Ruzanna Sargsyan recalls her mother-in-law’s words: “She told me I can’t even bear children. Why should they keep me? She said they had to continue the family bloodline, not keep a freeloader. I was told to get my things together and go back where I came from.”
The anger, the insult and the pain is intense. On the one hand, Ruzanna’s wish to have a child remains unfulfilled, on the other hand the treatment she received from her former relatives torments her. The 29-year-old says, “I am a woman, I supported my husband in all matters, I was by his side during difficult times. I understand having a child is a wonderful thing, giving birth to someone brings great joy, but I have not been given that gift,” she says and asks, “Does this mean it’s the end? I can’t be loved anymore? Am I just a tool to bear children?”
Ruzanna faces many issues. Finding answers to them is probably pointless. She found out about her infertility two years after she got married at the age of 23. She was 25 when her husband’s family decided there was no need to keep her anymore.
“My mother-in-law told me since her son is still young he should get a wife who can bear him children so they can be healthy,” says Ruzanna. “My husband didn’t oppose his family that much. He was in Russia half the year anyways. It didn’t matter to him if I was his wife or some other woman.”
Ruzanna is from the region of Gegharkunik, which is considered the most conservative region in Armenia. When after a year of marriage she wasn’t getting pregnant, relatives urged her to see a doctor. When the doctor told her that her husband also had to be checked, a fight erupted in Ruzanna’s home.
“My mother-in-law said her son couldn’t be infertile. According to her I was the reason and I should not shame the family. She didn’t let my husband see a doctor,” Ruzanna recalls. “There was no point in fighting anymore. For us the best outcome was separation, even though there are many couples like us that have been able to overcome this problem.”
Even though Ruzanna has been left alone with her problem, however, she is not alone in being diagnosed with infertility.
According to different research, 15 percent of couples in their reproductive years are infertile around the world. Despite the fact that a lot of research has not been done on infertility in Armenia, the UN Population Fund along with the Ministry of Health of Armenia and other organizations, conducted a survey in 2009 in which they found that the infertility rate in Armenia is 17 percent.
In 1992, the World Health Organization conducted a number of surveys to determine infertility rates in the world. According to the results of the first survey, the infertility rate in married couples in Armenia was 23.4 percent. The second survey was done in 2004, which found 31.8 percent infertility in Armenia. The third survey carried out in 2010 found that the infertility rate in Armenia had dropped to 16.8 percent.
What is infertility?
According to gynecologist Dr. Armine Hovhannisyan, when a woman younger than 35 years of age fails to get pregnant after a year of unprotected, regular sexual intercourse without any complaints, such as pain, discharge or absence of a menstrual cycle, they should go see a doctor, but not sooner. “However, our society starts wondering when the new bride bear them a child 2-3 months after the wedding,” she says.
According to Dr. Hovhannisyan, woman over 35 should wait half a year before going to see a doctor.
There are two types of infertility: primary and secondary. According to the UN survey, Armenia’s primary infertility rate is five percent, and its secondary infertility rate is 12 percent. It’s worth noting that the highest rates of infertility were found in Yerevan, and the regions of Gergharkunik, Shirak and Armavir.
Dr. Hovhannisyan explains: “Having a fertility center already means that the country has a serious problem. The main reason for infertility is inflammatory diseases which lead to blocked fallopian tubes. Other causes of infertility are pollution and stress, which also affects hormones.”
Another reason for infertility according to experts is the fact that the generation that has reached reproductive age now is the one that grew up during the cold and difficult years of the 1990s in Armenia. Their childhood was accompanied with malnutrition and heavy stress during a time when the country was at war, in a blockade and in an economic crisis.
However, the dominant reason for infertility, according to doctors, remains to be the lack of education and awareness.
Infertility and the Lack of Sex Education
The main reason for secondary infertility in Armenia are sexually transmitted diseases (STDs) and abortions.
Research has shown that almost all women who had primary infertility had never had an abortion. However, in cases of secondary infertility, every other women (33.6 percent) had had an abortion. While conducting their research, experts also examined the effects abortion has on a woman’s reproductive health and found that only 22 out of 33 women who had an abortion were able to get pregnant later on.
It’s worth pointing out that this problem would have been prevented had there been better education and awareness. However, initiatives to implement sex education in schools has always had some pushback. Those who oppose it’s introduction in schools believe that this would lead to perversion in children and endanger so-called national traditions.
Meanwhile, research has shown that in Armenia, abortion rates in adolescents (15-19 years old) is growing. According to state statistics, out of 12,000 abortions that were performed in 2011, 600 were adolescent girls, or five percent of girls aged 15-19 years-old (per 1000 girls). In 2009 that percentage was 4.6 percent.
Only in 2008, after a long campaign, did schools include a subject call “Life Skills” in higher grades, where 10-11 hours were to be allocated yearly to teach children about sexual intercourse, STDs and how to avoid them. However, education experts have pointed out many times that the subject is being taught by incompetent experts and teachers who have yet to overcome their own fears of talking about sex, and the quality in which the subject is taught is rather questionable.
In the capital city Yerevan, it seems that reproductive health is gaining more attention and people who have problems go see a doctor without hesitation. However, according to experts the regions remain to be the target.
Dr. Hovhannisyan explains: “Lack of information is not the only reason people seek help from a doctor when it’s already too late. “Spurious traditions are a reason as well. For instance, people believe it’s shameful for an unmarried girl to go see a gynecologist: what would people think? However, everyone can have a problem and solving them in time can prevent complications later on.” She says that all men, if they might have fertility issues, take it very personally and are usually embarrassed and avoid going to a doctor. “However, every single couple needs to be examined,” stresses the doctor.
Hovhannisyan emphasizes that in Armenia the main reason for infertility is labor immigration. Men go abroad to work and return with STDs. According to her, the problem Armenia faces is that there is no culture of having medical examinations before marriage.
Dr. Hovhannisyan believes that couples need to have medical check-ups: “This would allow alleviating risks and health problems. The most important thing is that couples have to be honest with each other, communicate and not be afraid.”
Infertility is Not a Sentence
It would be naive to think that infertility is a sentence. A corresponding solution can be found for every situation. Today, investments are being made in modern reproductive technologies, like artificial insemination, surrogacy, etc. These are helping infertile families receive the gift of life.
Artificial insemination is complicated, expensive and a long process. It’s possible the process has to be repeated. However, sometimes this the only hope many couples have.
Thirty-year-old Lusine Hakobyan is getting ready to go through artificial insemination in a month. This is also known as in-vitro fertilization (IVF), which is a type of artificial insemination when an embryo is grown in artificial conditions and after a certain time period placed in the uterus where the pregnancy continues.
This is Lusine’s third attempt at IVF.
Looking back at her two failed attempts Lusine says, “During the first attempt, the pregnancy was in its third month when the doctor told us the foetus had been dead for a couple of days. It was the worst day of my life. I felt like my world fell apart. I had already heard the heartbeat. All my expectations were destroyed. My husband and I ran away from the city. We went somewhere far away from everyone, only the two of us. It felt like those feelings would never go away.” Lusine says that at times like this, the only person you want by your side is your partner. “Without him, I would have gone crazy. I was depressed for half a year. I was angry, I blamed everyone. One day one of my acquaintances very bluntly told me I shouldn’t spread my bad mood onto others. No one was responsible for my problem. That really affected me. It was then that I understood that truly no one was obligated to do anything. Then without understanding why, you want to try again. After the second failed attempt we got over it more easily. We had already gone down that road, we knew what was in store for us.”
Lusine found out about their infertility seven months after their wedding when she had gone for a general medical check-up. “You usually never think these kinds of things will happen to you. We were both shocked. We saw several doctors to get different opinions. However, they all said was that we needed to start treatment,” she recalls.
While Lusine was dealing with her own emotions, she had to deal with relatives who had not medical background, but would offer unnecessary advice, like taking certain medication or herbs to solve her problem.
She became bitter and felt very alone. “It felt unfair: why should someone have a baby and not me? However, I understood this state of mind was not leading me to a good place. I worked on myself, but it was awful when people felt sorry for me, or when someone we knew was pregnant and nobody would tell me,” Lusine says. “I then accepted the problem and started seeing a doctor. Of course, everytime you go to the doctor you wait for some miraculous news, maybe something has changed for the better. However, it doesn’t work that way. The first time I went to the doctor I had to wait a couple of months. There was such a long line of people ahead of us. It was then that I understood that I was not alone and there were hundreds of people like me.”
After the diagnosis, the next shocking realization is how much it costs to have a child. However, even after all the expenses and treatments, the probability of conceiving is less than 50 percent.
“It starts at $5000 US. The first time is always more expensive, because it’s difficult to figure out the exact problem. There are a lot of tests. There could be many hidden problems,” Lusine explains. “The whole process is accompanied by so many emotions, especially when you’re in the hospital. It turns out you have to first ‘fight’ the problem, then manage your emotions and then find the financial means to solve your problem.”
In Ruzanna’s case the problem was solved through separation. However, Lusine says she never even considered it.
“I chose my partner because I loved him, not so we can have a child. This problem never affected our relationship. I can’t remember a time when I thought, oh if only we had a child, our problems would be different. Problems either unite or alienate you. If you don’t become alienated from each other then you are more whole. Couples have to understand that this problem should not consume them, they have to continue to live, be happy every day,” explains Lusine. “Being ashamed or upset is pointless and you shouldn’t make a big deal out of this problem. I’m getting ready for my third attempt at this difficult process in a month. But this week, I’m going to a zumba dance class. I’m not going to wait to have a child for everything to be good. Life continues and you have to live.”