AMMAN—In the late 1990’s Qasim Al Ammouri, a schoolteacher from northern Jordan, was celebrating his marriage. It wasn’t long after the festivities had died down that he and his new wife were able to rejoice at becoming pregnant.
Sadly the joy was short lived.
Six weeks into the pregnancy, his wife suffered a miscarriage. Soon after, the newlyweds began to seek medical assistance to fulfill their dream of having children. They were unsuccessful for many years but finally in October, after 16 years of marriage, Al Ammouri’s wife gave birth to triplets, though not without heartbreaking complications.
The process has been costly and on a salary of about $700 per month, Al Ammouri had to borrow money to pay the bill, which he estimates to be about $5,000 alone for in vitro fertilization, or IVF, although prices vary across the region. The cost of the treatment, which involves combining a sperm and an egg cell in the laboratory and then transferring it to the woman’s uterus, excludes hospital bills incurred at birth. “We still have the incubator expenses,” he says.
Infertility is thought to affect one in seven couples. Experts say Al Ammouri and his wife’s story is not uncommon. Couples across the Arab world are spending thousands of dollars they may not have on IVF and other assisted fertility treatments because the stigma of a childless marriage can be too much to bear.
Adoption, though legally permissible, is uncommonly considered an alternative in most Arab countries because some interpretations f Islamic teachings dictate adopted children cannot take the name of their new family. Al Ammouri and his wife didn’t ever entertain the notion of adoption. “In Islam I can’t attribute the adopted child to myself,” he says, “Besides, nothing could be like biological children.”
With so many young couples seeking to become parents despite biological obstacles, researchers are trying to find ways to help them. At the Jordan University of Science and Technology, scientists are researching the potential of certain antioxidant compounds to improve sperm motility. “People sell their lands, save up and take loans for IVF,” says fertility expert Saleem Bani Hani, an assistant professor of clinical chemistry and molecular medicine. “If we can improve the success rates of assisted fertility treatments then we can help reduce this burden.”
Couples often come to Bani Hani more than anxious to conceive after relentless pressure from their extended family. “Within a month of being married, mothers and mother in-laws will be asking if the wife is pregnant and if not they want to know why,” he says, “My patients often want to have a child just to get rid of these questions.” The stress caused by such peer pressure hampers the chances of conception even more, he adds.
The hefty price tag of IVF and other treatments doesn’t seem to put Arab couples off.
According to data published in a 2014 study by the International Committee for Monitoring Assisted Reproductive Technologies, Egypt with a per capita GDP $3,300 sees 346 cases of assisted fertility treatments per million of its population each year. Canada’s per capita GDP is roughly 16 times larger than Egypt’s, yet it has an almost identical rate of assisted fertility treatments. (Also, some fertility treatments are available free of charge on Canada’s public health system.) “Non-Arab countries of similar means are more likely to have lower rates of assisted fertility,” says study author Dr. Ragaa Mansour who helped to found the Egyptian IVF Center in Cairo.
When it comes to the IVF procedure, there are two ways to fertilize an egg cell outside of the human womb. One is to inject a sperm cell into the egg cell with a delicate needle; this is usually done if sperm cells are sluggish. The other is to coat the egg cell in semen and allow sperm cells to race for the privilege, this is called melting. The second option is preferable, says Bani Hani, because it’s less likely to produce medical complications. “Studies have shown that injecting sperm might create problems like mutations in the DNA, which can cause miscarriages.”
Bani Hani’s research aims to help as many couples as possible to use the melting method. He added various concentrations of an antioxidant called L-carnitine to sperm samples and then measured their motility. L-carnitine is naturally found in proteins—codfish, milk and chicken breast are all high in the substance but beefsteak contains by far the most of the antioxidant.
In results of experiments published two years ago in the Andrologia journal, Bani Hani found that motility was improved when L-carnitine reached a level of about 0.05 percent of the total semen sample. But when the level of the antioxidant reached 5 percent it had a negative influence.
For couples experiencing fertility problems, Bani Hani advises the man to eat more dairy and meat products—although he cautions that it may not always work. “Sometimes there can be an issue in your body where it doesn’t absorb it properly.”
Mansour on the other hand counsels against this and warns there isn’t enough evidence to back up these claims. “I wouldn’t advise that they eat more meat, it’s too early to make such recommendations,” she says, “It could have a negative effect on general health, which is very important when you’re trying to conceive.”
Regardless, Bani Hani says he is continuing research in the hopes of increasing success rates and minimizing complications—something that Al Ammouri and his wife are all too familiar with. At the time of writing, two of his triplets died due to problems with their lungs. The third child seems healthy. Al Ammouri says the heartbreak and financial expense was worth it nonetheless, even though he also had to borrow money from family members to pay for funeral expenses.
“Nothing could make me happier than being a father.”