A controversial healthcare issue that is always making the rounds in society and amongst people is who to blame when a couple cannot conceive a child. In most cases it is because either one or perhaps even both partners are infertile. Infertility primarily refers to the biological inability of a person to contribute to conception, but may also indicate the state of a woman who is unable to carry a pregnancy to full term. In reality, the female partner is often labeled with being infertile if the couple cannot conceive. Dr. Hisham A. Arab heads the Dr. Hisham Arab medical center in Jeddah and is a consultant Obstetrician, Gynaecologist and Perinatologist (An obstetrical subspecialist concerned with the care of the mother and fetus at higher-than-normal risk for complications) who has been leading - for the past 15 years - treatments for infertility and assisted reproduction. “The category of patients approaching infertility centers has become apparent and recognizable,” remarked Dr. Arab, in an interview with Saudi Gazette. “Most couples come expecting to hear that they cannot conceive because the woman is infertile, but it is usually the other way round and the man is infertile. In these cases we need an Andirologist (a physician-scientist who performs clinical evaluations of male fertility) and these days, those specialists are usually affilitated with fertility treatment centers working with in vitro fertilization (IVF).” “There are also cases where women are infertile - called primary infertility - but surprisingly, in most cases there is nothing wrong with either the man or woman and after conducting all possible investigations, we realize that the couple is still able to conceive and the delay in being able to do so is inexplicable,” he added. “50 to 70 per cent of infertility cases are due to the man, contrary to what society believes, and a much smaller percentage is because of the woman,” concluded Dr. Arab. The investigations themselves are vastly different for the man and woman with Dr. Arab stating that he asks a couple to undergo different tests; the man is asked for a semen analysis, while the woman undergoes levels of hormonal investigations. While the Urologist sets about examining the man's semen analysis, the woman has to undergo an ultrasound of her pelvic area to ensure that her uterus and ovaries are normal, after the hormonal tests. Alternative medicine Some people also believe that herbal and traditional medicines will help in conceiving, particularly when conventional medicine has failed. “The whole situation is related to God's will. I am a scientific person who has been trained on trial and error and in treating patients with the most up-to-date procedures, so I don't advise people to undergo herbal or traditional treatments,” stated Dr. Arab. “However, I have seen cases that have been treated with IVF and failed, but within six months, a couple have been able to conceive without taking any kind of medication.” What is IVF? IVF is a process by which egg cells are fertilized by sperm outside of the womb (in vitro). It is a major treatment in infertility when other methods of assisted reproductive technology have failed. The process involves hormonally controlling the ovulating process, removing ova (eggs) from the woman's ovaries and letting sperm fertilize them in a fluid medium. Though there is no guarantee that the procedure will work, the chance to have better ovulation and therefore, get pregnant, is high. “The IVF treatment is about 30 years old and I have never succeeded with anything else. It remains the only chance available to couples today. The technique itself has been upgraded, but currently, there are no signs that it will be changing any time soon,” said Dr. Arab. He added that there was no point in comparing with the West since IVF is flourishing over there largely because women are buying donor eggs from other women, which is unacceptable in Islam. In reply to widespread claims that infertility treatment is charging exorbitant amounts of money and reaping profits, Dr. Arab said that the treatment itself was an expensive one. “One injection costs 270 Saudi riyals and a patients requires 20 to 30 of such injections,” he explained. “It is not the doctor who charges this much, but rather the companies that produce them and which gain governmental approval for them.” How successful is IVF? Dr. Arab claimed that the IVF success rate ranged between 45 and 50 per cent, but the woman's age is the deciding factor. A young woman in the early twenties, for instance, has a 70 per cent chance for success but this figure goes down to 20 per cent for a woman in the forties. “The ovulation induction procedure is very important, and there are a lot of doctors who have not specialized in doing this treatment,” he added. “I would like to stress that such treatments should only be conducted by specialized doctors, as the risks of not doing the treatment properly are high.”
