Medical and socio-cultural aspects of infertility in the Middle East

Abstract

The Middle East (ME), an area rich in history and tradition with >300 million population, includes 18 heterogeneous countries concerning resources, income per capita, available healthcare services, population density, growth rate, birth rate, total fertility rate and life expectancy. There is a high prevalence of infertility in the ME because of post-partum infection, unsafe abortion, iatrogenic tubal and pelvic infertility, tuberculosis, schistosomiasis and high incidence of male factor infertility. It is argued that in the ME, the solution to the problem of infertility is its prevention, and population control should take precedence over infertility treatment. However, for a successful family planning program and adoption of small family norms, couples should be reassured that they will be helped to achieve pregnancy should they decide so. Prevention and treatment of infertility are of particular significance in ME because a woman social status, her dignity and self-esteem are closely related to her ability to have children. Also there is gender suffering of infertility in the ME. One of the stumbling blocks to acceptance of assisted reproductive technology (ART) as a line of treatment of infertility was the unacceptability to the main religious groups of the involvement of a third party in the act of procreation. Practices of ART in the ME have many common features and little differences. A mechanism had to be found to provide low-cost ART to the needy.