Fertility experts in Iran, Egypt, Lebanon, Saudi Arabia, Qatar, Turkey, Cyprus and Israel have cooperated with a New York reproductive endocrinologist to publish what is reportedly the first-ever collaborative study on in-vitro fertilization services in the Middle East.
The unusual scientific paper that brings together countries, some of which are officially at war or have no diplomatic relations with Israel, has just been published in London's Journal of Experimental & Clinical Assisted Reproduction. The full manuscript may be freely downloaded from the journal's home page at www.jexpclinassistreprod.com.
Among the similarities in IVF found in the participating countries are more male infertility, low prices or even free treatment for help with the problem, and deliveries of babies by the doctors who performed the IVF procedures.
The paper, coordinated by Dr. Eric Scott Sills of RMA-Vassar Brothers Medical Center, summarizes fertility services available throughout the region after information on diagnosis and treatment was collected.
Two well-known Israeli fertility experts who participated were Prof. Ariel Revel of Hadassah-University Medical Center and the Hebrew University-Hadassah Medical School, and Prof. Zeev Blumenfeld of Rambam Medical Center and the Technion's Rappaport Medical School in Haifa.
Noting that doctors in Muslim and Arab countries joined Israelis, Sills noted: "These were outstanding scholars who I think welcomed an unusual opportunity to build some bridges." The study, he said, "is the first time so many diverse programs agreed to contribute data and share expertise for a common project. Remarkably, the group had never worked together before the current project."
Although "political and religious discord in the Middle East has thus far resisted attempts to bring a lasting reconciliation," they wrote, "IVF physicians of the region are called upon to see beyond enormous distractions and are expected to solve complicated, frustrating problems for their patients every day. An unusual, hopeful symbolism emerged from this background, where providers of the advanced reproductive technologies were considered as being well-placed observers of what can happen when measured combinations of balanced and opposing elements are carefully brought together, at the most basic and humanistic level, to yield new, positive beginnings," the authors wrote in their introduction.
"Our study showed that the conflict of the region is not necessarily the whole story," Sills said. "As physicians, we need to work for healing and peace wherever possible, and these colleagues demonstrated a desire and ability to work together despite any differences - one embryo at a time," he added.
Sills and colleagues looked for leading IVF centers throughout the Middle East, using the Internet, recommendations and contacts through US embassies in the region. No contact information was available from any source about IVF centers in Bahrain, Iraq, Kuwait, Oman, the Palestinian Authority, Syria, United Arab Emirates or Yemen, thus they were not included in the study, which, said Sills, shows that IVF experts are "willing to share data and work collaboratively."
When comparing the results from detailed questionnaires sent back to New York, Sills found that a relatively high proportion of infertility caused by the male partner, requiring intra-cytoplasmic sperm injection (ICSI), occurred in the Middle East, compared to other regions. In addition, IVF specialists in the Middle East tend to offer "seamless care" to their patients, from helping to them to conceive to delivering the resultant baby. In the US, for example, the IVF doctor rarely participates in the delivery.
In some countries, such as Israel, IVF treatment for infertile couples is included in the national basket of health services and paid for at public expense, unlike the US, where there is only private insurance and most policies do not cover IVF. But even in those Middle Eastern countries lacking coverage, costs for treatment were relatively low, with an average of less than $2,500, and sometimes they are free.
In addition, despite limited or non-existent government regulation of clinical IVF practice, the number of fertilized embryos transferred to the woman was fairly uniform in the region. Anonymous donations of ova was offered in Israel, Iran, Lebanon and Cyprus, but only under specified circumstances (except in Cyprus).
"Since clinical outcomes may be compared only if treatment is carried out under equivalent circumstances and complete standardized data are collected," the authors concluded, "building bridges to share information freely across international borders is crucial...This pilot study provides an encouraging framework to achieve this goal in the Middle East."
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