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Lack of sun exposure impacting reproduction.

Summary: Infertility specialist says age not just number when it comes to pregnancy.

The prevalence of consanguineous marriage in the UAE, coupled with its high incidence of vitamin D insufficiency among women is having a huge impact on infertility in the country.

Though a higher age in both males and females is commonly related to global infertility, in the UAE, it is women who are presenting most with issues in reproduction.

"Women in this region whose parents are first cousins have a reduced number of eggs when they are first born. This female offspring will have the reproductive age of someone 10-15 years older than what they are," Professor Human Fatemi from the specialised clinic for reproductive medicine, IVI, told Khaleej Times .

With 60 per cent of the marrying population in the UAE between first cousins, the impact on fertility is huge, he said.

"It's some of the daughters of this couple who has the problem, not the female of the marrying couple," he said.

From the age of zero to puberty - about 12-years-old - most girls carry about 300,000 eggs in their ovaries. But for the offspring of first cousins, that number is far less, Prof. Fatemi said. Globally, about one in six women experience problems with fertility.

In the UAE, the 2010 Dubai Health Authority (DHA) research report, 'The demand for fertility services in Dubai', puts today's infertility figures at about 150,000.

There are many attributing factors for this including sedentary lifestyle, obesity, smoking and bad nutrition.

However, the second - and most surprising - cause of infertility in this country is a female's lack of Vitamin D.

Despite living in a climate where the sun shines all year round, local customs decrease a woman's exposure to the sun.

"Because it is so hot here, people tend to stay inside. When Emirati women do go outside they are covered up which reduces their exposure to the sun."

Prof Fatemi added that as per a planned observation conducted amongst patients visiting the IVI clinic, Abu Dhabi, the prevalence of Vitamin D insufficiency is 100 per cent among Emirati women and many previous studies have proved a link between Vitamin D and ovarian reserves.

"In addition to sex steroid hormones, vitamin D also modulates reproductive processes in women and men. Vitamin D is a key component in processes involved in reproductive success."

In this region, Prof Fatemi said physicians tend to copy and paste knowledge of global infertility but it is vital we find out the cause of region-specific infertility.

"We simply need more research conducted within the country."

Of the patients Dr Fatemi treats in IVI Abu Dhabi, about 70-80 per cent are locals.

Don't waste your time

For Medical Director at Bourn Hall Clinic in Dubai, Dr David Robertson, if you're an advocate for parenthood - whether you achieve it through natural conception or the most cutting-edge of IVF methods, time is of the essence.

"Unfortunately, scientific evolution hasn't quite caught up with changes in today's social attitudes," he told Khaleej Times.

With more women in this region actively working in high-powered roles, this focus on a career is conflicting with childbearing.

Many are now choosing to start families later in life, but despite science providing a helping hand in some cases, a person's biology remains the most powerful tool when it comes to motherhood.

"Biologically, it is better to get pregnant in your twenties. But this shift in social attitudes is seeing the average age of motherhood increase. Naturally, this sees an increase in fertility issues."

As the age increases, the chances of getting pregnant goes down. For a woman aged 25, her chance of getting pregnant naturally is one in four monthly, he said. But for a woman aged forty, this drops to one in 20 chances per month.

"The average age of female patients in our clinic is 38-42 years. It has been scientifically proven that women over 35 significantly lower their chance of getting pregnant naturally compared to those under 35."

Though this doesn't mean women have to stay home and become mothers in their twenties, Dr Robertson said couples do need to be more aware of the challenges they face in getting pregnant as age increases.

But cases of infertility are higher in this region for several other reason too: the genetic implications of blood relative marriages, and the high rate of polycystic ovaries diagnoses among women.

"In the UAE, cases of polycystic ovaries are high. The cause is often genetic as a result of blood marriages but being overweight also contributes towards this. As a result, fertility is affected."

Dr Robertson said he treats a mixed demographic of patients at his clinic.

About 50 per cent are Western expatriates and the remaining 50 per cent is made up of Emiratis, Arab expatriates and Asian expatriates. "The ratio of men facing problems with fertility compared to women is about 50/50 at our clinic."

But what was once a taboo subject in this region is now more openly discussed.

"Arab and Emirati residents in particular are becoming much more open to speaking about and dealing with a potential issue. I have seen attitudes change so much in my 25 years in this region."

Both men and women are now much more aware of the changes in their bodies, and they are more open to seeking the right help.

"Years ago, a newly married couple may have tried to get pregnant for a few years before seeking professional help. Nowadays, when the decision to start a family is made, couples immediately seek advice about how to best go about it."

For couples experiencing problems getting pregnant, Dr Robertson said the most important message is "do not waste time".

"In many cases it may just be a basic problem like not being familiar with your body clock. For couples with more complex issues, there are a variety of treatments like IVF."

kelly@khaleejtimes.com

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Publication:Khaleej Times (Dubai, United Arab Emirates)
Geographic Code:7UNIT
Date:Nov 28, 2015
Words:1002
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