We ask two doctors what you can do when you’re struggling to get your family started

According to a report by the United Nations, fertility across the UAE has been declining for a while. In fact, by the time we reach 2025, it’s projected to have declined by 75 percent of what it was in the 1970s. Another study found that men account for over 50 percent of cases of infertility thanks to lifestyle issues in the UAE. With that in mind, it’s time to talk about what all this means for your future of having a family.

From knowing the causes of infertility to finding the right clinic and procedures for you, we sit down with two Abu Dhabi experts to find out all you need to know about IVF and beyond.

Finding the source

Reasons for infertility are complex, and they might manifest in one or both members of a couple trying to conceive.

“There are several reasons why infertility can occur,  and there are different causes in females and men,” notes Dr Yasmin Sajjad, consultant of obstetrics and gynaecology and reproductive endocrinology at Burjeel Hospital.

“In females, it could be blocked tubes where fertilisation happens,” she explains. “The woman might not be ovulating properly, or it could be hormonal problems and irregular menstruation. There might be problems with the womb, including lumps or fibroids, or there might be infertility as a result of endometriosis. It could also be your age, or it could be something like polycystic ovarian syndrome. In ten to 20 percent of cases, we might not find the cause and it could be unexplained.”

Michael Fakih, medical director of Fakih IVF Group

Dr Michael Fakih, medical director of Fakih IVF Group and consultant of obstetrics and gynaecology and reproductive endocrinology and infertility, agrees, stressing the need for a full history and work-up: “We have to make a full diagnosis to know what the problem is before we can advise. This might entail blood tests, or minor procedures such as looking inside with a scope.”

But that’s only half of the equation, says Dr Michael – it takes two to make a baby and the men are just as important as the women.

“Sometimes I see patients who have been having treatment for two years before they come to me,” he notes. “They’ve taken medication, and had surgery, but the husband has never been checked for a sperm count – but over 50 percent of problems we see in the UAE are caused by male infertility, so it is important that they get a work-up.”

Knowing the process

After you’ve gained a better sense of what’s going on biology-wise for you and your partner, it’s time to discuss what comes next.

With many options available from assisted conception to in-vitro fertilisation, your doctor will be able to advise what’s best for you depending on the results of any tests carried out.

Dr Yasmin Sajjad, consultant of obstetrics and gynaecology and reproductive endocrinology at Burjeel Hospital

“Initially, we’ll help with ovulation induction and see if the tubes are open,” Dr Yasmin explains. “The second step is intra-uterine insemination, where we take the sperm out and inject it directly into the womb at the point of menstruation. We can try two to three cycles of this; that is the maximum success rate. If that doesn’t work, we move onto the last step: in-vitro fertilisation, or IVF.

“In simple terms, IVF means that the eggs are taken out of the woman under ultrasound and anaesthetic guidance,” Dr Yasmin adds. “The egg is then fertilised with a sperm outside of the body and an embryo is created, which is implanted back into the uterus.”

One of the key restrictions to IVF is age, particularly for the woman.

“Our biggest enemy as fertility specialists is the woman’s age,” says Dr Michael. “In general, after 35, female fertility begins to decline, and it’s drastic by 40. At age 42, we have a cut-off; less than five percent of women get pregnant.”

Other restrictions, says Dr Yasmin, include pre-existing conditions that might endanger the patient’s life.

“If other medical problems such as cardiac problems, hypertension or diabetes do exist, then we do not always advise it. That’s when we work with other consultants to ensure these conditions are controlled before we go ahead,” Dr Yasmin comments. “Above all, my priority is the safety of  the patient.”

In the UAE, there are also other rules to consider: “There are restrictions present here that are not in other countries,” Dr Michael says. “You cannot use donor eggs, and you cannot use frozen embryos.”

IVF is considered an invasive procedure, and while the process can be taxing on the body, Dr Michael advises his patients that it’s tough on the mind, too.

“The invasive part isn’t always so much about the surgical part as it is about the emotional part,” he says. “Extracting the egg is actually very simple, as is the actual transfer of the embryo, but it can take up to three weeks to complete an IVF cycle.

“For the woman it means daily injections, which need to be monitored closely. It’s a very hard journey and that is the reality of the treatment.”

Dr Yasmin agrees: “It’s an emotional rollercoaster. Patients go through a lot of ups and downs – that’s why we have a lot of open discussions with our patients on their expectations.”

The rate of success

Open discussion is especially needed when it comes to getting an idea of how successful the treatment will be. With many clinics boasting high numbers, it’s important to know what to expect.

“The patient comes to me to take their baby home, not to get them pregnant,” Dr Yasmin acknowledges. “We are upfront with patients on their expectations.

“The success rate is based on three stages: the chemical pregnancy, the clinical pregnancy and the live birth,” she explains. “The chemical pregnancy is tested by a blood test. The clinical pregnancy is when we see the baby’s heartbeat, and the final step is live birth.

“Many centres advertise their success rates as around 70 to 80 percent in women under 35, but this figure relates to the chemical pregnancy stage. The reality is that 20 to 25 percent of chemical pregnancies do not progress, while on an international level, the live birth figure from IVF is not more than 40 to 45 percent of pregnancies.”

Dr Michael agrees, advising potential patients to exercise a little caution in their research: “There’s no way to publish proper success rates – there might be places that publish theirs on social media, but these are not substantiated. Don’t believe everything you read.”

Choosing your doctor

With so many clinics across the UAE, it can be daunting to lay your trust in one person’s hands to help you and your partner start a family.

“Many fertility problems may not need to be treated in a designated clinic – if you’re young and still have time, you can go to a gynaecologist for initial treatment, testing and advice,” says Dr Michael. “If that approach fails, then you can progress to the clinic. However, if you are over 38 years of age, I recommend that you go straight to a fertility clinic for treatment.”

So how can you know what clinic is right for you? It’s a little bit of gut feeling and a little bit of education, says Dr Yasmin: “What’s important is openness and the explanations offered by the doctor. If patients are choosing a clinic, they should do so on the basis of the way the doctor explains the process, as well as considering their data and gut feeling. You need to be comfortable with the doctor and you need to be able to understand every step of the process.”

For Dr Michael, peer advice and being able to ask friends about their experiences is invaluable: “The best way is to talk to your friends who have undergone fertility treatment,” he notes. “They will be the best people to tell you the way in which they were treated and give you a sense of the success rate.”

Need to know

Burjeel Hospital Corner of Fatima Bint Mubarak and Hazza Bin Zayed Streets. Contact: 02 508 5555, burjeel.com

Fakih IVF Hazza Bin Zayed Street. Contact: 800 32544, fakihivf.com

HealthPlus Fertility Hazza Bin Zayed the First Street. Contact: 02 643 3494, hplus.ae

IVI Middle East Fertility Clinic Villa B22-23, Marina Village, behind Marina Mall. Contact: 02 652 8000, ivivf.com

WORDS Camille Hogg