“A woman is incomplete if she does not have a child. Creating, nurturing and giving birth to life are what set a woman apart from a man,” says Qamar (not her real name), a young woman in her mid-30s and the mother of one-year-old girl.

Unlike the stereotypical bored housewives, Qamar is a computer programmer currently living in Australia and is one of the growing numbers of Pakistanis visiting their homeland for medical treatments, particularly those pertaining to infertility and in-vitro fertilisation (IVF).

“Five years into my marriage and I was unable to conceive. The tests and treatments I underwent abroad were very expensive and given that IVF was not covered by my company, I started to research on low-cost options,” she says.

According to a research paper ‘Risk Factors for Secondary Infertility among Women in Karachi, Pakistan’, the prevalence of primary (where a couple never had a child) and secondary infertility (inability to conceive for one year after having conceived at least once before) in Pakistan is nearly five per cent and 18 per cent respectively while the global average hovers around 10–15pc.

A non-resident Pakistani, Qamar says that she feels blessed to be a mother and more importantly a Pakistani.

“I started looking up and then finally decided that I will head to Pakistan as IVF is cheaper here. The country has given me a child and in a way restored my ‘identity’ as a creator,” she says with a big grin.

Despite her successful treatment, she says she prefers to keep mum about the subject of infertility at family events in Pakistan.

She says that IVF is still considered a taboo and says that she and her husband made the decision to stay quite on this front.

“My mother-in-law would often make fun of a relative’s children who were conceived after IVF treatment. ‘Pata nahi petri dish mein kya kuch mix kar diya hoga’ she would say, doubting their parentage,” Qamar says.

“I think it’s better to stay silent and get done with the deed. Thankfully my husband is equally supportive too,” she says, explaining her decision to keep mum about the purpose of her ‘unexpected’ visits to Pakistan in front of her in-laws.

However, she has found a voice online and is an ardent supporter of IVF at various forums including Mumsnet (www.mumsnet.com) and helps in easing desi women’s fears and apprehensions.

On a serious note, she says that when the medical consultant asked her about gender selection, she was dumbfounded.

“I sure wanted children but never differentiated between a male or female child. However, during the time I spent at various IVF centres in Islamabad and Lahore for consultations, I realised that most people coming to meet doctors ‘wanted’ boys,” she says.

Booming business

The idea of achieving immortality by passing one’s gene pool by having children often touches a raw nerve. Add to this the idea that man was created to procreate, and there you have it, the desire to see ‘mini-me’ versions of ourselves that give us the will to live through the hardest times.

But the possibility of having a child is not always there due to various reasons, particularly biological. In this backdrop, it’s not an unusual sight to scan through newspapers and magazine where full page ads featuring pictures of Caucasian babies with XYZ doctors or quacks offering hope to ‘infertile’ couples.

Leaving aside the murky world of peers and Alims that promise one a guaranteed male progeny, fertility issues are big business in Pakistan.

The first IVF facility in Pakistan was set up in the mid 1980s. Offering hope and longevity in the form of a child, the number of IVF centres is booming, with one facility in Islamabad claiming that they receive over 400 patients a month who want to opt for IVF.

Though there is no official database or registry of test tube babies in Pakistan, estimates available from various centres said that some 5,000 babies were born through IVF in the country.

Talking to Dawn, Dr Syed Sajjad Hussain, chief executive at the Australian Concept Infertility Medical Centre, says that the concept of IVF is gaining hold but is also a victim of misinformation.

Calling IVF ‘assisted fertility’ he explained: “In vitro fertilisation (IVF) is an assisted reproductive technology (ART) that helps women become pregnant.

The procedure involves fertilising an egg outside the body, in a laboratory dish, and then implanting it in a woman’s uterus and then nature takes over.”

“I have been in this business since 1998 and over the years I have noticed that lack of education and misgivings often turn IVF controversial in Pakistan. The first test tube baby, Louise Brown, was born in 1978.

“Islam is a progressive religion and in the early 1980s, Egypt’s Al Azhar University issued a fatwa stating that IVF could be used by infertile couples who were legally married,” he said.

“The issue of ‘mixing up’ cannot arise in Pakistan as we do not have sperm/egg donations,” he says.

When asked about his hectic schedule in Punjab recently, where he is visiting at least five cities in a week, he says, “There is a growing demand for IVF. Most people who come to us are those who have given up hope and were guided by someone who had a successful IVF treatment. The centres I visit are not in remote corners of Pakistan but yes small cities.”

“IVF is way cheaper in Pakistan than other countries. You can get it done for one third the price that is in Dubai. The USA and UK are way too expensive. In 1998, there were barely three IVF centres in Pakistan and now the number has grown to over 15 centres,” he says.

In a report issued by the International Committee for Monitoring Assisted Reproductive Technologies (ICMART) in 2012, five million babies were born around the world after IVF and other assisted reproductive treatments.

However, the report also noted that “major barriers to access are economic and societal in some situations”.

In the US, average cost of an IVF cycle is around $12,000 according to the American Society of Reproductive Medicine. In Pakistan, cost of IVF treatment hovers between Rs200,000 to Rs450,000 but is still out of the reach of many middle and lower middle class couples.

Expensive ‘need’

In a recently held meeting, the Council of Islamic Ideology allowed test tube babies under certain conditions. Furthermore, it maintained that gender selection was not prohibited in Islam and it can be done within the limits of the Shariah.

CII member and chairman Pakistan Ulema Council Hafiz Tahir Ashrafi explained that IVF is permissible if the sperm and eggs belonged to a married couple.

“It’s an innovation and if it is done within the parameters set by Islam, its fine.”

He further added that surrogacy and donation, where another woman’s womb/eggs or another man’s sperm is used, is not at all permissible.

Talking about the option of gender selection, he says that although the CII is not against it, “the move must be discouraged”.

“In our society, girls are looked down upon and if this selective trend is allowed, it is not a good omen. The logic that IVF gender selection is not like abortion is pointless. In our society, no one wants a female child and if the concept of gender selection due to IVF gets hold, it won’t do much for our girls,” he said.

He urged the medical community to think morally and ethically and not make financial gains the sole prerogative.

A consultant at a Lahore-based IVF centre said that most couples, even those who were not infertile, approached them for male child.

“People say that if they are going for such an expensive treatment, they might as well spend some more and get a male child,” the consultant said.

While the concept of IVF is catching up, he says that a lot of people have shown interest in gender selection (Pre-implantation Genetic Diagnosis) and ‘for all the wrong reasons’.

Globally, PGD is used for screening and diagnosis of genetic diseases in early embryo prior to implantation and pregnancy as well as finding out the gender. The purpose is to cut down the chances of having a baby with genetic disorders by offering screening.

“In Pakistan, people are least bothered about long-term implications of genetic diseases and rather focus on having a male child. A test-tube baby is expensive and people want the desired result which is a ‘male child’. It pains me to see that rather than a health baby, we obsess about the sex of the child,” he says.

Sharing the story of a farmer in Faisalabad who sold his cattle in order to finance the treatment, he says there are always exceptions to the norm too.

“The gentleman sold his cows and was more than happy when he heard that his wife was carrying twins. Not for a minute did he question us about the gender of the children. He is lucky that he had twins, a boy and a girl. Science can do a lot of things but to this day I feel that was God’s way of rewarding him.”