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Abstract
Objective
To review and summarize the current state of knowledge with respect to female infertility in Arab countries.
Methods
Review and summarize eight articles retrieved from PubMed electronic database on female infertility in Arab Countries.
Results
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There are a number of women infected by secondary infertility after a specific period from their last birth.
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Infertility decreases steadily for women over 25 years of age.
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Infertility decreases in urban areas and increases in rural areas.
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Women cease reproduction after the age of 45 years.
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Homologous insemination is allowed in Islam, whereas heterologous insemination is absolutely prohibited in Sunni Islam.
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Women with infertility challenges have more epithelial abnormalities and lesions in the cervix uteri than productive women.
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Infertile women exhibit higher psychological problems than fertile women. (viii) Chlamydia trachomatis infection is significantly correlated to women infertility.
Conclusion
Special attention should be focused on conducting a future study on female infertility in Arab countries because many women are infertile and waiting for effective treatments to address the infertility problems.
Background
Merriam-Webster dictionary defines the word family as a group of persons of common ancestry (Merriam-Webster dictionary, n.d.). Parenthood and making up a family is not an easy task. People do not seek it only for joy since it requires a deep commitment to raising and educating the members of the family. Moreover, people need to make families in order to continue their generations. Female infertility refers to the inability of a female to become pregnant after having regular sex. It can also be defined as a woman who cannot carry a baby to full term. In addition, some countries defined it as the failure of couples to conceive after 12 months of regular sexual intercourse without using contraception.
Most of the studies have evidenced that more than half of infertility cases are as a result of female problems, while the remaining are either idiopathic or caused by sperm disorders (Nordqvist, 2016). There are two types of infertility, that is, primary and secondary infertility. Basically, primary infertility occurs in a situation when a woman is unable to have a child due to the inability to become pregnant or to carry a pregnancy to live birth. Secondary female infertility is the inability of a woman to get pregnant or bear after a previous successful pregnancy or live birth. Examples of the secondary female infertility are cases of repeatedly spontaneously miscarriage or pregnancy that ended up with a stillbirth (World Health Organization, n.d.).
The prevalence of female infertility has been reviewed across the globe. In the U.S, the infertility rate was reported as 11.2% in 1965, followed by a gradual decrease until the year 2002, when the rate rose up to 7.4% (Stephen & Chandra, 2006). A review of infertility rates in developed and undeveloped countries for about 72.4-120.6 million women aged between 20-44 years from the year 1990 to 2006 indicated that 25% of this population were reported infertile.
The same review reported that these women received infertility treatment, and their number is estimated to be between 40 and 90.4 million (Boivin, 2007). In Sub-Saharan Africa, the prevalence was totally different as women infertility was estimated at11.8% in Ghana, 9% in the Gambia, 21.2% in Northwestern Ethiopia and 20% to 30% in Nigeria. In Asia and Latin America, the World Health Organization indicated values in the range of 8%12% in 1991.12 (Adeniyi, et al., 2012).
The risk factors that can contribute either directly or indirectly to infertility are subdivided into factors related to disorders of the woman and factors related to the spouse /man as discussed below:
Factors Related to Disorders of the Womans Ovulation
General health condition
High BMI or overweight might result in chronic diseases such as diabetes, hyper or hypothyroidism, lupus, arthritis, hypertension, or asthma, hormonal imbalance, history of two or more miscarriages, and polycystic ovary syndrome in which the womans ovaries function abnormally.
Environmental factors
Cigarette smoking or alcohol consumption might interfere with ovulation.
Emotional factors
Depression and stress may have a direct effect on the hormones that regulate reproduction and affect ovulation.
Age
Female fertility begins to deteriorate at the age of 32 years and above. A 50-year-old man is usually less fertile than a man in his 20s (male fertility progressively drops after the age of 40).
Sexually Transmitted Diseases (STDs)
Diseases such as gonorrhoea, syphilis and chlamydia transmit more easily to women and can lead to pelvic inflammatory disease (PID) in women and epididymitis in men. Complications are more common in women, including subsequent scarring, miscarriage, adhesions, blocked tubes, and ectopic pregnancy. Ultimately, infertility can be a consequence of STDs (The National Infertility Association, n.d.).
Problems in the uterus or fallopian tubes, including
Tubal Disease
Accounts for about 20% of infertility cases treated.
Endometriosis
This condition occurs when the uterine tissue is found outside of the uterus; on the ovaries, fallopian tube, bladder and bowel. It can occur in menstruating women of all ages, including teenagers. While the connection between endometriosis and infertility is not clearly understood, early detection may result in successful control and preservation of fertility.
Surgery
Pelvic surgery may sometimes cause scarring or damage to the fallopian tubes. Cervical surgery can sometimes cause scarring or shortening of the cervix. The cervix is the neck of the uterus.
Medications
Some drugs can affect the fertility of a woman. These include:
NSAIDs (non-steroidal anti-inflammatory drugs)
Women who take aspirin or ibuprofen long-term may find it harder to conceive.
Chemotherapy
Some medications used in chemotherapy can result in ovarian failure. In some cases, the side effects of chemotherapy may be permanent.
Radiotherapy
When radiation therapy is aimed near a womans reproductive organs, there is a higher risk of fertility problems occurring after the treatment.
Factors Related to Infertility Disorders in Men
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Sperm problems: The most common causes of male infertility are related to sperm problems such as low sperm count, slow sperm movement meaning that they die before they reach the egg, sperms that are not formed correctly, and seminal fluid that is too thick; sperm cannot move around in it very easily. Sperm-related problems may result from too much or too little of some of the hormones that guide sperm making.
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Ejaculation problems: In some cases, tubes inside the male reproductive organs are blocked.
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Idiopathic /unexplained infertility: In the case when there is no known reason for someones infertility, which can be a very frustrating diagnosis (Nordqvist, 2016).
The golden chance of a woman to have a baby is always reflected by a good prognosis of her condition, which depends on many factors, including her age or any underlying cause for infertility. The earlier the causes are detected the better chances of conceding. Since just a few couples are unable to conceive genuinely, having regular intercourse without any medical intervention remains the most preferred method of conceiving (Hull, 1995).
In the event of failure to conceive, supplements might be prescribed to the patient. For instance, Clomiphene citrate is a highly successful substance that acts by inducing ovulation in patients with an intact hypothalamic ovarian axis. It is important to note that the respond to clomiphene citrate in patients with PCOS is approximated at 73% of the time. The probability of pregnancy is 36%. Among these pregnancies, approximately 10% will be twins (Homburg, 2005).
Besides, studies have evidenced that using injectable gonadotropin in the treatment of infertility may have an overall success rate of between 20% and 22% per cycle in the properly selected patient. Almost 30% of these kinds of pregnancies are multiple gestations, and higher order pregnancies occur if monitoring is suboptimal. However in patients over 35 years of age, the pregnancy rates are markedly decreased (Dickey, 2009).
Another alternative supplement is the IVF, which is the most successful treatment for infertility, regardless of diagnosis. In the year 2011, around 450 fertility clinics in the US performed 151,923 fresh IVF cycles (using the womans own eggs), resulting in the births of around 61,000 infants. For women under 35 years of age, the live-birth rate/transfer accounted to almost 41% (with 33% of pregnancies ending in multiples). However the live-birth rate/transfer decreased by age, that is, 38.4% for women aged 35 to 37 years; 27.3% for women aged 38 to 40 years; 16.5% for women aged 41 to 42 years; and notably only 7.6% in women aged over 42 years as was reported in the 2011 research findings. There are international variations in success rates for assisted reproductive techniques as summarized in figure 1 below.
Literature Review
Introduction
There are many studies on infertility conducted in the Arab countries. However, there are no reviews conducted to summarize the findings of these studies. Therefore, the literature appraisal will perform systematic review of the past research studies on fertility in Arab countries to summarize the findings with respect to the problem of female infertility in the Arab countries. This section briefly discusses and reviews eight previous articles that addressed the problem of infertility among the females in the Arab counties.
Articles Review
El-Shalakani and Suchindran (1993) article, Estimation of Fecundity and Secondary Sterility from Survey Data on Birth Intervals in Egypt, aimed to estimate the fecundity and secondary sterility among males and females based on age, residence, and educational subgroups. The authors assumed that after a specific period from the last birth, a certain proportion of women become secondarily sterile. The researchers proposed and applied a special model to approve their assumption. They collected the data of 5667 women from the Egyptian Fertility Survey conducted in 1980 and conducted survey data analysis statically.
The findings revealed that fecundity decreases steadily for women over 25 years of age. Besides, the findings indicated that fecundity decreases in large urban areas and increases in rural and semi-urban areas. In addition, the findings suggested that most of the women cease reproduction at age 45 (El-Shalakani & Suchindran, 1993). Apparently, the substance in this research article is valuable for the scholars who are interested in establishing infertility in women in Arab countries since the location of the study was in Egypt. Moreover, the article addressed fecundity problem that affected a big number of Arab women in an attempt to find its causes.
The article, Ethical Considerations in Syria Regarding Reproduction Techniques, by Arbach (2002) discussed the Islamic substantial ethical considerations regarding the reproduction techniques in the Arab countries in general and particularly in Syria. The author focused on the ethical consideration of homogenic insemination, heterogenic insemination, surrogate motherhood, embryonic sex selection. The results of the study included the following:
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Homologous insemination by sperm of the husband is allowed in Islam.
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Heterologous insemination is absolutely prohibited in Islam.
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Semen storage is allowed for a husbands semen and not from any donor.
This article is very important in understanding the acceptable insemination as a fertility treatment in the Arabic world and Islamic religion in general. The article provides knowledge to Arab population who are living in non-Muslim countries all over the world. Therefore, if they want to be treated for reproduction and fertility, they will go to foreign clinics and hospitals. These medical centers usually offer variety of operations that are incompatible with Sharia and Islamic law such as the heterogenic insemination and surrogate motherhood. The article discussed ethical issues in details in order to help the Arab families not fall into the haram ways of treatment. Therefore, the article is essential for all the Arab families who want to be treated for reproduction and fertility in non-Muslim countries.
The study, The Prevalence of Abnormal Cervical Cytology in Women with Infertility, by AbdullGaffar et al. (2010) aimed to compare the frequency of abnormal cervical cytology in women with infertility problems with that of fertile women by using ThinPrep® liquid-based Pap Tests. The authors conducted a retrospective case-control study for a period of over 2 years. The cases included 490 women with infertility problems who had Pap tests during their infertility treatment period (infertility group) and 7150 women without infertility problems who had regular Pap test checkups as part of their routine screening (control group). The cases of the infertility group were divided into primary and secondary infertility groups. The researchers analyzed the data they had collected from the cases statically.
They found the following results:
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Women with secondary infertility had more epithelial abnormalities and more high-grade lesions than women with primary infertility.
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Women with infertility had statistically significant higher frequency of squamous intraepithelial lesions than women without infertility problems of similar age and demographic background.
This article recommended that women with infertility might benefit from more frequent cervical cytology screening
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