Reproductive Aging, Clinical Authority, and Family Expectations in Urban Pakistani Fertility Clinics

• In Event: Medical Sociology Section Roundtables
  In Refereed Roundtable (90 minute): Table 3. Reproductive Health

Abstract

Infertility in Pakistan continues to be impacted by delayed childbirth, the widespread use of assisted reproductive technology, and persisting gendered norms regarding motherhood. This qualitative study examines the development, interpretation, and handling of infertility in women aged 35 and above, referred as “advanced maternal age" who visit fertility clinics in Rawalpindi. The study considers reproductive aging not just as a biological decline, but as a socially controlled life-course shift that is medicalized within clinical authority, screening methods, and institutional procedures.
Fertility clinics in Rawalpindi were chosen using purposive sampling, and in-depth semi-structured interviews were conducted with twenty-one infertility specialists, including gynecologists and nurse practitioners. The expert-centered design enables the study of clinicians' perspectives on age-related infertility, utilization of biological risk categories, and the development of treatment pathways. Thematic analysis of interviews was carried out to examine how medical discourse redefines reproductive aging as a medical problem and shifts responsibility among male and female partners. Research shows that reduced ovarian reserve, hormonal decline, and reduced oocyte quality are frequently cited as clinical signs supporting early intervention through assisted reproductive technologies, such as In Vitro Fertilization (IVF) and Intracytoplasmic Sperm Injection (ICSI). Despite the increasing acceptance of male-factor infertility amongst practitioners, women over 35 continued to be the main subject of assessment, pressure, and social accountability. Aging operates simultaneously as a biological reality and a culturally enforced reproductive pattern, increasing stigma and accelerating biomedical intervention. This study advances medical sociology by demonstrating how reproductive aging is institutionalized in fertility clinics, turning life-course variation into a medically managed condition requiring technological intervention. The paper presents infertility as an issue that is categorized by age, gender-specific, and subject to medical regulation in urban Pakistan by integrating theories on medicalization, gender stratification, and aging.

Author

• Momna Rani, University of North Texas