The pros and cons of fertility treatment

For many couples, pregnancy and childbirth are the happiest times of their lives. For others it can be one of the most stressful and emotionally draining periods imaginable, facing repeated failure to conceive.

Fertility evaluation and treatment has undergone tremendous change over the years and with the introduction of innovative technologies, successful outcomes have become increasingly attainable. For couples, options have expanded thanks to doctors and lab personnel becoming increasingly skilled at new techniques. And for potentially older mothers-to-be, earlier and more thorough evaluations are opening a door that was previously closed.

Recent introductions of a more ‘holistic’ approach – such as that carried out by Dubai’s Orchid IVF – in the care and treatment of the couple dealing with infertility have also emerged. What we’re talking about here is complementary medicine including yoga, acupuncture, mindfulness and psychological support. They have all contributed to greater success in achieving pregnancy. Clinics and facilities around the world are now integrating this kind of philosophy of care into their treatment.

The care is now far more tailored to the specific needs and fertility evaluation of the couple. Such bespoke and holistic care offers a new beacon of hope to couples seeking a more positive and harmonious experience with a greater chance of taking a baby home.

But it is not an easy road, so let’s look at some of the challenges a couple might face. 

A brief history of IVF and its introduction to the UAE

IVF (in vitro fertilisation) is the treatment of fertilising eggs outside of the female body before introducing them back into the womb. The eggs are collected from the woman, mixed with the sperm (from either partner or donor) and cultured and monitored in a laboratory from 3-5 days. The strongest of the embryos is then chosen to be transferred into the womb.

The first successful IVF baby was born in the UK in 1978 and it is estimated that since then over 5 million more have been born. In the UAE, the demand for IVF has ballooned over the last quarter of a century – nearly 6,000 women underwent fertility treatment in Dubai alone last year, with that number expected to nearly double by 2030.

Specialised fertility clinics were actually first introduced into the UAE in the early nineties with the Dubai Gynaecology and Fertility Centre opening in 1991. Abu Dhabi also has centres of excellence in IVF with the Corniche and Al Noor hospitals. In 2004, Conceive opened in Sharjah (and later in Dubai), while Fakih IVF Fertility Center opened in Dubai in 2011 with clinics in other emirates following shortly after. The long-established UK clinic Bourn Hall opened its doors in Dubai in 2012, while Orchid IVF opened in August 2016 and boasts a partnership with Northwestern Memorial Hospital in Chicago.

So there is an established IVF ‘industry’ in the region, but the process of fertility treatment – regardless of the numbers of positive stories we hear every year – is far from a guaranteed success. IVF is an expensive and arduous choice where nothing is certain. Those who undertake the treatment do so in the hope of creating new life, but should equally be aware of the potential disappointments.

The varying costs of IVF and what you get for your money

Let’s start with expense: Anywhere from DH20,000 at the low end right up to DH45,000 – for each cycle of treatment. While it’s true that the opportunity of a lower price may seem initially attractive, this is usually more suitable for younger couples who have elected for IVF as a way of boosting the natural course of things and who ultimately may not need the full course of treatment.

The service provided can vary, so it’s important to check exactly what you are getting. It may be that certain plans only entitle you to egg retrieval, fertilisation and transfer. Those couples who require the more standard service that includes initial tests, consultations, hormone treatment and (once pregnancy has been confirmed) regular reviews at the IVF centre for up to three months with the fertility specialist would likely incur costs much nearer to the DH35,000 mark.

Patients who are considered ‘older’ and have faced complications or poor results in previous cycles of treatments will face even higher costs due to the amount of medication and type of procedures that they will require. High levels of consanguinity (cousins marrying each other, for example) in the UAE mean that embryos are often subject to extra testing and once again this drives up the cost due to the increased risk of congenital abnormalities.

When you factor in that there is a general average of three IVF cycles before pregnancy is achieved, couples could very easily be looking at a bill of over DH100,000. This is all before the emotional, psychological and physical risks are taken into account.

Motives for using IVF

Women may have many different motives for wanting to control or accelerate their chances of becoming pregnant. In our region, women are now marrying later in life meaning that the window for having children is somewhat compressed. They may also be aware of the ticking clock in terms of the rates of infertility growing significantly with age – when the woman is in her early twenties the chances of infertility are around 3% but that jumps up quickly to 30% for those 40 and over.

Another driver in the decision to enter IVF treatment can be the desire for twins – whether that is due to hopeful mothers wanting to have two children at once and therefore have a family in ‘one go’, or just the desire to have a set of twins or triplets.

The treatment is also used to freeze eggs or embryos – taken from the woman when she is younger and used later when she is ready to have children. This is a little complicated, however, given the UAE IVF law passed in 2008 and enforced in 2010 which prohibits the freezing of any human embryos. Freezing unfertilised eggs though is still an option and is a popular treatment in the country – but it has added cost as the process of fertilisation on the frozen eggs has to be repeated every time due to the law stopping any successful embryos from being frozen.

The Health Authority in Abu Dhabi does not recommend the implantation of any more than one embryo per cycle and actually stipulates that IVF providers do not transfer more than two at a time. In the other emirates, patients aged 35 or older can have up to four embryos implanted while those under 35 can have a maximum of three. As more embryos are implanted, the risk to the mother increases as does the chance of having a multiple birth. In the UAE, the rate of multiple births from IVF runs at 55% whereas in the West it would be significantly lower at 20%.

The soft factors: Conditions that affect fertility

So from what we have discussed so far, it may seem that the outlook for IVF in the UAE is not sunny. While this is indeed a candid picture of the landscape, there is potential for great improvement. Why? Because there are many factors within our control.

What we are talking about here are health issues such as overweight and obesity, as well as diabetes – all of which are likely to have a negative effect on fertility. Then there is smoking which in particular has a very damaging effect, decreasing sperm count in men while the female smoker will find it on average twice as hard to conceive as a non-smoker.

So there seems here to be an opportunity to help people who wish to improve their fertility levels without choosing the IVF path straight away – with a more holistic approach using fertility education. Stopping smoking, eating a healthier diet, weight loss, sleeping better, reducing alcohol intake, and so on, would all go some way to giving people the best chance before considering IVF.

If the couple then still decides to enter an IVF programme, the provider could maximise results by having a team of counsellors, nutritionists and even financial advisers on hand to support the couple through the process. The best results are achieved when the couple involved are at ease and in physically good condition – having any emotional trauma, money worries or poor diet during the process will reduce chances of success.

So why not provide a patient support team that can help with these issues? The fertility doctors and embryologists can focus on their expertise and the support team can ease the worries and concerns of the prospective parents, providing a service that ensures the couple feel as relaxed and supported as possible during the journey.