The recent World Contraception Day, marked on September 26 under the theme “A choice for all. Freedom to plan, power to choose,” serves as a reminder of the often-overlooked issue of infertility. This global struggle affects millions of couples, posing a significant challenge to reproductive health. The World Health Organization (WHO) defines infertility as the failure to conceive following at least 12 months of regular, unprotected sexual intercourse, pointing to the need for equitable access to reproductive health care and family planning for all.
In terms of numbers, the World Fertility and Family Planning 2020 report shows that worldwide fertility fell from 3.2 to 2.5 live births per woman from 1990 to 2019. Furthermore, the WHO states that one in every six persons globally was infertile as of April 2023. Although infertility is considered a challenge, it can be treated with medicine, surgery, or assisted reproductive technologies such as in-vitro fertilization (IVF), in which an egg and sperm are fertilized in a lab dish and transferred to a womb as an embryo.
UAE’S RISE AS AN IVF HUB
Since the world’s first successful IVF birth in 1978, fertility medicine has made tremendous progress, giving individuals and couples new opportunities to realize their dreams of having a family. This remarkable progress instils hope and optimism, especially in the UAE, where the IVF market was valued at US$231.57 million in 2021 and is predicted to grow at a CAGR of 9.64% over the forecast period.
Given the increased awareness of the importance of early detection, the UAE adoption of IVF to produce healthy infants with the option of family balance has had a favourable impact on the UAE’s IVF industry. This has established the UAE as a leader in providing IVF services, with major hospitals such as ART Fertility Clinics Abu Dhabi, King’s College Hospital Dubai (KCH), American Hospital Dubai, Orchid Fertility Clinic, First IVF Clinic, and M42 Group’s HealthPlus Fertility & Women’s Health Center.
THE HIDDEN COST OF TRADITION
Infertility among women is highly prevalent in the UAE, with an estimated 90% of cases linked to vitamin D deficiency due to limited sun exposure. In cities such as Dubai, Abu Dhabi, Sharjah, and Al Ain, many Emirati women traditionally wear burqas or abayas outdoors, significantly reducing their exposure to sunlight. This lack of sun exposure limits the body’s production of vitamin D, a critical nutrient that influences the antiMullerian hormone (AMH), which is responsible for maintaining both the quantity and quality of eggs. Additionally, insufficient vitamin D levels may elevate cholesterol levels in women, adding further complications to fertility and pregnancy.
Obesity and secondary infertility are other leading causes of infertility in Emirati women. According to the UAE’s 2017-2018 National Health Survey, 67.9% of persons aged 18 to 69 are overweight or obese. In women, obesity results in decreased uterine receptivity and poor egg quality. Secondary infertility, which occurs when it is difficult to become pregnant after conceiving for the first time, is also common.
UNDERSTANDING THE INFERTILITY JOURNEY
For many couples, the journey to parenthood begins with the painful reality of infertility.The emotional toll is significant as couples endure a series of medical tests, consultations, and difficult decisions. This understanding and empathy are crucial in supporting couples through their IVF journey. According to Dr. Nadia Najjari, a Consultant in Reproductive Medicine and Infertility at HealthPlus Fertility Center, part of the M42 group, IVF is more than just a medical procedure; it is a shared experience requiring resilience and determination.
“Infertility is more common than many realize, and it can be an emotionally and physically challenging experience. The journey can be overwhelming, filled with medical appointments, tests, and tough choices,” explains Dr. Najjari.
THE IVF PROCESS EXPLAINED
IVF is a multifaceted process that involves collecting mature eggs from the ovaries and fertilizing them with sperm in a laboratory. Typically, the entire IVF cycle takes about four to six weeks, starting from the administration of fertility medication before egg retrieval until the patient is retested for pregnancy. Once fertilisation occurs, the embryo is transferred to the uterus, and pregnancy is established if it successfully implants into the uterine wall.
For women, IVF demands a significant physical effort, as it requires daily hormone injections and an egg retrieval procedure. This stage can be physically taxing, making emotional support from partners, family, and friends essential. In contrast, men may experience fewer visible physical challenges, but their role is equally crucial as they provide the sperm for fertilization, and in cases where male infertility is a factor, advanced treatments are available. The newly opened HOWA Men’s Health Clinic at HealthPlus Fertility offers personalized and compassionate care to men, aiming to optimize fertility outcomes for both partners.
THE POWER OF NUTRITION
Alongside medical interventions, adopting a healthy lifestyle plays a crucial role in the success of IVF treatments. A well-balanced diet is vital, as it provides essential nutrients, minerals, and vitamins necessary for optimal egg and sperm production, which increases the chances of a successful outcome. Moreover, consuming nutrient-rich foods nourishes the eggs and uterus, promotes timely ovulation, supports the womb, and slows egg degeneration. By aiding egg health and maintaining balanced reproductive hormones, such a diet helps protect cells and boosts the likelihood of pregnancy.
HOPE FOR MANY, NOT ALL
IVF is a common treatment for infertility, particularly for those over 40. This procedure is also a viable option for those facing conditions such as diminished egg reserve, ovulation disorders, endometriosis, fallopian tube damage or blockages, uterine fibroids, or certain genetic disorders. Additionally, it can benefit individuals who have undergone past surgeries to prevent pregnancy or those affected by male infertility factors like low sperm count or quality. However, while IVF offers a significant pathway to overcoming infertility, it is essential to note that success rates can vary depending on factors such as age, health, and the cause of infertility. It is not recommended for people with large fibroid tumours, severe ovarian dysfunction, or morbid obesity.
EXPANDING HORIZONS OF FERTILITY
Beyond traditional IVF, advances in fertility preservation and genetic testing offer couples even more options for family planning. Techniques such as egg, sperm, and embryo freezing allow individuals to delay parenthood if they are not yet ready to start a family. Additionally, for those undergoing treatments that may impact fertility, such as cancer therapy, options like ovarian and testicular tissue cryopreservation are proving invaluable.
“Ovarian tissue cryopreservation and transplantation are vital fertility preservation methods for adult cancer patients who need immediate chemotherapy,” explains Dr. Wael Ismail Madkour, a Fertility & Reproductive Endocrinology (IVF) Consultant at HealthPlus Fertility Center. He adds that ovarian tissue freezing is currently the only method available to preserve fertility in prepubertal cancer patients, giving cancer survivors the future opportunity for motherhood.
Meanwhile, advancements in genetic screening have significantly improved IVF success rates. By identifying and selecting embryos without genetic abnormalities, doctors can increase the likelihood of a healthy pregnancy. Dr. Najjari highlights that transferring a single genetically normal embryo can lead to a success rate of up to 70%, while transferring two embryos may increase this rate to 80%. However, she cautions that transferring multiple embryos raises the risk of multiple pregnancies, which can be more complex and is generally not recommended.
DISPELLING THE MYTHS
Despite the growing acceptance of IVF, several misconceptions persist. Many still perceive infertility as primarily a women’s issue, though WHO reports male factor infertility, which can be caused by disruption of testicular or ejaculatory function, as well as by hormonal and genetic disorders contributing to nearly half of all cases. Additionally, many people believe IVF guarantees success, but while it significantly improves the chances of pregnancy, it does not work for everyone. IVF can also be costly, but there are various financial support systems available to help couples manage the expense.
NAVIGATING THE ETHICAL MAZE
As IVF continues to gain popularity globally, the United Arab Emirates has taken steps to regulate this growing industry with significant policy updates. In June 2024, the UAE updated Federal Law No. (7) of 2019, which concerns medically assisted reproduction, to permit unmarried non-Muslim couples to undergo IVF. This amendment also removed the previous restriction that prohibited the use of surrogate mothers, and the country has relaxed its laws on embryo freezing, which was once banned in the Gulf nation. Nevertheless, the law still mandates that only a husband can be the sperm donor, and only the wife can provide the egg for IVF procedures.
Meanwhile, the landscape surrounding reproductive rights remains contentious in the United States, where the issue is increasingly tied to the debate over abortion. In February 2024, the Alabama Supreme Court ruled that frozen embryos are considered children, which meant that anyone who accidentally destroys them could be held liable. This has placed the future of IVF treatments in Alabama in question; several healthcare providers in the state have suspended their IVF services, while some antiabortion advocates support the decision, arguing that embryos should be granted more robust legal safeguards.
DESIGNING THE FUTURE OF FAMILY
Despite these legal challenges, the field of fertility treatment is evolving rapidly, with innovative solutions offering hope to those struggling to conceive. Emerging technologies, including IVF-on-a-chip and digital microfluidic processing, promise to streamline traditional IVF methods, making them more efficient, effective, and affordable. Additionally, developments in bioprosthetic ovaries could restore reproductive function, providing new possibilities for women who have lost their natural fertility. For a sustainable future, it is crucial to address ethical considerations, enhance accessibility, and create supportive regulatory frameworks surrounding IVF to enhance the benefits for individuals and society.
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