CAIRO: Infertility is can be a taboo subject in Egypt. Getting married and having children is the accepted way of life for many. So when a couple has problems conceiving, the shock and sadness is tinged with a kind of social stigma. Infertility in both men and women can occur for many reasons, and affects between 15-49 percent of couples worldwide, varying in prevalence between countries and regions. In Egypt, the Egyptian IVF Center, estimates the figure to be around 15 percent, higher than the 10 percent recorded in America by the American Fertility Association, but lower than the rates recorded in the infertility belt of sub-Saharan Africa, where upwards of 30 percent are afflicted, according to a number of studies including that of John Hopkins University. Until recent decades there was little hope of having children for those diagnosed as infertile, but the birth of the first test-tube baby in England in 1978 changed that. Louise Brown was the first baby ever born using in vitro fertilization (IVF), the process whereby a woman s egg is fertilized by sperm outside of the womb. In terms of treating infertility IVF was, and is, revolutionary, paving the way for infertile couples everywhere to have children. The procedure has been met with suspicion by Egyptians but is still extremely popular, and has quickly become the country s primary method of treating infertility. It was difficult at the beginning because it wasn t socially acceptable, says Dr Ahmed Serour, a physician at Egypt s first IVF clinic, the Egyptian IVF Center, established in 1986. But now we are getting over 3,000 patients a year. And that is in spite of the considerable cost. For a single treatment cycle , patients can expect to pay around $1,500 excluding medicines, which will cost a further $1,000. Even then success is not guaranteed. At the Egyptian IVF Center the rate of infertile couples who are treated successfully averages at 35-40 percent. The younger the couple, the better the chances of success, says Serour. For patients in their 20 s the rate of success is about 50 percent, but for older patients maybe only 10 percent. Mai M. is one of the success stories. After trying for four years to have a child she and her husband worried they may never succeed. A friend told her about IVF treatment and after trying once unsuccessfully in another clinic, she found Dr Serour s IVF Center. She is now seven months pregnant with a baby boy. It was like a miracle, she says. The actual treatment involves the woman undergoing two months of hormonal treatment, before taking fertility medicine to stimulate the production of eggs over a period of about 10 days. When the eggs are judged to be adequately mature they are retrieved from the ovaries using an ultrasound-guided needle. Single eggs are then transferred into a culture medium with around 75,000 sperm and left for 18 hours. Alternatively an egg can be injected with a single sperm in what is called an Intracytoplasmic Sperm Injection. The treatment was not so comfortable, says Mai, but it was worth it. According to Marcia Inhorn, Anthropology Professor at University of Michigan and author of "Local Babies, Global Science: Gender, Religion and in vitro fertilization in Egypt , IVF treatment in Egypt is quite advanced. In good IVF centers - those with well-qualified staff, a high-enough volume of patients, and good facilities - the success rates are as high as the best centers in the West. One reason is the role played by Egypt s Islamic authorities. A fatwa issued in 1980 by the Grand Imam of Al-Azhar, Sheikh Muhammad Abd Al-Rahman Bisar, permitted the use of IVF, from which point it became widely accepted throughout the Muslim world. Muslims are encouraged to avail of technology to alleviate suffering, says Inhorn, and with over 50 IVF clinics, she adds, Egypt is now one of the most advanced [treatment centers] in the Middle East. And yet, she says, there still exists a profound social stigma in Egypt attached to IVF. Infertility is a major social burden here, and almost always the woman bears its load, even though more men are infertile than women. Additionally there are lingering fears that mistakes in the lab will lead to the use of donor eggs or sperm, strictly prohibited in Sunni Islam. As a result says Inhorn, There is a culture of secrecy surrounding the procedure. Greater controversy surrounds IVF elsewhere. The catholic church equates discarding unused embryos, common in IVF, with murder, and IVF physicians have been ostracized everywhere from India to South America on both religious and social grounds. Those protestors might do well to speak with Mai. [IVF] gives hope to people who can t get pregnant, what could be wrong with that? she asks. Myself and my husband want to have more children, and if we need to, we will definitely use it again.
