26-year-old Baku native Nahid Ismayilov never imagined that his marriage would end in just a year and a half. Although the union was arranged by their families, the first months were quite happy and Nahid often expressed his desire to be a father. It wasn't long before the parents of the new couple also started talking about future grandchildren.

“My wife was a student and didn't want to be a mother yet. But I dreamed of becoming a father and even bought a 'test' from the drugstore several times to check. Seeing my enthusiasm, she went to the doctor and the gynecologist said she had no problems with fecundity,” Nahid says.

He notes that after that, he went to the doctor to see if he had any issues.

The doctor confirmed that Nahid had some issues that could affect his ability to have children. He received treatment for two months but it did not help.

Once it was determined that his wife did not have any issues, Nahid's mother-in-law started to blame him.

“This also damaged my relationship with my wife. Eventually, she told my mother 'your son is not a man' and this put an end to our relationship.” 

Nahid Ismayilov's divorce is not unique.

Infertility is a leading cause of divorce in the country, second only to domestic violence, according to Elgun Safarov, a representative from the State Committee for Family, Women and Children.

The latest study into male infertility in Azerbaijan, carried out in 2017, found several reasons for the problem including infections, stress, genetic factors and malnutrition. Smoking, alcohol consumption and drug addiction also play a role.

For the Mirzayev family, male infertility is much more than a statistic. Married for 10 years, 38-year-old Sahin and his wife Tarana desperately want a child. The couple, who live in Baku after being displaced during the Karabakh conflict, tried for years before finally seeking medical help for Sahin.

 “In the early years of our marriage, I received long-term treatment. I even went to different types of doctors and even unprofessional healers known in the community. My mother-in-law didn't see why Sahin should receive treatment. They said ‘He is a man, he has no problems, there are no infertile men in our family.’ But then Sahin went to the doctor and found out there was a problem,” 36-year-old Tarana Mirzayeva says. 

Sahin was recently diagnosed with sperm deposition disorder. Treatment has not helped yet and now the couple wants to try artificial insemination. 

“It is an expensive process; we do not have the means to pay for it. Hopefully, with God's help, the problem will be solved," Tarana says, noting that Sahin is still receiving treatment and the doctor is hopeful it may help.

"In any case, no divorce can ever take place. I can live without children, not without Sahin,” Tarana adds.

Tayyar Shukurov, a leading doctor of dermatology and venereology in Baku, notes that women often consult the gynecologist when couples have trouble conceiving, but men rarely seek medical treatment.

“However, male reproductive health problems increase every day," he says, noting that poor diets and the increased use of energy drinks and bodybuilding supplements play a role. "These are detrimental to men's health. Of course, when they get married, they go to the doctor, but it is very rare for boys to go to the doctor before they get married, check their sperm, check their seeds, and so on.” 

“Today, if we divide the causes of infertility between men and women, it is 50 and 50. Today's young people are not learning or educating themselves. Sometimes, at the age of 25, a man comes to me who has no idea about sexually transmitted infections,” Shukurov says. 

He adds sexually transmitted diseases are common among adolescents.

“This is a taboo issue in the family, especially in the provinces, and there is a reluctance to talk to young people [about reproductive health]. When there are no children, the woman is taken to the doctor, while they tell the man 'go to the mullah, do quackery’ and so on. All of this is the result of ignorance.”

Poor or incorrect treatment can damage the reproductive health of both men and women, notes urologist Vasif Ismayil.

He notes that many men still seek out a treatment that was popular over 70 years ago: injecting a silver protein solution into the penis.

“For example, a young boy is infected with a sexually transmitted disease. Doctors wash the channel with a silver solution. As a result, the channel narrows. And he is left defective for the rest of his life,” Ismayil says.

“If antibiotic treatment is now possible, it is incorrect to treat the issue using a method that was written in a book 100 years ago. True, patients like it, they say, ‘the doctor worked on me more,’ while [with antibiotics] ‘this doctor simply wrote a prescription.’ The patient wants to go to a doctor who washes canals. Therefore, this process is not being abandoned by our health system.”

The causes of men's infertility are far more complex than women, Ismayil argues.

“Either the problem comes from genetics, or there is a problem with the function of the testicle, and so on. We are not able to check every possible issue…because the costs are very high," he notes.

“This is not just about Azerbaijan. Women have many problems that can be prevented, and that is why women are more likely to be burdened [with getting treatment].”

Ismayil adds that unprotected sex plays a large role, especially in terms of human papilloma virus (HPV), which is also transmitted by men.

 “One of the most fatal diseases for women today is childhood cervical cancer, which has only been linked to HPV. A man gets the virus from somewhere, then he has an affair with another woman, ignores the warts on his sexual organs, and the woman is infected,” he says.

Ismayil recalls a patient, a fellow doctor, who did not treat his warts because he believed they increased his pleasure during sex. “He had a new family, and I asked him why he was infecting his wife? There are more than 30 types of these viruses, some of which cause cancer. If you have cancer, what if you lose your partner in five or six years from cancer?”

He notes that one in three of his patients are infected with sexually transmitted diseases due to unsafe sex.

“Some do not care. One of the protective means to reduce this risk is to use a condom. They rarely use one,” Ismayil says.