"It seemed everyone around me, all my friends, were having children," Sharif Halimov recalls, "but my wife couldn't get pregnant."
Traditionally, the solution to the Tajik man's fatherhood dilemma has been a simple one -- find a new wife.
But while the truth was tough to handle -- the 36-year-old military officer admits "his masculinity was hurt" when it was first suggested that he, not his wife, was likely responsible for the couple's infertility -- Halimov is glad he listened to the doctor.
Thanks in part to medical treatment, Halimov and his wife now have plenty of mouths to feed: Nargis, their biological 1-year-old daughter; and 5-year-old Nafisa, whom the couple adopted from a Dushanbe orphanage.
"I think no one here has my patience. I went to many doctors, I tried traditional medicine, and I also prayed to god," he says.
Halimov admits that his life in the military, in which he and his family are constantly on the move, helped immensely when it came to dealing with what he describes as a "demoralizing" problem. Life on isolated military compounds -- far from the prying eyes of relatives and neighbors -- provided him and his wife the privacy they needed to buck tradition.
One in five marriages in Tajikistan is affected by infertility. But with male infertility a nearly taboo subject in its traditional society, such problems are more likely to result in a divorce initiated by the man than a medical solution.
Physician Akbarsho Ahmedov is out to change that.
It Takes Two
In "The Structure and Details Of the Clinical Course Of Infertility In Tajikistan," billed as the first scientific study looking into infertility issues in the country, Dr. Ahmedov says that men are to blame nearly half the time.
"In our society, where families have multiple children, it has become a psychological trauma for men," Ahmedov says. "It's a social [stigma]. In infertile couples, men usually send their wives to doctors to seek treatment, telling them, 'It's your fault.' But in reality, in 50 percent of the cases, men are the reason behind infertility."
Low sperm count, abnormal sperm morphology, and low sperm motility are among the major infertility issues caused by male partner, Ahmedov says, noting that infections, childhood diseases, and immune-system abnormalities can also play a role.
Treating the issue as a "health problem" which, in many cases, can be cured with proper medical treatment, is key to finding solutions that could perhaps save marriages.
'Wouldn't Cross Anybody's Mind'
Ahmedov says nearly one in four of his male patients seeking treatment for infertility has at least two failed marriages behind him.
Zuhrabonu Imomova, a lion-minder at the Dushanbe Zoo, says her first marriage fell apart because she failed to get pregnant. Imomova describes the last several years of the marriage as "nightmare," because her husband and her in-laws blamed her for the childless home.
"It wouldn't even cross anybody's mind that it could be my husband fault," Imomova says. "We don't think like that."
Her husband went on to marry another woman, while Imomova -- "convinced and resigned to being infertile" -- left her native southern town of Kulob. Imomova says she remarried after 10 years, and had her first child a year later.
Imomova regrets "wasting many years" believing that only women are responsible for infertility.
The doctor, Ahmedov, says there are signs that Tajik men are becoming more open about infertility problems. The doctor says an average of about 100 male patients visit him every month.
"It is important for men to know that their visits to doctors remains secret, and we reassure them about doctor-patient confidentiality," Ahmedov says.