Armenia's Fertility Problems Worry Officials

One in five Armenian families are unable to have children, with doctors saying women’s fertility has been damaged by stress and abortions, while men are harmed by ill health.

The situation has improved from that in the 1990s, but experts worry that the country’s demographic future could be threatened if more is not done to reverse the dire trend.

“Although the results of past investigations (32 per cent of women were infertile compared to 17 per cent now) significantly differ from the current indicators, the level of infertility in Armenia continues to be dangerous,” said Karine Saribekyan, the head of the mother and children’s department at the health ministry.

A report into the problem jointly produced by the United Nations, the health ministry and other organisations said that “treatment is hard to access in Armenia because of the high cost, the low level of awareness among the population, and also its low effectiveness”.

Saribekyan blamed a range of conditions for the problem including venereal diseases and hormonal problems, however experts said many of the reasons could be traced back to the economic collapse and poverty of the 1990s.

“People from the generation of the 1990s, who during the war [against Azerbaijan] lived in conditions without electricity, in cold and with constant stress, are now coming to us as potential mothers. It is specifically these women who have problems with getting pregnant,” Eduard Hambardzumyan, director of the Centre of Human Reproduction, said.

Experts also blamed abortions for damage to women’s reproductive capabilities.

“Previously pre-marriage sexual relations did not exist, but you see that now. As a result of those relations, accidental pregnancy is common, and women try to end that with abortions, which can have fateful consequences for them,” said Karine Arustamyan, deputy director of the Scientific-Research Institute of Obstetrics and Gynecology in Yerevan.

According to studies conducted by the health ministry, the highest levels of childless families are in Yerevan itself, and in the Armavir, Ararat, Gegharkunik and Shirak regions. In Yerevan and Gegharkunik, some 12 per cent of men are infertile, which experts link to the high incidence of men from these regions travelling abroad to earn money.

“Around 40 couples come to our clinic every month suffering from reproductive problems. In 70 per cent of cases it turns out that the man is the cause of their infertility,” Christina Melikyan, a gynecologist from the Shengavit medical centre, said.

Hambardzumyan said that male infertility was often caused by a poor lifestyle: drinking too much, smoking, eating poor-quality and fatty food and lack of exercise. Saribekyan also said that men were reluctant to visit the doctor, and so were often unaware of the problem.

“It has always been acceptable to blame women for infertility. Often men divorce their wives after several years of marriage if they haven’t had a child, then it turns out that it was they who were infertile not their wives,” she said.

If doctors cannot find a specific reason for infertility, they describe it as of “unknown cause”. Some 8.2 per cent of Armenian men, and 10.5 per cent of women fall into this category, and treating them is often impossible.

“Often it is necessary to undergo treatment several times. And since these procedures are very expensive, after a couple of rounds couples often give up. Either they don’t have enough patience, or enough money,” Hambardzumyan said.

The government, concerned by the demographic situation in the country, has approved strategies for improving mother’s and children’s health as well as reproductive health. Currently, there are 3.2 million people in Armenia, the population having fallen by around 50,000 since 1991. Last year, 44, 810 children were born in Armenia, which is one percent more than in 2009.

The government has charged doctors with attempting to improve the fertility situation, and they confirm that a lot needs doing if Armenia is to return to Soviet levels when women on average had two or three more children than they do today.

Doctors say that fertility treatment is expensive and unavailable to the majority of Armenians, and even those who can afford it are not guaranteed results.

Anahit and Karen Zorikyan, for example, have been trying to have a child for four years. They have appealed to several specialists, undergone courses of treatment, but without result. They do not even know the reason for their infertility.

“We have spent several thousand dollars on analysis, on medicine, on doctors and on treatment. Our only hope now is in-vitro fertilisation, but that is too expensive here in Armenia,” Anahit said.

In-vitro fertilisation costs around a million drams (2,700  US dollars), which is out of reach of the vast majority of people in a country where the average salary is 300 dollars. Using a surrogate mother is even more unaffordable at 20-30,000 dollars.

Arpi Harutyunyan is a freelance reporter.