anxiety grew with advancing age.
“The pressure became overwhelming,” Reena recalls. Repeated infertility treatments and multiple IVF attempts failed. About a year and a half ago, she turned to senior gynaecologist Dr Jageshwar Gautam at Om Hospital. Tests revealed that obesity had caused blockages in her fallopian tubes. After corrective surgery followed by another IVF procedure, Reena finally conceived.
Beyond these personal stories lies a growing national trend. Doctors say infertility-related childlessness is rising steadily across Nepal.
“On average, at least 10 infertility patients visit my OPD every day,” said Dr Gautam.
At Paropakar Maternity and Women’s Hospital alone, 35 to 40 couples seek treatment daily at the infertility unit, according to gynaecologist Dr Jwala Thapa, amounting to nearly 1,000 cases a month.
Fertility specialist and professor Dr Sita Pokhrel Ghimire says infertility has increased markedly over the past 10 to 15 years. “The nature of infertility today is very different from the past,” she noted, pointing to lifestyle-driven causes rather than purely biological ones.
What the studies show
Research backs these observations. A 2023 study by Kathmandu Medical College found that 10 to 15 percent of couples suffer from primary infertility, while 72.94 percent experience secondary infertility—defined as infertility after having at least one child.
Similarly, a 2024 study conducted at Paropakar Maternity Hospital found infertility in 22.4 percent of couples. Of these cases, 34 percent were attributed to women, 30.1 percent to men, 22 percent to both partners, while 13.5 percent remained unexplained. The study covered 156 patients treated over six months.
Infertility: Agony in developing countries
Among infertile women, 41.51 percent suffered from fallopian tube-related problems, while others had ovarian, uterine, or endometriosis-related conditions. In men, doctors found abnormalities in semen quality and hormonal imbalances. The study included men aged 20 to 48 and women aged 18 to 44.
Reasons behind infertility Rise
Foreign employment
Doctors say long separations caused by foreign employment, delayed marriages, and untreated infections affecting reproductive organs are key contributors.
“When husbands work abroad, couples may only have two or three months together and expect pregnancy immediately,” Dr Gautam explained. “Infertility cannot be diagnosed unless a couple lives together regularly for at least a year.”
Medical abortion
Improper medical abortion is another growing concern. If pregnancy tissue is not fully expelled, infection can occur, leading to prolonged bleeding and fallopian tube blockage.
“When abortion pills fail to work completely, infection sets in, and fertility is compromised,” Dr Gautam said.
Other surgeries
Abdominal surgeries also carry risks. Leakage of blood or fluids during surgery can cause infection around the uterus, eventually blocking the fallopian tubes.
Obesity
Sedentary lifestyles have driven obesity rates higher, particularly among women. Obesity disrupts hormonal balance and menstrual cycles, significantly reducing fertility.
Delayed marriage
Career-focused lifestyles have led many men and women to delay marriage. Doctors warn that advancing age reduces egg quality in women and sperm quality in men, increasing infertility risks.
Repeated infections
Poor sanitation and inadequate hygiene—especially in public toilets—have increased urinary tract infections among women.
“Because women’s urinary and reproductive organs are anatomically closer, infections spread more easily,” Dr Ghimire explained. Untreated infections can lead to infertility.
Changing gender roles and hormonal impact
Dr Ghimire also pointed to intense gym routines, delayed marriages, and multiple sexual relationships as factors contributing to hormonal imbalance among women.
Entering new relationships before formally ending previous ones increases the risk of sexually transmitted infections, further affecting fertility, she added.
Heat exposure in men
Men working in extremely hot environments—particularly in Gulf countries—are increasingly facing fertility problems.
“Prolonged exposure to heat reduces sperm quality,” Dr Thapa said.
Unhealthy lifestyles
Excessive screen time, junk food, lack of sleep, and chronic stress are also major contributors. Studies show that prolonged use of mobile phones, motorcycles, and computers negatively affects male fertility.
Stress and insomnia disrupt hormonal balance, increasing infertility risks in both men and women—especially among youths working in high-pressure environments like Korea and Japan.
How to prevent infertility
Doctors stress timely marriage and early childbearing as key preventive measures. “Delaying childbirth reduces chromosome quality,” Dr Gautam said.
However, advances in medical technology now offer alternatives. According to Dr Thapa, sperm and eggs can be cryopreserved for future use—particularly helpful for couples separated due to foreign employment.
“Children born through these methods are healthy,” she said.
Doctors also emphasise infection prevention, balanced diets, weight control, regular exercise, stress management, and adequate sleep.
“With the right lifestyle choices,” they say, “many infertility cases can be prevented.”
