Having children later in life and a range of lifestyle factors mean a growing number of couples are struggling to conceive. Fertility doctors in some of the UAE's best established clinics see a high number of couples in their late thirties and early forties. Often - but by no means in every case - a history of smoking, drinking alcohol or having weight problems is a factor. A recent report from market research company Colliers found the infertility rate in the Middle East to be at least 15 per cent, with a 50/50 split across men and women. This is higher than the global rate published by the World Health Organisation, which estimates that 10 per cent of women around the world are infertile and require assistance to enable conception. IVF is not an easy option for making babies. More than $200 million is spent in the Emirates each year on <a href="https://www.thenationalnews.com/lifestyle/wellbeing/10-things-to-know-about-female-fertility-from-freezing-eggs-to-age-and-lifestyle-every-woman-needs-a-reproductive-life-plan-1.1220128">fertility treatment</a>, compared with $300m in Saudi Arabia - with more than three times the population - and $500m in Egypt, according to Colliers. Emiratis are entitled to three free cycles of IVF per year, but insurance packages for non-Emiratis rarely cover treatment. Couples spend about Dh20,000 to Dh30,000 per cycle, and women have to inject themselves with hormones, before an operation to harvest their eggs. Maria Banti, a clinical embryologist and laboratory director at Orchid Reproductive and Andrology Services based in Dubai, attributed the high infertility rates to a combination of factors. “Infertility rates in the region are quite high in the UAE, because of lifestyle choices. Obesity and diabetes are closely related to infertility in both males and females,” said Ms Banti. “We're not talking just about one nationality – many people in the UAE are not taking good care of their diet, some people smoke, drink, and this is going to affect their health, and lower their fertility rate and potency. “For women, egg quality can decline significantly as can sperm quality in men. Age also plays a critical role – because as a woman ages, their egg quality and quantity declines.” Women's fertility starts to deteriorate from the age of 35, while for men it begins falling from around 40 to 45. Cassie Destino, the founder of IVF Support UAE, said she saw the reality of these statistics all the time. “People have waited to find the right partner and waited to find the right moment in their lives for parenthood,” said Ms Destino, who is from the US and draws on her own experience to help other couples with their IVF journey. “They focused on their careers in their 20s and 30s, now they're looking to start their family. “I would say that a great majority of the women that I talk to are very health conscious and very careful about keeping their bodies strong and healthy, but they have severely diminished ovarian reserves.” The mental anguish far outweighs the physical discomfort and expense, said Ms Destino who now has twins aged five. “You go through all of this and spend all this money, and there's absolutely no guarantee that it's going to work,” she said. “I have watched people go at it over and over and over, and spend hundreds of thousands of dirhams and not end up with child. That's the hardest part.” Dr Bohaira Elgeyoushi, an IVF consultant with HelpPlus Fertility Centre in Dubai, said the effect of infertility on couples could be devastating. “IVF is an emotional rollercoaster journey, and it can be a make or break for some families, especially those in the Middle East, because family is everything,” she said. “Arab families like children and they like to have large families. So there is a big emotional aspect for couples who struggle to conceive.” Fleur Beach, 39, has been through several exhausting IVF cycles. The first was successful, and she gave birth to a daughter, but the following five cycles were unsuccessful and left her feeling utterly drained. “The egg stimulation and retrieval cycle is the hardest part. It really takes its toll,” said Ms Beach, from the UK. “I ended up being overstimulated and had to wait a few months for implantation. I actually had to go and buy maternity clothes afterwards because I was so bloated, and that lasted for weeks and it was very uncomfortable. “Eventually, I made a decision – this isn't working. I actually felt like the process was harming my body. I just thought, I can't keep on injecting myself with these hormones.” Ms Beach stopped IVF and instead changed her lifestyle and eating habits, while undertaking a more holistic approach to optimise her physical and emotional health. After 18 months she became pregnant with twins, without any fertility treatment. “I think sometimes people are branded infertile or fertility-challenged too easily. I don't think it's always a fertility thing – sometimes it's more of an overall health issue,” she said. The UAE's booming IVF market is not just caused by infertility problems in its population, according to the Colliers market report. “The growth in the sector stems not only from domestic demand but also the success of the UAE, particularly Dubai, promoting medical tourism and availability of infertility treatment centres, which are of international standards,” it said. Nearly a third of the 1,000 couples treated at Orchid Reproductive and Andrology Services in Dubai are medical tourists. Ms Banti said this is in part, due to the laws governing fertility treatment. “We offer services that are not available in other countries like family balancing, so people come from other countries where this option is not available,” she said. “If people have two girls and they want the boy, then they can come to Dubai for IVF.” The UAE allows gender selection through either Preimplantation Genetic Diagnosis (PGD) or Preimplantation Genetic Screening (PGS) of the embryos, after the egg has been fertilised. In the case of PGS, this process also allows doctors to screen for potential genetic abnormalities, and with PGD to detect a specific disorder. Both of these procedures occur before the embryo is implanted in the uterus. Using PGD or PGS to identify gender is illegal in countries such as Australia, Canada, China, India and the UK, but allowed in the US, Mexico, Italy and Thailand. In other countries, the technology is simply not available. Dr Elgeyoushi said the UAE's geographical position also helps to make the Emirates attractive to medical tourists. “I see patients from all over the world – from Europe, from Africa, I even see them from the United States to a lesser extent. “The UAE, and specifically Dubai, is a medical hub – we have a good, solid reputation in health care, and specifically in the fields of fertility and IVF. “We're very advanced technologically and people like to combine a holiday with getting treatment.”
