A woman’s worth is not determined by her ability to bear children but by the love she brings to the world. However, this is simply not the tale told by the gaze of society.
Slesha and Niranjan built a picture-perfect life in their Texas home: successful careers, a cozy apartment, and weekend drives in the countryside. By any outsider's view, they had it all. But there was a quiet ache behind those shut doors. It wasn’t the silence of peace but the emptiness of unfulfilled dreams of parenthood.
Every morning, Slesha woke up with this weight in her chest—not seen by anybody, but felt. It wasn't that Slesha did not love her life with Niranjan, but that this thing just hung between them, unsaid yet understood. They were a couple, yes, but not family-like—not in the way those around them set examples for.
Seven years. That was how long they had been married, how long they had tried for a child. It had been eight years of prayers, remedies, and herbal medleys. Of course, the American healthcare system offered solutions, but the costs were overwhelming, and the emotional toll of repeated failures weighed heavily on them.
With each passing year, Slesha and Niranjan grew quieter, their hearts heavy with questions to which they didn't have the answers. What are we missing? What's wrong with us?
With each year came another added weight, smothering them further with every question society placed upon them as a family.
Then, during a trip home to Nepal, a cousin mentioned something unexpected: IVF in Nepal. Slesha hadn’t considered it before. It felt strange. Would it really work? Was it safe? Could Nepal, the country they had left behind for better opportunities, now offer them their greatest hope?
And then, after months of research, they took the plunge. They returned to Nepal, this time not for a visit, but for a chance at parenthood.
It was not easy. Days between consultations and injections were filled with cautious hope and quiet prayers, as every procedure, every test, was a battle—one of accepting the raw truth that this was what it had come to. Yet, somehow, through needles, through waiting, through fear, in each other, they found strength. It was no longer about having a baby; it was about fighting for the life they had dreamed of together.
And then one day in June 2024, they heard it—the soft cry of their daughter, now seven months old, born through IVF.
It wasn’t just a cry. It was the sound of everything they had dreamed of for so long. It was the sound of joy, of healing, of something finally falling into place. "Our miracle," Niranjan said, his voice thick with emotion, his eyes wet.
Slesha knew not how to explain it, this flood of relief and joy that washed over her every time she looked at her daughter. And yet, she still couldn’t shake the question that lingered: Would society see her as a miracle? Or would she always be something less than what others expected?
Slesha and Niranjan are just a case in point. Across Nepal, nearly 25 percent of couples struggle with fertility issues. In Nepali families worldwide, countless couples silently bear the burden of infertility on a journey lined with stigma, misinformation, and limited access to treatments. But for them, Nepal would be the place where hope turned into reality.
Video : Infertility's Silent Struggle
Infertility: A Rising Public Health Issue in Nepal
Infertility is more than just an individual struggle; it is an unspoken public health issue affecting couples across the globe. According to the World Health Organization (WHO)’s 2024 report, globally, approximately one in every six people of reproductive age experience infertility in their lifetime. The WHO has described infertility as a disease when a couple cannot conceive even after having unprotected regular intercourse for at least a year or when the couple is unable to carry a pregnancy to term. It is reported that 10-15 percent of couples experience infertility. The figure, however, is as high as 25 percent in developing countries like Nepal. The WHO categorizes infertility as a reproductive disease and elaborates that it affects both physical and mental health. About 8-12 percent of couples (approximately 60-80 million people) worldwide face infertility, making it a major health concern.
In Nepal, the issue of infertility is sensitive because expectations regarding childbearing are deeply rooted in the culture. Traditional concepts of gender roles put heavy pressure on women to conceive soon after marriage. Failure to marry young results in social exclusion, loss of status, and psychological torment. Early marriage worsens the condition. According to a 2024 report by NHRC and UNICEF, child marriage has affected 700 million women worldwide and 5 million adolescents in Nepal, out of which 1.5 million are below 15 years of age. Infertility, however, does not only plague women. Male infertility accounts for 40 percent of the cases, though this is not acknowledged because most societies consider discussing male reproductive capabilities taboo.
Infertility: Causes and Diagnosis
Varied biological conditions in either partner are responsible for infertility in a couple. Infertility is classified broadly into two groups: primary infertility, when conception has never taken place, and secondary infertility, when a couple fails to conceive after having one or more children. Other causes in women include ovulatory disorders, blockage of the fallopian tubes, and abnormalities in the uterus. Ovulation testing: This checks hormone levels to see whether a woman is ovulating. Hysterosalpingography: This is an X-ray test used to check whether the fallopian tubes are blocked. Laparoscopy: This is a surgical way of diagnosing by peering into the uterus for abnormalities. Hormone testing and ovarian reserve tests are also conducted.
In males, infertility can be due to low sperm count, poor sperm motility, or hormonal imbalance. The most important test to diagnose this disorder is semen analysis, which provides information about sperm count and quality. Hormone testing determines testosterone levels. Testicular biopsies are done for disorders related to sperm production. Ultrasound studies examine structural problems of the reproductive organs.
Causes of infertility also include environmental pollution, psychological stress, and lifestyle changes that may lead to infertility. Among the causes of infertility, air pollution, especially microplastic elements, has been found to be alarming. Recent studies show that microplastics can cause cell death, inflammation, and disruption of gut bacteria, leading to infertility, colon cancer, and respiratory problems. These particles, smaller than a grain of rice, are prevalent in various products and are harmful when inhaled or ingested. The NYTimes in 2024 published an article that said microplastics have been detected in several human tissues and fluids, including the lungs and blood. The research emphasizes the need for further studies on the health impacts of microplastics and ways to reduce exposure.
Psychological factors also play a role in infertility, including anxiety and depression. A study published in the Nepal Journal of Public Health reveals that women of reproductive age with fertility problems experience considerable anxiety and depression. The study emphasizes the importance of addressing the mental health aspect in managing infertility conditions.
Millennial youth are clueless about age-related fertility decli...
Moreover, alterations in lifestyle—particularly migration for jobs—have contributed to the rising infertility rate. According to the Journal of Nepal Medical Association published in 2022, the migration of individuals in their fertile years for job opportunities, along with lifestyle changes and increased pesticide use in crops, may be significant factors behind the increasing infertility cases in Nepal.
Infertility among Migrant Workers
Another important determinant driving fertility issues in Nepal is the growing number of Nepali migrant workers, particularly returnees from Gulf countries and Malaysia. The geographical and climatic conditions in which an individual is raised affect heat tolerance and sperm function. Generally, Nepalis are adapted to temperatures of 32-37 degrees Celsius, but in Gulf countries, temperatures can rise as high as 45 degrees. Over time, overheating in the testicular region may reduce sperm motility and impair spermatogenesis. In some cases, sperm count may drop to zero. Adding the heat exposure on top, hygiene factors, tensions at work, tight-fitting innerwear, and unhealthy way of life resulted in azoospermia, which shows up as 'no sperm at all' and has been driving males to an infertile state.
As per data provided by Paropakar Hospital, 40 percent of infertility cases are found among migrant workers, the majority of whom suffer from azoospermia. Dr Jwala Thapa, Fertility Specialist at Paropakar Hospital, says, "Many migrant workers endure harsh conditions including extreme heat exposure that significantly impact sperm production. Long-term exposure to such conditions increases the likelihood of male infertility."
Dr Jwala Thapa, Fertility Specialist
The working environments and habits take a great toll on the sperm quality through various factors such as extreme heat, toxic exposure, smoking, alcohol consumption. For that reason, in June 2023, Paropakar Hospital introduced the service of semen storing for migrant workers so that they could store their sperm before going for foreign employment. Although a number of private infertility centers in various parts of the country also provide the same service, often at a higher price, Paropakar remains the only government facility offering the service. These services, particularly due to their high cost and limited availability from a general perspective, have thus far made many couples experience it as unreachable. This exacerbates the affordability issue of fertility care.
IVF in Nepal: A Growing Trend
Dr Thapa states that IVF treatment in Nepal has greatly improved over the years. "The availability of trained human resources, experienced doctors, and embryologists has contributed to the development of the IVF sector. Better laboratory technologies and techniques such as laser hatching have helped enhance success rates."
Nepal has emerged as a destination for fertility treatment due to its affordability. Many Nepalis living abroad prefer to return home for IVF because Nepal offers reasonably priced treatment while maintaining high success rates.
While challenges regarding infertility persist, fertility treatments like IUI and IVF offer hope to numerous couples. Despite these advancements, the high cost of IVF remains a significant barrier. According to a blog published by Hardik IVF Center in 2024, a single cycle costs between Rs 200,000 and 300,000, a daunting figure in a country where the average monthly income is significantly lower.
Why IVF in Nepal Stands Out
What makes the IVF landscape in Nepal so unique is the predominantly high success rates, often reaching 60–70 percent, and even higher in some clinics. One key reason behind that? Quite simply, it is legally and commonly practiced to transfer two embryos per cycle, while in most countries, single embryo transfer is the norm. This increases the chances of conception, attracting both local and international patients seeking effective and low-cost treatment. But that also means running a greater risk of multiple pregnancies: a factor fertility specialists carefully weigh.
"Nepal's success rates are comparatively higher because we use double embryo fertilization—two embryos in the blastocyst stage or three in day-three transfers. This increases the chances of conception, whereas in other countries, single embryo fertilization is more common," Dr Thapa says.
"There's no fixed rule on how many embryos should be transferred," says obstetrician and gynecologist Dr Upama Basnet, Fertility Specialist at Vatsalya IVF and Fertility Center, "It depends on the patient's age, health condition, and medical history. We assess whether to transfer one or two embryos accordingly."
Dr Upama Basnet, Fertility Specialist
This has proven to be advantageous for fertility centers in Nepal, and most of them have good success rates. In December 2024, the success rate of Vatsalya IVF was reported as 74.79 percent due to this method, showing that Nepal has emerged as one of the destinations for fertility treatment.
Beyond IVF
Like many childless couples, the journey into parenthood for Sabina and Arbin was riddled with frustration, disappointments, and emotional strain. Arbin had spent several years working in Qatar, away from his wife Sabina, who faced challenges conceiving. After years of unsuccessful attempts to get pregnant, the couple began to feel the weight of their situation.
The infertility issue made Sabina's life stressful and emotionally draining. In her 40s, with the pressure of aging, she also gained weight, further impacting her confidence and self-esteem. Arbin's family added more pressure, suggesting that he remarry to have children, a culturally charged opinion that further increased the emotional strain on the couple.
Undeterred by external pressures, Sabina remained steadfast in her marriage and took control of her health. She went to a private clinic for counseling, and the doctor prescribed a course of medication. Miraculously, after she started taking the medication, when Arbin returned on a four-month leave, it worked. Within a few months of his return, she naturally conceived.
Dr Jamuna Kiran Paudel, an obstetrician and gynecologist at Ayu Superspecialty Clinic in Gatthaghar, says, "Sometimes couples go for IVF directly without proper consultation. A few couples have conceived naturally after the failure of IVF conception. So, education and consultation are necessary before jumping into such procedures."
Dr Jamuna Kiran Paudel, Obstetrician and Gynecologist
Other fertility treatments apart from IVF include those for male infertility, especially in cases of hormonal imbalance or physical obstruction. One such treatment is hormone therapy. Hormone replacement therapy, which has increasingly been applied in fertility clinics in Nepal, can help men facing low testosterone and other hormonal issues. According to Fertility Clinic Nepal, although studies on the efficacy of hormone therapies in Nepal are still in the early stages, many clinics report positive results, especially in cases of low sperm counts caused by hormonal imbalances.
Aside from hormone therapy, there are also options like sperm retrieval techniques, which can be helpful for men with blockages preventing sperm from being ejaculated. Treatments such as Testicular Sperm Aspiration (TESA) are increasingly available in Nepal, with many fertility centers citing success. TESA helps retrieve sperm from the testis, which can then be combined with assisted reproduction technologies such as IVF.
Medications that stimulate sperm production through oral intake are also common in Nepal. A blog by Clinic One says that these medications improve sperm count and motility, offering hope to men with poor sperm production. Results can vary depending on the cause of infertility; however, fertility centers report encouraging outcomes when these medications are used in conjunction with proper diagnosis and treatment.
Fertility treatments are ever-evolving in Nepal, with increasing access to more options for childless couples. However, while accessibility is improving, there is still a great need for increased awareness and further research into the specific effectiveness and success rates of these methods within the Nepali context.
The Stigma of Infertility in Nepal
The stigma surrounding fertility challenges often results in an experience of disempowering loneliness, as many women like Slesha and Sabina have realized. Despite medical reports proving that infertility issues can be due to the husband, it is often the woman who is blamed by in-laws and subjected to alternative remedies. “Nobody even thought it could be because of my husband. All whispers, all taunts, seemed to float towards me.” This deeply ingrained stigma in Nepali society pushes many women into silence, anxiety, and depression.
In Nepal, infertility is significantly stigmatized; most societies exclusively blame the woman for a couple’s childlessness, even though a considerable portion of infertility cases are due to male factors. This stigma has aggravated psychological distress, anxiety, and depression in sufferers, with the majority, mostly women, silently enduring these problems. Couples, especially in rural areas, often seek traditional healers instead of proper medical treatments. This societal silence regarding infertility issues heightens the emotional burden on families.
According to Dr Thapa, in rural Nepal, infertility is often linked to child marriage and high male migration, leading to delayed conception attempts. In urban areas, delayed marriage due to career priorities is a major factor. Experts believe that public education programs should be implemented to increase awareness about infertility and reduce the associated stigma. There is an urgent need for government intervention to make fertility treatments more accessible, especially for migrant workers who, despite being vital to Nepal’s economy, cannot afford the necessary treatment. The culture of silence and the lack of support further intensify the psychological strain; breaking this silence may help ensure better care for those suffering from infertility.
According to Dr Basnet, infertility treatments empower women by allowing them to take control of their reproductive health, challenging traditional norms, and promoting gender equality in family planning. "The increasing visibility of IVF success stories in the media has encouraged open conversations about infertility within families. The growing acceptance of infertility treatments has also played a role in changing societal views. In Nepal, infertility has long been stigmatized, often placing blame on women. However, IVF has helped shift the perception of infertility from a personal failing to a medical issue. Couples who openly share their IVF journeys have encouraged others to seek help, reducing social shame. While traditional beliefs still dominate in rural areas, urban societies are becoming more accepting of alternative family-building methods," said Dr Basnet.
Shifting Perspectives: Subfertility and Adoption as Paths to Parenthood
Dr Jamuna Kiran Paudel, an obstetrician and gynecologist at Ayu Superspecialty Clinic in Gatthaghar, believes that awareness must begin with a change in perception.
"Many couples experience fertility issues on their journey to parenthood, but that does not mean they cannot have a baby," she says, "With today's advancements in technology, medical treatments, and medications, it’s essential not to despair over fertility issues but to seek proper advice and treatment from doctors. With the right approach and support, having a child is possible."
Dr Paudel also notes that many people have misconceptions about fertility challenges, leading to unnecessary despair. She encourages couples to explore all available options, including advanced fertility treatments like IVF and IUI, emphasizing that the key is to remain hopeful and seek guidance when needed.
Beyond medical treatments, Dr Paudel introduces another dimension to the conversation: adoption. "I have visited Manav Sewa Ashram and seen babies abandoned by their parents at just two months old," she shares, "It is a sad reality that many children need homes, and couples facing infertility may consider adoption as another path to parenthood. Parenthood is not just about having a biological child; it’s about nurturing and giving a child a loving family."
#Interview
‘IVF acceptance in Nepal growing significantly in recent years’
As fertility treatments like IVF gain momentum in Nepal, a deeper understanding of the challenges surrounding fertility issues has emerged. In this interview with Republica, Obstetrician and Gynaecologist Dr Upama Basnet discusses the challenges, progress, and innovative trends in fertility treatments. From addressing financial and emotional hurdles to exploring emerging technologies and the future of fertility care, Dr. Basnet provides a comprehensive perspective on this vital aspect of modern healthcare in Nepal.
How has the acceptance of IVF evolved in Nepal over the past few years, and what role does it play in changing societal views on infertility?
The acceptance of In Vitro Fertilization (IVF) in Nepal has grown significantly over the past few years, reflecting societal changes, increased awareness, and improved access to medical technologies. Educational campaigns by fertility clinics and the media have helped improve public understanding of infertility and its treatments, reducing misconceptions about IVF. Medical advancements, such as the availability of well-equipped fertility centers in cities like Kathmandu, have made IVF more accessible, while technological progress and the presence of skilled professionals have increased trust in the procedure. Although IVF remains expensive, the introduction of competitive pricing and payment options has made it more accessible for middle-income families. Younger generations, especially urban couples, are more open to seeking medical help for infertility compared to traditional reliance on herbal remedies or spiritual practices. Additionally, legal and ethical support from the Nepalese government ensures patient safety and ethical practices, further building public confidence in IVF. By offering a solution to infertility, IVF strengthens families and challenges outdated societal judgments about childless couples. Despite these advancements, challenges remain, particularly in rural areas, where awareness and access to fertility treatments are limited.
Can you discuss the success rates of IVF in Nepal compared to global standards, and how have these improved over time?
In Nepal, the success rates of In Vitro Fertilization (IVF) have improved over the years, gradually aligning with global standards. However, success rates can vary depending on factors such as a woman’s age, individual health conditions, and the quality of the fertility clinic. Globally, the success rate for IVF is approximately 35-40% when a single embryo is transferred, whereas in Nepal, the success rate is around 60-70%, as two embryos are often transferred to increase the chances of implantation.
Several factors influence IVF success rates, including age, as younger women generally have higher chances due to better egg quality. Embryo quality also plays a crucial role, with high-quality embryos increasing the likelihood of successful implantation. Lifestyle factors, such as maintaining a healthy diet and avoiding smoking, can positively impact outcomes. Additionally, the expertise of fertility clinics, including the experience of medical professionals and the availability of advanced technology, contributes to treatment success. While Nepal’s IVF success rates have shown significant progress, individual outcomes still vary based on these factors.
What are the main challenges faced by couples seeking IVF in Nepal, both financially and emotionally?
Couples seeking IVF in Nepal face both financial and emotional challenges. Financially, IVF is expensive, and many couples require multiple cycles, which increases the overall cost. The lack of insurance coverage for infertility treatments forces couples to pay out of pocket. Those from rural areas also face additional costs for travel, accommodation, and food when seeking treatment in urban centers like Kathmandu.
Emotionally, infertility is stigmatized, with women often blamed for the inability to conceive. Couples undergoing IVF may feel immense pressure to succeed quickly, leading to heightened stress. The emotional toll of repeated cycles, hormonal treatments causing mood swings, and the fear of failure add to the mental strain. The stress can also strain relationships, with many couples choosing to remain silent about their struggles, resulting in isolation and a lack of support. Logistical barriers also exist, as fertility clinics are mostly concentrated in major cities, making access difficult for rural couples. Cultural and religious factors can also delay seeking treatment.
Are there any emerging trends or innovations in IVF treatment that are improving outcomes for patients?
Several emerging trends in IVF treatment are improving patient outcomes worldwide, including in Nepal. These innovations aim to boost success rates, reduce costs, and minimize the physical and emotional toll of IVF. One key development is the use of advanced embryo selection techniques like Preimplantation Genetic Testing (PGT), which screens embryos for chromosomal abnormalities, increasing the chance of successful implantation and reducing miscarriage risks. Personalized IVF protocols, such as Natural Cycle IVF, minimize hormonal medication use and are ideal for women with specific medical or age-related conditions.
Advancements in cryopreservation, particularly vitrification, have improved the freezing and preservation of embryos, eggs, and sperm, resulting in better success rates in subsequent cycles. Egg freezing is also gaining popularity as an option for women who want to delay parenthood. Other innovations like microfluidics are improving sperm selection by mimicking natural processes, enhancing fertilization rates. Techniques like Intracytoplasmic Morphologically Selected Sperm Injection (IMSI) use high magnification to choose the healthiest sperm for fertilization, further improving success rates.
Fertility preservation has grown in importance, especially for cancer patients. Oncofertility advancements allow individuals to freeze eggs, sperm, or embryos before undergoing chemotherapy or radiation. Mental health support is also becoming more common in fertility clinics, with counseling services and mindfulness programs to help patients cope with IVF’s emotional challenges.
Affordable IVF options like Mini-IVF, a low-cost, low-stimulation alternative, are helping reduce financial and physical strain. Telemedicine for IVF, offering virtual consultations and monitoring, is especially beneficial in Nepal, where travel can be a barrier. Additionally, emerging therapies like Platelet-Rich Plasma (PRP) therapy and experimental stem cell therapy are being explored to improve fertility outcomes, offering hope for more effective and accessible IVF treatments in Nepal.
How is the stigma around infertility and IVF changing, particularly among rural patients in Nepal?
The stigma surrounding infertility and IVF in Nepal is slowly changing due to increased awareness, education, and access to modern healthcare. However, cultural barriers remain, especially in rural areas. Media and education are helping people understand that infertility is a medical condition, not a personal failure. More couples are sharing their IVF success stories, which encourage open conversations. Fertility clinics and health organizations are also conducting outreach programs to educate rural communities about reproductive health. Younger generations, particularly those with better education and urban exposure, are helping break traditional taboos and embrace IVF.
Despite these positive changes, challenges persist. In rural areas, infertility is often blamed on women, leading to discrimination and domestic abuse. IVF is sometimes viewed with suspicion, and misconceptions about its ethical implications exist. Financial barriers also limit access to IVF, as many rural families see it as a luxury. However, in areas where IVF success stories are known, acceptance is growing. Women’s empowerment initiatives are helping individuals seek medical care without fear of judgment, and local leaders are contributing to changing perceptions. The younger generation, especially those with urban exposure, is less likely to view infertility as a moral failing, which is helping reduce stigma and make IVF more widely accepted. More efforts in awareness and accessibility are needed to further break the stigma and make fertility treatments accessible to all.
What do you see as the future of fertility treatments in Nepal, and how can access be improved for more people?
The future of fertility treatments in Nepal looks promising with advancements in technology and a shift in societal attitudes toward infertility. The adoption of techniques such as IVF, Intracytoplasmic Sperm Injection (ICSI), genetic screening, and cryopreservation methods like egg and embryo freezing are improving success rates. As fertility clinics expand to cities like Pokhara, Biratnagar and Chitwan, treatments will become more accessible. Collaborations with international organizations can enhance expertise and bring cutting-edge technologies. Research into Nepal-specific infertility causes could lead to more tailored and effective treatments.
However, the high cost of IVF remains a barrier. To improve access, subsidies, insurance coverage or government-supported programs are necessary. Policy-level support for public fertility clinics, regulation of treatment costs, and awareness campaigns to educate people about reproductive health are essential. Infrastructure development, particularly in rural and semi-urban areas, would reduce travel burdens for treatment. Training more healthcare professionals in fertility care and continuing education and awareness programs can help break societal taboos. Partnerships with NGOs and international organizations can offer financial aid and support for low-income families, making fertility care more inclusive and effective.
Dr Jamuna Kiran Paudel (Video Interview)
