ALKHOBAR, 7 June — A couple goes out, gets married and then the honeymoon begins. But here in Saudi Arabia it can end very quickly. The primary purpose of the honeymoon is not for the newly married couple to have a good time, relax, and get to know each other. No! The real purpose of the honeymoon is for the bride to become pregnant as quickly as possible. Woe betide her if it doesn’t happen.
While many attitudes in Saudi Arabia are changing, the push to produce a child immediately after marriage is not one of them. According to Dr. Solaiman A.M. Solaiman, one of this nation’s foremost consultants on infertility, the pressure to conceive is as high as ever.
"Couples come to me who have been married just two or three months and they want me to treat them for infertility," said Solaiman. "It’s ludicrous. It makes me furious. These couples are being pushed by their relatives to produce a child and they are considered to be failures if a pregnancy doesn’t occur immediately after marriage. So many things have to go right for the human species to reproduce that it’s a miracle it happens at all. Do you know that in each month there are only 8 ideal hours during which a woman can get pregnant? But surprisingly, infertility issues will affect only 14-19% of all couples — although the percentage is rising. In any case, outside of ensuring that a newly married couple knows the basics about sexual intercourse, there is nothing to do except send them home to keep trying for at least a year."
It may be astonishing to imagine that a married couple might not know the basics about sex, but that is the truth. Only the most limited biological concepts relating to sex are taught in Saudi schools. This can lead to serious problems when couples do not discover correct information about sexual intercourse on their own.
"We had one case where a couple came to us after seven years of marriage, during which time pregnancy did not occur," said Solaiman.
"At first glance there was definitely a problem with the couple’s fertility.
We tested the man and he was fine. So then we decided to do an ultrasound test on the woman. It was at that point that we discovered her virginity was intact. We had to gently sit the couple down and discuss the delicate issue of their sexual life over the past seven years. That’s when we found that there was some misunderstanding about the correct methodology for sexual intercourse. Once we gave them proper advice, they went home and within two months reported back that pregnancy had been achieved."
In that couple’s case they were extremely lucky. In addition to having poor information about the sex act, the couple had been consulting "Attarain" or herbalists for advice. The herbalists had given them numerous potions to take to improve their fertility, when in fact their fertility was not really the issue. Other couples have met with disaster after consulting a herbalist. Perhaps the woman had an infection that wasn’t treated properly and consequently her reproductive organs became permanently damaged. Some women have been given treatments that caused renal failure and even death.
Horrified with the needless agony that so many couples have gone through in their quest for a child, on two occasions Solaiman went to the Shoura Council to request that stricter controls be put into place for the diagnoses and treatment of infertility. He feels that it is urgent to implement proper regulation of infertility medications. So far his efforts have met with failure and he is disappointed.
"The drugs used in treating infertility are extremely complicated and dangerous," pointed out Solaiman. "When they are prescribed to the wrong patients they can cause serious illness and even death. This is not a joke. A herbalist will go to a pharmacy and get an infertility medication and mix it with some herbs and start selling it as a natural infertility treatment. A general practitioner, who has little experience in the causes of infertility, will prescribe a drug that can increase ovulation or change the way the body allocates its fluid resources. When the woman gets pregnant with 9 babies or her kidneys fail, everyone is horrified. These instances of malpractice are completely preventable.
There should be as tight a check on infertility drugs as the controls we have on painkillers and tranquilizers. Only specialists in gynecology or infertility should be allowed to prescribe infertility treatments."
Solaiman stated that a large part of the problem with infertility treatment lies with the local medical profession. "Barefoot doctors," his term for under qualified doctors, prescribe infertility drugs at random just to appease patients and keep them coming back. Some infertility clinics are disreputable and to make money actually treat couples who are not really infertile. The medical profession has not emphasized to the media that multiple births achieved through infertility treatments are not occasions for rejoicing.
When a woman is carrying multiple fetuses her pregnancy often ends prematurely with the babies suffering horrible abnormalities. The risks for the mother are also increased.
"There are certain important steps in fertility treatment and bypassing any one of them can decrease the chances of a couple eventually taking an infant home," said Solaiman. "It is important to emphasize that the only outcome of fertility treatment that really matters is a happy couple taking home a healthy infant. When a couple comes to an infertility clinic, a complete medical and sexual history must be taken.
Then based on the history, initial investigations into the reason or reasons for the couple’s infertility may begin. These days we usually start by checking the fertility of the man. Fifteen years ago we would have probably looked at the woman first, but now, internationally, it is more likely that there is a problem with the sperm. In the Kingdom, since the Gulf War, due to the pollutants released into the local environment, male infertility has risen. The testes, where sperm are produced, are extremely susceptible to environmental poisons."
Spermatogenesis, or the differentiation of primary cells, called spermatogonia, into viable sperm, takes 64 days. Spermatogenesis occurs in four stages and any disruption in the process results in male infertility. If a man has only spermatogonia or spermatocytes in his semen, stages one and two in the process, there is no hope for him to father a child. If he has spermatids or spermatozoan, stages three and four in sperm production, then conception is possible. "If a male has only spermatids in his semen, then he will need to be assisted in helping his wife conceive," explained Solaiman. "At my clinic in 1996, the first infant was born through the use of Intracytoplasmic Sperm Injection (ICSI) with the spermatid. ICSI is the micromanipulation of the egg and the sperm to produce the embryo. The success rate of this technology using spermatids is still less than 10% but at least it has given a chance to otherwise infertile men."
Internationally, the success rate for in vitro fertilization (IVF) using stage four spermatozoan is 80% in the laboratory. After that point, when the embryos are transferred to the woman, there is 30-40% chance of pregnancy. But the only number that matters, says Solaiman, is the baby take home rate, and internationally this is about 14%. Everywhere, many clinics play with their numbers publicizing the pregnancy rate not the baby take home rate. Clinics may also treat couples who do not meet the criteria for infertility, with the incentive of both profit and an improvement in their statistics. Any couple considering treatment at an infertility clinic should ask for the baby take home rate, not the pregnancy rate or even the number of live births.
"Right now in Saudi Arabia infertility treatment is a free-for-all.
Believe me, even the sellers at the vegetable market are giving out information on overcoming infertility," said Solaiman. "Many unqualified barefoot doctors are in the clutches of the pharmaceutical companies and they will prescribe anything just to increase drug sales. The herbalists are wreaking havoc and actually causing infertility and other illnesses.
Relatives are the worst enemies of a young couple because they just want a baby at any cost. My advice to couples wanting to conceive is to relax. If you are in doubt and think you might have an infection, are having pain during intercourse, or might not understand how to perform the sex act properly, visit a gynecologist to discuss these specific issues — not for infertility treatment. If a couple still cannot conceive after a year of having frequent sexual intercourse, only then is it time to consult an infertility specialist."
