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Ethnical and sociocultural differences causing infertility are poorly understood—insights from the Arabian perspective

  • B. LawrenzEmail author
  • C. Coughlan
  • Laura Melado
  • Human M. Fatemi
Assisted Reproduction Technologies
  • 32 Downloads

Abstract

Infertility is acknowledged worldwide as a major health concern. Although global levels of primary and secondary infertility have hardly changed between 1990 and 2010, significant regional differences have been reported. The prevalence of infertility in women has been estimated to be one in every seven couples in the western world and one in every four couples in developing countries. Male infertility may be under-reported in some regions due to an unwillingness of the male partner to undergo fertility investigations. Geographical, sociocultural/religious and ethnical dissimilarities contribute to these global variations in infertility prevalence. Infertility has a major impact on family stability in many cultures, especially in developing countries, where childlessness can impact sociocultural status. Moreover, it is important to realise that most fertility treatment protocols are based on studies performed in Caucasian population. The purpose of this opinion paper is to critically appraise the existing evidence regarding the association between infertility and relevant sociocultural factors in Middle East countries focusing on aspects such as parental consanguinity, obesity and vitamin D deficiency. There may be reason to believe that in addition to the current standard evaluation of infertile couples, region-specific counselling and treatment modalities are required.

Keywords

Infertility Middle East Consanguinity Vitamin D deficiency Obesity Ethnical difference Research 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest.

References

  1. 1.
    Inhorn MC, Patrizio P. Infertility around the globe: new thinking on gender, reproductive technologies and global movements in the 21st century. Hum Reprod Update. 2015;21(4):411–26.CrossRefGoogle Scholar
  2. 2.
    Mascarenhas MN, Flaxman SR, Boerma T, Vanderpoel S, Stevens GA. National, regional, and global trends in infertility prevalence since 1990: a systematic analysis of 277 health surveys. PLoS Med. 2012;9(12):e1001356.CrossRefGoogle Scholar
  3. 3.
    Luk BH, Loke AY. The impact of infertility on the psychological well-being, marital relationships, sexual relationships, and quality of life of couples: a systematic review. J Sex Marital Ther. 2015;41:610–25.CrossRefGoogle Scholar
  4. 4.
    Fido A, Zahid MA. Coping with infertility among Kuwaiti women: cultural perspectives. Int J Soc Psychiatry. 2004;50(4):294–300.CrossRefGoogle Scholar
  5. 5.
    Khayata GM, Rizk DE, Hasan MY, Ghazal-Aswad S, Asaad M. Factors influencing the quality of life of infertile women in United Arab Emirates. Int J Gynaecol Obstet. 2003;80:183–8.CrossRefGoogle Scholar
  6. 6.
    Agarwal A, Mulgund A, Hamada A, Chyatte MR. A unique view on male infertility around the globe. Reprod Biol Endocrinol. 2015;13:37.CrossRefGoogle Scholar
  7. 7.
    Khandwala YS, Zhang CA, Li S, Behr B, Guo D, Eisenberg ML. Racial variation in semen quality at fertility evaluation. Urology. 2017;106:96–102.CrossRefGoogle Scholar
  8. 8.
    Feichtinger M, Göbl C, Weghofer A, Feichtinger W. Reproductive outcome in European and Middle Eastern/North African patients. Reprod BioMed Online. 2016 Dec;33(6):684–9.CrossRefGoogle Scholar
  9. 9.
    Salem WH, Abdullah A, Abuzeid O, Bendikson K, Sharara FI, Abuzeid M. Decreased live births among women of Middle Eastern/North African ethnicity compared to Caucasian women. J Assist Reprod Genet. 2017;34(5):581–6.CrossRefGoogle Scholar
  10. 10.
    Elbardisi H, Majzoub A, Al Said S, Al Rumaihi K, El Ansari W, Alattar A, et al. Geographical differences in semen characteristics of 13 892 infertile men. Arab J Urol. 2018 Feb 2;16(1):3–9.CrossRefGoogle Scholar
  11. 11.
    Inhorn MC. Middle Eastern masculinities in the age of new reproductive technologies: male infertility and stigma in Egypt and Lebanon. Med Anthropol Q. 2004;18:162–82.CrossRefGoogle Scholar
  12. 12.
    Ahmadi H, Montaser-Kouhsari L, Nowroozi MR, Bazargan-Hejazi S. Male infertility and depression: a neglected problem in the Middle East. J Sex Med. 2011;8:824–30.CrossRefGoogle Scholar
  13. 13.
    Forty years of IVF, Niederberger C, Pellicer A, Cohen J, Gardner DK, Palermo GD, et al. Fertil Steril. 2018;110(2):185–324.e5.CrossRefGoogle Scholar
  14. 14.
    Baker VL, Luke B, Brown MB, Alvero R, Frattarelli JL, Usadi R, et al. Multivariate analysis of factors affecting probability of pregnancy and live birth with in vitro fertilization: an analysis of the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System. Fertil Steril. 2010;94:1410–6.CrossRefGoogle Scholar
  15. 15.
    Polyzos NP, Drakopoulos P, Parra J, Pellicer A, Santos-Ribeiro S, Tournaye H, et al. Cumulative live birth rates according to the number of oocytes retrieved after the first ovarian stimulation for in vitro fertilization/intracytoplasmic sperm injection: a multicenter multinational analysis including ∼15,000 women. Fertil Steril. 2018;110:661–70.CrossRefGoogle Scholar
  16. 16.
    Tabbalat AM, Pereira N, Klauck D, Melhem C, Elias RT, Rosenwaks Z. Arabian Peninsula ethnicity is associated with lower ovarian reserve and ovarian response in women undergoing fresh ICSI cycles. J Assist Reprod Genet. 2018;35:331–7.CrossRefGoogle Scholar
  17. 17.
    Tadmouri GO, Nair P, Obeid T, Al Ali MT, Al Khaja N, Hamamy HA. Consanguinity and reproductive health among Arabs. Reprod Health. 2009;6:17.CrossRefGoogle Scholar
  18. 18.
    Seher T, Thiering E, Al Azemi M, Heinrich J, Schmidt-Weber CB, Kivlahan C, et al. Is parental consanguinity associated with reduced ovarian reserve? Reprod BioMed Online. 2015;31:427–33.CrossRefGoogle Scholar
  19. 19.
    Baccetti B, Capitani S, Collodel G, Cairano G, Gambera L, Moretti E, et al. Genetic sperm defects and consanguinity. Hum Reprod. 2001;16:1365–71.CrossRefGoogle Scholar
  20. 20.
    Latini M, Gandini L, Lenzi A, Romanelli F. Sperm tail agenesis in a case of consanguinity. Fertil Steril. 2004;81:1688–91.CrossRefGoogle Scholar
  21. 21.
    Inhorn MC, Kobeissi L, Nassar Z, Lakkis D, Fakih MH. Consanguinity and family clustering of male factor infertility in Lebanon. Fertil Steril. 2009;91:1104–9.CrossRefGoogle Scholar
  22. 22.
    Lips P. Worldwide status of vitamin D nutrition. J Steroid Biochem Mol Biol. 2010;121:297–300.CrossRefGoogle Scholar
  23. 23.
    Mishal AA. Effects of different dress styles on vitamin D levels in healthy young Jordanian women. Osteoporos Int. 2001;12:931–5.CrossRefGoogle Scholar
  24. 24.
    Hatun S, Islam O, Cizmecioglu F, Kara B, Babaoglu K, Berk F, et al. Subclinical vitamin D deficiency is increased in adolescent girls who wear concealing clothing. J Nutr. 2005 Feb;135:218–22.CrossRefGoogle Scholar
  25. 25.
    Gannagé-Yared MH, Chemali R, Yaacoub N, Halaby G. Hypovitaminosis D in a sunny country: relation to lifestyle and bone markers. J Bone Miner Res. 2000 Sep;15:1856–62.CrossRefGoogle Scholar
  26. 26.
    Gannagé-Yared MH, Maalouf G, Khalife S, Challita S, Yaghi Y, Ziade N, et al. Prevalence and predictors of vitamin D inadequacy amongst Lebanese osteoporotic women. Br J Nutr. 2009 Feb;101:487–91.CrossRefGoogle Scholar
  27. 27.
    Lips P. Vitamin D status and nutrition in Europe and Asia. J Steroid Biochem Mol Biol. 2007;103:620–5.CrossRefGoogle Scholar
  28. 28.
    Fabris AM, Cruz M, Iglesias C, Pacheco A, Patel A, Patel J, et al. Impact of vitamin D levels on ovarian reserve and ovarian response to ovarian stimulation in oocyte donors. Reprod BioMed Online. 2017;35:139–44.CrossRefGoogle Scholar
  29. 29.
    Drakopoulos P, van de Vijver A, Schutyser V, Milatovic S, Anckaert E, Schiettecatte J, et al. The effect of serum vitamin D levels on ovarian reserve markers: a prospective cross-sectional study. Hum Reprod. 2017;32:208–14.Google Scholar
  30. 30.
    Shapiro AJ, Darmon SK, Barad DH, Gleicher N, Kushnir VA. Vitamin D levels are not associated with ovarian reserve in a group of infertile women with a high prevalence of diminished ovarian reserve. Fertil Steril. 2018;110:761–6.CrossRefGoogle Scholar
  31. 31.
    Arefi S, Khalili G, Iranmanesh H, Farifteh F, Hosseini A, Fatemi HM, et al. Is the ovarian reserve influenced by vitamin D deficiency and the dress code in an infertile Iranian population? J Ovarian Res. 2018;11:62.CrossRefGoogle Scholar
  32. 32.
    Paffoni A, Ferrari S, Viganò P, Pagliardini L, Papaleo E, Candiani M, et al. Vitamin D deficiency and infertility: insights from in vitro fertilization cycles. J Clin Endocrinol Metab. 2014;99:E2372–6.CrossRefGoogle Scholar
  33. 33.
    Polyzos NP, Anckaert E, Guzman L, Schiettecatte J, Van Landuyt L, Camus M, et al. Vitamin D deficiency and pregnancy rates in women undergoing single embryo, blastocyst stage, transfer (SET) for IVF/ICSI. Hum Reprod. 2014;29:2032–40.CrossRefGoogle Scholar
  34. 34.
    Taylor J. The changing health of the Middle East population through oil and automobiles. Eur Heart J. 2009;30(11):1291–3.CrossRefGoogle Scholar
  35. 35.
    Hruschka DJ, Hadley C. How much do universal anthropometric standards bias the global monitoring of obesity and undernutrition? Obes Rev. 2016;17:1030–9.CrossRefGoogle Scholar
  36. 36.
    Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ. National, regional, and global trends in body-mass index since 1980: a systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet. 2011;377:557–67.CrossRefGoogle Scholar
  37. 37.
    Broughton DE, Moley KH. Obesity and female infertility: potential mediators of obesity's impact. Fertil Steril. 2017;107:840–7.CrossRefGoogle Scholar
  38. 38.
    Palep-Singh M, Picton HM, Barth JH, Balen AH. Ethnic variations in the distribution of obesity and biochemical metabolic abnormalities in fertility clinic attendees. J Reprod Med. 2008;53:117–23.Google Scholar
  39. 39.
    Kahn BE, Brannigan RE. Obesity and male infertility. Curr Opin Urol. 2017;27(5):441–5.CrossRefGoogle Scholar
  40. 40.
    Practice Committee of the American Society for Reproductive Medicine. Obesity and reproduction: a committee opinion. Fertil Steril. 2015;104:1116–26.CrossRefGoogle Scholar
  41. 41.
    Lim SS, Davies MJ, Norman RJ, Moran LJ. Overweight, obesity and central obesity in women with polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update. 2012;18:618–37.CrossRefGoogle Scholar
  42. 42.
    Mykhalchenko K, Lizneva D, Trofimova T, Walker W, Suturina L, Diamond MP, et al. Genetics of polycystic ovary syndrome. Expert Rev Mol Diagn. 2017 Jul;17(7):723–33.CrossRefGoogle Scholar
  43. 43.
    Haq F, Rizvi J. Infertility and polycystic ovarian syndrome: a study of association between body mass index and intrafamily marriages. Gynecol Obstet Investig. 2008;4:269–74.CrossRefGoogle Scholar
  44. 44.
    Knochenhauer ES, Key TJ, Kahsar-Miller M, Waggoner W, Boots LR, Azziz R. Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern United States: a prospective study. J Clin Endocrinol Metab. 1998;83:3078–82.Google Scholar
  45. 45.
    Kauffman RP, Baker VM, Dimarino P, Gimpel T, Castracane VD. Polycystic ovarian syndrome and insulin resistance in white and Mexican American women: a comparison of two distinct populations. Am JObstet Gynecol. 2002;187:1362–9.CrossRefGoogle Scholar
  46. 46.
    Bozdag G, Mumusoglu S, Zengin D, Karabulut E, Yildiz BO. The prevalence and phenotypic features of polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod. 2016;12:2841–55.CrossRefGoogle Scholar
  47. 47.
    Wolf WM, Wattick RA, Kinkade ON, Olfert MD. Geographical prevalence of polycystic ovary syndrome as determined by region and race/ethnicity. Int J Environ Res Public Health. 2018;15:11.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.IVIRMA Middle-East Fertility ClinicAbu DhabiUnited Arab Emirates
  2. 2.Obstetrical DepartmentWomen’s University Hospital TuebingenTuebingenGermany

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