Giving birth to hope.
BBW: What are the causes of the rising rate of infertility in the GCC region and globally?
MF: You can look at this from two different angles, the first one is that there are a big number of infertile couples that were not talking about the problem looking at it as a taboo but now because there is treatment they are coming out. Secondly, when a woman marries after the age of 30 or 35, the fertility rate dramatically goes down with the woman’s rising age. Many women with careers do not want to get married early and some who are married do not want a child at a young age so they delay their pregnancy, these women are the ones that ultimately might have a problem getting pregnant. This is another dawning cause that tremendously contributes to the rising trend in infertility.
There are a few diseases like endometriosis, which are common amongst women who delay their pregnancy. Let’s say if a woman doesn’t bear a child in her 20s, she has a greater chance or risk of developing the disease in her 30s. The other factor which is very important is a rise in obesity. With the rising rate of obesity, if women do not adapt with proper workouts and exercise, and do not try to make their bodies fit, they are likely to gain weight. Weight gain can affect ovulation in women and at the same time cause polycystic ovaries and this will cause infertility. So, women end up with infertility because of their lifestyles. Another factor that contributes to the rise in infertility is the environment. There are a lot of toxins in the air and in food that might affect fertility, especially in men. These are the major factors that have really caused an increase in fertility problems in the GCC region and globally.
BBW: How has the treatment for infertility evolved in terms of technology, new studies, and new findings?
MF: Prior to the 1980s we could only do basic surgery and some hormonal tests. But after that, IVF was invented for those women who had both their fallopian tubes blocked and there was no way that they could get pregnant without medical help. IVF back then meant that you bypassed the fallopian tube; you took the egg out from the ovaries; fertilised it with the sperm and then put the embryo inside the uterus, bypassing the tube. But with time this treatment has evolved and the success rate has increased and improved.
Men who could not get or give a good specimen, or did not have very efficient sperm, were still struggling to cause pregnancy through IVF. So, In the early 90s, a procedure came about which was known as intracytoplasmic sperm injection (ICSI). The difference between IVF and ICSI is that with IVF you mix the eggs with the sperm and with ICSI you inject the sperm into the egg. This was a breakthrough in treating male infertility. Some men did not produce any sperm on the outside. To help, we found that if we explored the testicles, we found sperm inside. This is termed mapping of the testicles. This is a newer procedure and has been exercised over the last five years. This has helped a lot of couples. Another challenge in this procedure was finding mature sperm. A sperm has to mature to be affected. If you take 100 men who have no sperm, you could help 40 per cent to 60 per cent of them and the remaining 40 per cent could not have been helped. Recently there is another procedure known as round sperm injection, where you inject the immature sperm into the egg but before you inject it you have to basically apply an electric current to activate it. This procedure is called ROSI. It is a very new technology that we have brought to our centre here. This can help the men who cannot be helped with sperm mapping.
For women, the IVF success rate has improved with time and the reason is that we understand IVF more, and its success rate has come up from 2 per cent to 70-80 per cent because of improvements in the environment, in lab conditions and in the media. It took about 30 years for IVF to reach this success rate.
BBW: What are the new breakthrough technologies that you think could help infertile couples in the near future?
MF: From a woman’s point of view, our biggest enemy is her age. If a woman is over the age of 40, it is very difficult for her to get pregnant. Once they are 43 or 44, chances are less than 10 per cent, and it is almost zero over the age of 45. This is due to an increase in the amount of abnormalities in embryos with increasing age. For women in their 20s, 8-10 embryos out of every 10 are normal, somebody who is 20 has 10 embryos, but for those over 40, only 2 out of every 10 are, and it is very rare to find a healthy embryo in ladies over 42. Hence the pregnancy rate comes down with age. Scientists are trying to delay this phenomenon and trying to improve the quality of eggs with proper nutrition and diet, rather than surgeries on the ovaries.
There are some procedures which are being done now but are still experimental. One of them is Overplant Procedure where you take the cortex which is the covering of the ovary which has immature eggs, then you do some preparation in the lab and you get the very primitive cells which are egg precautious cells, or EPCs. Then you inject an EPC into the ovary with the hope that they will regenerate into eggs. We have done a few of those, and have been successful with 1 out of every 15 women. But this procedure is still experimental, still very early, and we do not know where it will go.
Of the other programmes, I know of one in Jordan and another in India that uses stem cells. In it, they take the woman’s stem cells and inject them into the ovary. I have not really read any reports which said this procedure has been successful so far. But I am sure that with time; science will be able to produce embryos, or eggs and sperm, from very immature stem cells to help couples who cannot produce those to have a child.
BBW: What percentage of your patients opt for genetic screening and do you recommend that as a standard procedure?
MF: There are many types of genetic screening or testing. Preimplantation genetic diagnosis is one such procedure. The technology is called PCR where a couple comes to you with a child who is already affected. They know they have a problem. You do the testing on the husband, wife, and the child to check what disease they have and then you can make sure that the embryo does not carry that disease.
When you grow older there is an increased risk of Down Syndrome. So genetic screening for the same is recommended for women over the age of 38. Then some women come to you for gender selection. Let us say they want to bear a girl, so they do the test. In all, around 10 per cent of our patients will end up opting for genetic testing or diagnosis.
BBW: Would you say there still remains a stigma around IVF in certain markets and that people are not very receptive to accepting it as a solution?
MF: IVF now is an accepted treatment, it is gaining acceptance as an option, and people are more willing to talk about it. If you go to Lyon, they have had IVF hospitals since the early 90’s. So, it also depends a lot on where you live, but in general, it is becoming acceptable. People these days understand that It is a well-regulated procedure. Ninety per cent of the couples we treat have no problem saying that they opted for IVF.
BBW: Could you tell us about your current operations and could you give us an insight into your expansion plans?
MF: We have an IVF lab in Dubai and one in Abu Dhabi City. We also have an infertility clinic in Al Ain. We are currently building an IVF lab in Al Ain that should be ready in the next 2 to 3 months. We are also building a complete IVF unit with laboratories in the western region, in Madinat Zayed, which should also be operational in the next 2 to 3 months. We are currently finishing our IVF units in Oman and Doha, Qatar, and are planning to expand in Sharjah and Saudi Arabia. In terms of the patients we treat, that has changed. Previously we would get 10 to 15 patients coming in from Nigeria every month, now we get just 2 or 3. I am sure that has something to do with the oil prices coming down. We are very much present in the USA where we have a very big programme, which is the biggest in the mid-west, in Michigan and Ohio. We have also just built a new IVF centre in Bloomfield hills, Michigan, and it is one of our busiest and most successful centres so far. We are now partners with the NMC. NMC already has many programmes running in Europe, Spain, Italy, the Netherlands, Denmark, South America, and Columbia, and together we are trying to expand to more cities and more countries.
BBW: Talking about you personally, what are your passions apart from your job. What keeps you excited and motivated?
MF: Honestly when they call me to tell me the patient is pregnant, that is a very happy moment for me. Ninety-nine per cent of my passion comes from my work. My other main passion is my family. The good thing is that my wife understands what medical doctors do and how they work, so she is fine with that.
Bloomberg Businessweek Middle East
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