Changing the fertility conversation: UAE experts on what to know about reproductive health

How do we talk about the rise of infertility without creating anxiety? When is it appropriate to broach topics such as egg freezing ? Is it possible to discuss links between lifestyle and the chances of conceiving without appearing to blame or judge? These are challenges that medical professionals are all too familiar with. “Fearmongering around fertility can create unnecessary anxiety and prevent people from making informed decisions,” says Dr Bharathi Veeraswamy, gynaecology and obstetrics specialist at Dubai's Aster Clinic. Dr Aarti Javeri, an internal medicine specialist in Dubai, also advocates changing the approach to such discussions. “If conversations could be approached with more compassion, empowerment and education instead of fear, we could start changing the narrative – especially in this region, where fertility remains a huge taboo,” she says. Issues can also stem from conversations away from medical settings. Examples include myths that infertility is only an issue for women, and that there are no solutions after a certain age. However, that is no longer true, says Ahmed Abo El Fadl, general manager at pharmaceuticals company Merck Gulf. “Science and technology have advanced significantly, providing tailored treatments at different ages,” reassures Abo El Fadl. From tackling misinformation to empowering couples and acknowledging advances in treatment options, here's what people in the UAE should know about reproductive health. A report by the World Health Organisation in 2023 found that 17.5 per cent of people worldwide have experienced infertility. “It's a number we see rising every year,” says Javeri. The figure is derived from more than 100 global studies, each using a different methodology, showing that infertility rates vary widely across demographics, locations and socioeconomic status. Likewise, clear trends over time are hard to determine due to the scale and methodology of historical studies, making the worldwide decline in fertility unclear. Some countries have not consistently reported birth rates, for example. The WHO defines infertility as “a disease of the male or female reproductive system defined by the failure to achieve a pregnancy after 12 months or more”, meaning it is something a person experiences that can result from a multitude of contributing factors. Health is an obvious one, particularly conditions that are undiagnosed for long periods. “Up to one in four women in the Mena region have PCOS and 70 per cent of them are walking around undiagnosed,” says Javeri. PCOS, or polycystic ovary syndrome, is a leading cause of infertility. Diagnosis can lead to managing symptoms such as irregular ovulation. However, health is just one element. In up to a third of couples, neither partner is diagnosed with a medical issue. This means that lifestyle – which is more in the control of the individual – often plays a bigger role. “Lifestyle, stress and delaying marriage have all contributed to declining fertility rates,” says Abo El Fadl. Javeri says that both men and women need to be assessed, adding that male infertility accounts for 30 per cent of cases. After a medical examination to check for potential complications, the next step is to understand lifestyle tweaks that can be made. Or, as Javeri calls it, go through “the lifestyle process” with a fertility doctor. This can include obvious changes, such as quitting smoking and reducing alcohol consumption, but also psychological factors. “Sometimes, when doctors diagnose infertility, there is no organic or hormonal issue … It's more about psychological stress. We know that stress has raised over the period they have been trying to conceive,” says Abo El Fadl. The responsibility is not solely on patients. “As a medical doctor, I was never trained to talk about the power of lifestyle medicine,” says Javeri. “Primary care providers need to start working with mental [health] professionals and lifestyle medicine physicians to provide patients with a seamless care pathway, which I think right now is a little bit fragmented.” Research shows that intensive lifestyle changes can boost ovulation and fertility, but Javeri avoids terms like “holistic medicine”, which she feels are often dismissed. “Lifestyle medicine is a very evidence-based field of medicine where you focus on pillars like nutrition, movement, sleep, connection and substance abuse. You put all of these together, and we have research studies and evidence guidelines to show that this actually helps with fertility rates,” she says. Focusing on getting the fundamental pillars right can have a powerful impact on fertility, and it may not require medical intervention, although doctors and fertility specialists can provide guidance. So how does the conversation shift to empowerment rather than alarm? Veeraswamy stresses the importance of open discussions that clarify facts, rely on evidence-based information and avoid overhyping negative statistics. For example, many women with PCOS are told – and therefore believe – that the condition means they are less likely to bear children. While it can impact ovulation, Javeri insists that “birth rates between women with and without PCOS aren’t very different … they may need more help, but they can still have kids”. She also advocates people to become more aware of their bodies. “The more you track your symptoms, cycles, food and your movement, the more insight you have. It gives doctors objective data that can help personalise treatment.” Discussing fertility health throughout adulthood – not just when trying to conceive – is essential. For both men and women, this means making positive lifestyle choices early on, though it is never too late to adopt healthier habits. Abo El Fadl says that for women “the most important part of the decision to preserve eggs or not is empowerment – ensuring people make informed choices about their future”. He adds that, as the father of three daughters, he wants them to understand their reproductive health and have confidence in their choices. This should not mean pressuring all young women into egg freezing, but it comes back to information and open conversations. “A balance of awareness, empathy and accurate information is key to fostering a healthy, informed conversation about fertility,” says Veeraswamy. In 2018, the first person born from IVF celebrated her 40th birthday. What was once thought not only impossible but also controversial is now commonplace and openly discussed, showing just how far fertility treatments have come. There are three primary treatment avenues for couples: pharmacological, surgical and assisted reproductive techniques (ART). Pharmacological focuses on hormonal interventions that can make both men and women (although primarily the latter) more fertile. “The most common ones are clomiphene citrate and letrozole … they help to produce eggs and help ovulation,” says Javeri. Others include bromocriptine and metformin, which are also generally taken orally. Hormone injections can be prescribed, such as for follicle-stimulating hormone (FSH), human menopausal gonadotropin (HMG) and human chorionic gonadotropin (HCG), all of which aim to stimulate the ovaries to produce follicles and/or trigger egg release. Men with low testosterone may also be prescribed medication such as HCG, clomiphene citrate and anastrozole, to help boost sperm production. Risks are involved with all hormone treatments, however, and patients should discuss them with medical professionals before starting. Surgical treatments can treat structural abnormalities, such as endometriosis, fertility tube blockage and pelvic adhesion. Surgery can also help to ease PCOS, to increase the chances of natural conception. More commonly, surgery is used for egg retrieval for those either freezing their eggs or going through IVF. According to the US National Library of Medicine, assisted reproductive techniques are defined as “any fertility-related treatments in which eggs or embryos are manipulated”, of which IVF is the most common. IVF treatment can be in response to, for example, tubal factor infertility (blocks in the fallopian tube), diminished ovarian reserve (fewer eggs than typical for a woman's age) and male fertility (low or abnormal sperm production). The embryos (fertilised eggs) can be the biological children of both parents or result from egg and/or sperm donations. Such treatments are well established, but developments are continuing. “By understanding gene sequencing, we can tailor solutions to make fertility treatments more successful than ever before,” says Abo El Fadl. Veeraswamy adds: “For males, new sperm selection techniques – even the newer drugs – have come to give better fertility output for the couples.” For example, CRISPR technology (advanced DNA modifying) can impact spermatogenesis – the sperm development process – preventing mutations that can impact fertility. “Female-ovarian rejuvenating procedures with autologous (from the same person) bone marrow-derived stem cell therapy for poor ovarian reserve women, monoclonal antibodies for implantation failure, and time-lapse imaging of embryos to assess their metabolic functions, thereby improving the selection of embryos to transfer to get a positive result” are some of the other novel treatments in the fertility field, Veeraswamy explains. “The country has become a medical hub for fertility tourism, attracting patients from the region and beyond for high-quality reproductive care,” says Veeraswamy. Home to many advanced fertility clinics, a wide variety of treatments such as basic intrauterine insemination – IUI, meaning inserting sperm into the uterus – and IVF, alongside more advanced techniques which include egg or sperm freezing and genetic screening. However, there are limitations. “Fertility treatments in the UAE are regulated by the government. Some treatments, such as sperm and egg donation, are not allowed. However, IVF, IUI and egg freezing are available, with certain regulations about how these treatments are performed,” says Veerswamy. Cost is a factor to consider as fertility treatments can be expensive, and many insurance policies in the UAE may not cover these procedures. “Patients should be prepared for out-of-pocket costs or check with clinics to see if they have payment plans or partnerships with insurance providers,” Veerswamy adds. Overall, experts stress that those concerned about fertility should take comfort in the rapid advancements in treatment. They also emphasise the importance of improving reproductive health through lifestyle changes, emotional support and education, which are just as crucial as medical science. “Couples should feel empowered to seek help early, make informed decisions, and be proactive in managing their reproductive health, all while navigating the various treatment avenues in a supportive and informed environment,” says Veerswamy.

Changing the fertility conversation: UAE experts on what to know about reproductive health

Doctors and specialists from the region discuss common misconceptions, how to empower couples and innovations in fertility treatments