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When Louise Joy Brown was born in 1978, little did she realise that her birth would pave the way for millions of women who could otherwise never get pregnant to become mothers. Louise's mother suffered from years of infertility before conceiving her through a process that was then unique and still under experiment — in vitro fertilisation (IVF). More than 30 years later, hundreds of thousands of women have undergone various advanced assisted-conception treatments, including IVF, and many have been blessed with healthy babies.

Stressful experience

The arrival of a baby is a wonderful experience, but at times it can be psychologically daunting for couples to cope with the stress of conceiving. Infertility is a problem that is increasingly striking couples worldwide for a myriad of reasons. The emotional burden that accompanies the gruelling process of infertility treatment can sometimes appear enormous to couples: it calls for patience and a lot of mental strength to undergo the whole process of treatment.

Joanna Friedman (35) and her husband Kirk (37), Dubai residents for five years and proud parents of two-year-old Hannah, agree. "Since I had endometriosis I knew it would be difficult for me to conceive, but I never thought I would not be able to get pregnant naturally at all.

"Without wasting time, I approached a fertility expert and upon his advice I straight away went for IVF treatment. Thankfully, I conceived after one cycle, but I must say it was a terrible emotional roller-coaster ride, specially the two weeks wait after the embryo was implanted. The whole process made us realise what a miracle the making of the baby can be," says Joanna.

If couples can manage these psychological issues, assisted-reproductive techniques (ART) can help women who can't conceive naturally. Concerns over infertility are rising in the UAE as well, like any other urbanised society. Though exact statistics is not available, it's estimated that one in six couples now need assisted conception to become parents.

A number of fertility clinics across the UAE, both private and public, offer treatments ranging from a simple ovulation induction to a more complicated IVF and intracytoplasmic sperm injection (ICSI).

New facilities are also opening across the country. Couples in Dubai can soon get treatment at Bourn Hall Clinic founded by the Nobel Prize-winning physician Robert Edwards, who pioneered the reproductive technology of IVF and was behind the birth of Brown. "Many UAE residents travel abroad for the treatment. We will bring quality infertility services to Dubai, as the journey towards parenthood for the sub-fertile is painful enough without the added stress of travel into a foreign environment," says Dr Mike Macnamee, CEO of Bourn Hall Clinic.

GN Focus probes the issue of infertility to find solutions and treatment options that couples can explore in the UAE.

What is infertility?

When a healthy couple fails to conceive after 12 months of regular sexual intercourse without use of contraception, they are diagnosed as infertile.

Studies indicate that over half of all infertility cases are due to some disorders in women while the rest are caused by either sperm disorders in men or unidentified factors.

When to seek advice of a fertility expert?

A couple should ideally approach a fertility expert after one year of attempting to conceive, says Dr Thura Lutfi Mustafa, Specialist Obstetrician and Gynaecologist, Medcare Medical Center, Mirdif City Centre.

But if a woman is more than 35 years old, she should seek the advice of a specialist after six months of trying to conceive, as the chances of conception decrease from the mid-thirties onwards. Women can also consult fertility specialists earlier if they have other symptoms such as irregular or painful menstruation cycles, recurrent vaginal discharge with suspicion of pelvic inflammatory disease, or if they undergo recurrent miscarriages.

Causes of infertility in the UAE

"The leading cause of infertility among women in the UAE is polycystic ovarian syndrome (PCOS), an endocrine problem. However, we are also seeing more female patients with poor ovarian reserve," points out Dr Husnia Gargash of the Sharjah-based Dr Husnia Gargash Fertility Gynaecology and Obstetrics Centre. While for men, the infertility is mostly due to non-obstructive oligospermia or a low sperm count.

Studies show that more than 10 per cent of women of childbearing age suffer from PCOS and most of them aren't aware of it until they attempt to conceive. Dr Mustafa explains that PCOS cause irregular menstrual cycle and issues with ovulation (or anovulation), which often delay conception.

Pelvic inflammatory diseases, another cause of infertility, damage fallopian tubes and subsequently affect conception. "About 15 in 100 women who haven't been able to conceive have damaged or blocked fallopian tubes. Due to this condition, the eggs and sperm cannot meet to get fertilised," says Dr Anna Sepiolo, Specialist Obstetrician and Gynaecologist, Dubai London Clinic.

Endometriosis, fibroids, thyroid, renal illnesses and diabetes can also lead to infertility, as can delayed marriages, stress, lifestyle changes and unhealthy diets of couples.

Dr Sepiolo points out that there are many couples who suffer from unexplained infertility: despite having normal ovulatory cycles, healthy sperm count and patent fallopian tubes, they often fail to conceive.

Treatment options

The precise treatment depends on the couple, considering their age, the duration of infertility and the reproductive health of both partners.

Here is a low-down of some treatment options available in the UAE.

Ovulation induction

This treatment is suitable for women who do not have a regular menstruation cycle and ovulate irregularly. The treatment involves oral or intravenous medication to influence ovulation, and subsequent sexual intercourse can lead to successful conception. Constant monitoring through ultrasound scans helps doctors determine accurately when a patient is ovulating and suggest the best time for intercourse to get pregnant.

Cost: Around Dh1,500 plus medicines

Intrauterine insemination or artificial insemination

In this treatment the husband's sperm is prepared in the laboratory and placed directly into the wife's womb. Depending on the causes for infertility, artificial insemination can also be used along with fertility medications, if the wife doesn't ovulate regularly. It is normally used for couples suffering from unexplained infertility and mild male factor. Artificial insemination is unlikely to work if the husband's sperm count is very low or the quality of sperm is poor and the wife has blocked fallopian tubes.

Cost: Around Dh2,000 plus medicines

Artificial reproductive treatment

In vitro fertilisation: It is ideal for women who have blocked/damaged fallopian tubes but their husbands have optimum sperm count and health. The treatment involves the harvest of eggs from the woman and creation of embryos in the laboratory using her husband's sperm. Embryo is then transferred into the woman's uterus using a catheter where it can develop into foetus. The doctor conducts the blood test after ten days of transfer to check pregnancy.

Cost: Around Dh15,000 for one cycle plus Dh4,000 for medicines

Intracytoplasmic sperm injection (ICSI)

When the husband has a low sperm count, poor sperm motility or morphology, ICSI is an option that couples can explore. Here a single sperm is directly injected into an egg to fertilise it and the embryo is then placed in the woman's womb. Sperms can either be collected on the same day when the wife's ova are collected, or else can be retrieved through surgical procedures — Percutaneous epididymal sperm aspiration (Pesa) and Testicular Sperm Aspiration (Tesa).

Cost: Around Dh18,000 plus medicines. Tesa and Pesa cost around Dh3,000 n

How to cope with infertility

Feelings of apprehension, scepticism, anger and frustration, along with expectations from family and friends, take a heavy toll on the relationships of couples undergoing fertility treatment. In an interview with GN Focus, Dr Melanie Schlatter, Health Psychologist, Well Woman Clinic, Dubai, tells us how couples could deal with such psychological anxieties.

How could a couple manage emotional issues related to fertility treatment?

During this difficult process, it is more about managing anxiety as opposed to overcoming it entirely — primarily because these treatments involve a number of potential stressors such as injections, tests, and preliminary results. The couple must have a solid, and openly communicative relationship, where both parties are fully educated by the fertility experts as to the likelihood of pregnancy, the procedures and risks involved. They should be mentally prepared to manage a negative or disappointing outcome and perhaps identify alternative options if ‘all else fails'.

Can meditation help reduce stress?

With regular practice of meditation, one's mind and body are less likely to activate the fight or flight response, an evolutionary response system to fear and threat that is harmful in the long term if activated regularly. She will benefit from a slower heart and breathing rate, blood pressure normalisation, a clearer and more rested mind, as well as improved immunity.

How can couples deal with failures in fertility treatments?

This is very difficult because usually a lot of thought, time, energy, hope, and money are invested into the process. To have it fail, not once, but maybe many times, is often an absolute blow to the couple — especially when they have to decide ‘no more'.

It is natural to feel mixed emotions as they look at ‘what could have been' and of ‘what should have been'. Couples should be advised to talk with a therapist or ‘safe' friends, perhaps ones who have also been through a similar process, whom they can truly trust and open up to without reservation and also without fear of judgment or unwarranted advice.

They will have to be supported to the next place that is right for them at that time — perhaps taking a break or starting to slowly investigate alternatives such as adoption as well as being taught how to manage life in the future, for instance, seeing families and babies at the mall; how to talk to people about why they don't have children, and so forth.

It's about guiding them to a level of acceptance; teaching themselves to continue loving and supporting one another, and encouraging them to continue and or re-establish other life goals and ambitions.

Fertility clinics in the UAE

• Dubai Gynaecology and Fertility Centre

• Conceive Gynaecology and Fertility Hospital, Sharjah

• Jwan Murad Fertility Clinic, Sharjah

• Eve Fertility Centre, Sharjah

• Tawam Hospital,Al Ain

• Bourn Hall Clinic, Dubai (opening in 2012)