A closer look at infertility rates, fertility treatments and the path to pregnancy

Many couples are seeking fertility treatment sooner – but it does not imply rising infertility rates.

The number of couples entering parenthood is falling, but statistics show there is more to it than fertility issues. Getty Images

Being a parent is hard work, but for some, the hardest part is conceiving a child in the first place. The birth rate in the UAE has been declining and as more people seek help to conceive, some doctors say there are rising infertility issues as well as significant changes in the social makeup of the country.

One in five couples in the UAE face fertility issues, according to a recent study conducted by Aster DM Healthcare, which also projects that the number of women in Dubai seeking treatment annually will almost double, from an estimated 5,975 in 2015 to 9,139 by 2030, based on predicted population growth rates.

It is important to distinguish between fertility rate and infertility. The former is the total number of children born per woman and while it may drop, it does not necessarily mean more women are infertile. Infertility is defined as a failure to achieve a clinical pregnancy after 12 months of trying.

According to data from the World Bank and the United Nations, the fertility rate in the UAE dropped from 6.9 in 1960 to 1.8 in 2014. During the same time it dropped from 7.09 to 2.06 in Bahrain, and 7.2 to 2.8 in Saudi Arabia. The UAE figures do not account for demographical changes in that period, when huge numbers of expats moved to the country but may have decided not to have children here. It also does not necessarily indicate more people are infertile. The drop could be linked to the availability of birth control and the fact that more women, especially Emiratis, are pursuing careers, which may result in them leaving motherhood until later in life, and therefore have fewer children in total.

But along with a declining birth rate, some doctors say they are witnessing an increase in infertility issues.

According to Dr Gautam Allahbadia, head of the Aster IVF & Women Clinic in Dubai, and IVF (in vitro fertilisation) consultant, infertility is being diagnosed more often nowadays due to the increased incidence of endometriosis (a disorder of the female reproductive system), multiple miscarriage concerns, ovulatory disorders and polycystic ovary syndrome. “Age, obesity, life pressures and hormones all play a part in infertility, although polycystic ovary syndrome and obesity are the bugbears of fertility in the UAE.”

The problem also affects men, he says, with a low sperm count in men being “one of the most common issues” which causes infertility in his patients. A low sperm count can result from a hormone imbalance or genetic issue, or certain types of medications. Smoking, excessive drinking and drug use also causes a drop in healthy sperm.

Some doctors say there are other factors causing people to seek fertility treatment even though they are not infertile.

Dr Limia Ibrahim, specialist in obstetrics and gynaecology and reproductive endocrinology at Burjeel Hospital in Abu Dhabi says she finds couples often seek help earlier in the process, leaving less chance to conceive naturally within a year. “Ability to select the gender of the child and to have foetal screening for some diseases before conception [is possible] with IVF,” she says. “Fertility treatment is more affordable now and in the UAE, is highly supported by the government.”

She says infertility is rising in the UAE as much as it is globally, and that there are other factors influencing the declining birth rate including rising levels of female education, stressful lives, and the need for parents to provide a good quality of life for their children and are therefore opting to have fewer.

Despite anecdotal evidence and declining birth rate, the World Health Organisation says there has not been an increase in infertility. In a 2014 study that examined infertility prevalence since 1990, the authors said aside from the population growth and a worldwide decline in fertility rate – the preferred number of children – “we found little evidence of changes in infertility over two decades”.

Dr Shiva Harikrishnan, head of obstetrics and gynaecology at Medeor 24x7 in Dubai, said couples may seek help conceiving simply because they do not want to “waste time”. “Many tend to take treatment quicker than before. It is not because infertility treatment is affordable but awareness about infertility and treatment options is greater now.”

But fertility treatment is not without its risks. Many women taking the medicines used during IVF will experience headaches, mood swings and hot flushes. There is also a much greater chance of multiple births depending on how many embryos are implanted in the womb. This raises the risk of miscarriage, pre-eclampsia and gestational diabetes.

One Dubai woman, who married at 31, opting to focus on her studies and career, knows the challenges involved with becoming pregnant in her late-30s. The 38-year-old expat, who asked for her name to be withheld due to the sensitive nature of the pregnancy, says she and her husband knew the path to conception may not be easy. “When we tried to conceive naturally, it occurred to us that I had developed polycystic ovaries, which was a hindrance along with my age [35],” she adds. “My gynaecologist referred us to a fertility specialist.” The couple admit they were “pretty unsure” about the IVF process, but the doctors and staff were supportive from day one. “When I couldn’t conceive, I was questioned [by my friends and family] about why I hadn’t planned my pregnancy. I was ridiculed for choosing career over motherhood.”

Fortunately, the treatment worked and the couple will welcome a baby later this year.