Dr. Jibrel: “I make it a point to work within religious and ethical boundaries; there are limits to what can be experimented upon.” [Archives:2006/916/Health]
Nadia Al-Sakkaf
Dr. Sallam Omar Jibrel has worked in Yemen's reproductive health field for the past six years. He established Yemen's first In-Vitro Fertilization (IVF) and Assisted Reproduction Center (ARC) in 1999.
In the early years of establishment, Jibrel gathered information about infertility in Yemen and studied cases in order to provide valuable reproductive health treatment and services. Throughout his years in Yemen, in addition to working at the center, Jibrel regularly lectures on infertility at Yemeni universities and academic institutions.
He also represents Yemen and the Arab world at many international conferences abroad, most recently at last year's stem cell conference in the United Kingdom. He was the only Arab doctor and gave the international community insight on reproductive health problems in the Arab world, as well as learned about the latest developments in stem cell technology.
The Yemen Times ran a detailed interview with Dr. Sallam Jibrel in 2001. Since then, there have been many new developments in the field of assisted reproduction. According to Jibrel, the major developments were: introducing lasers in assisted hatching, spindle location of oocytes (choosing the proper angle for oocyte insemination), single embryo transfer using balstocyst culture media and stem cell studies involving future cloning. Such developments definitely are going to change infertility treatment methods.
ARC progress
Since Yemen's first IVF center began, the ARC has seen more than 12,000 cases, nearly 95 percent involving infertility. At the same time, the center's medical staff has performed 1,500 IVF treatment cycles and more than 4,000 surgical infertility treatment procedures on men and women.
In male reproductive treatment, medical staff performed different testicular sperm extraction procedures such as Percutanous Epididymal Sperm Aspiration (PESA), Testicular Sperm Aspiration (TESA), Testicular Sperm Extraction (TESE), as well as microsurgical vaso-epididyostomy and vasovasectomy.
In female reproductive treatment, medical staff performed all classical, laparoscopic and hysteroscopic gynecological and obstetrical procedures such as myomectomy, endometriotic ovarian cystectomy, laparoscopic abdominal adhesiolysis, ovarian cystectomy, hysterectomy, hysteroscopic uterine septum resection, intrauterine myomectomy, polypectomy and synechy resection.
Additionally, the ARC performed some procedures for the first time in Yemen such as amniocentesis (aspirating amniotic fluid to exclude genetic intrauterine disease).
Stem cell technology
Stem cells are the masters of all the body's cells and found in great concentrations in umbilical cord blood of newborns. Doctors also can prepare them in IVF labs for cloning purposes while embryos are in early development stages. After birth, the cells end up in bone marrow where they continuously replenish and produce blood cell constituents, as well as immune system cells. Stem cells are used to treat a large number of diseases and medical disorders and many more treatments are on the horizon.
Proven treatable diseases using stem cells include:
Malignancies such as: acute and chronic leukemia, Ewing's Sarcoma, Hodgkin's and non-Hodgkin's lymphoma, multiple myeloma, myelodysplastic syndrome and neuroblastoma.
Blood disorders such as: aplastic anemia, Diamond-Blackfan anemia, sickle cell anemia, thalassemia, Fanconi's syndrome, Kostmann's syndrome, Evans' syndrome, congenital cytopenia and amegakaryocytic thrombocytopenia.
Inborn metabolism errors such as: Gaucher's disease, Gunther's disease, Hurler's disease, Hunter's disease, Alamyloidosis, Bare Lymphocyte syndrome, adrenoleukodystrophy, congenital dyskeratosis, Lesch-Nyhan syndrome and others.
Immunodeficiencies such as: Wiskott-Aldrich syndrome, chronic granulomatous disease, severe combined immunodeficiency diseases, adrenosine deaminase deficiency and X-linked lymphoproliferative disease.
This new field has provided with vast medical dimensions and each year more diseases and disorders are being added to the list of diseases that could be treated through stem cells technology.
Stem cells are collected immediately after birth. Umbilical cord blood is rich with these potentially life-saving cells, which in the past would have been discarded with the placenta. In the past few years, research has shown that umbilical cord stem cells can be transformed into other types of cells and tissues in the body.
Scientists believe this discovery will positively contribute to treating other conditions and diseases, such as: Parkinson's disease, multiple sclerosis, restoring brain damage following a stroke and restoring closed heart arteries (creating blood vessels), thus possibly avoiding a bypass operation.
Infertility in Yemen
Before the ARC, infertility treatment in Yemen was very primitive. Introduction of high technology by the first Jordanian team made a big difference in diagnosing and treating infertility. Intra Cytoplasmic Sperm Injection (ICSI) first was performed in Yemen in March 2000, signalling a new era in Yemeni infertility treatment. During the past five years, Jibrel was keen to improve the center's work and introduce new field developments. He introduced a genetic lab so medical staff can detect and diagnose genetic background cases, such as repeat abortions and infertility among siblings.
Yemen's infertility awareness has increased in the past five years. “When I came to Yemen five years ago, it took me hours to explain to patients what IVF is, trying to convince them this was the only way they could be treated. Now I handle some cases fully aware of all aspects of IVF procedures. This is always the story whenever a new treatment technology is introduced in any country.” Jibrel explained.
The World Health Organization estimates that 15 percent of the world's married couples have infertility problems. In a previous interview, Jibrel stated that Yemen is more or less the same.
However, the type of infertility in Yemen is a little bit different, mainly due to male infertility. In 60 percent of cases, the husband is the cause of infertility and this goes back to the set-up of Yemeni community.
As in any other Arab country and other Muslim countries, the male always seeks treatment for himself. If the problem is the wife's, he might take another. But the husband's side in Yemen more or less has certain characteristics and qat chewing has its own influence on male infertility.
Most of the time, qat is filled with substances like pesticides, insecticides and other agricultural substances. Used to grow Qat very quickly and protect it from insects, such substances influence male sperm growth and development to maturity. Qat can produce abnormal sperm and affect sperm motility as well.
Another factor is nutritional quality of traditional Yemeni food, which affects sperm's ability to fertilize. Another factor is infection, which hits the male genital track and sometimes passes unnoticed or mistreated. All these factors impact male infertility.
Female infertility is less, between 15 and 30 percent of all infertility cases in Yemen. But factors attracting attention in female infertility in Yemen include tuberculosis, which still is seen in many cases of blocked tubes in Yemeni women. Tuberculosis affects female tubes, necessitating IVF treatment.
The next most common women's problem is Polycystic Ovary Syndrome.
At least 25 to 30 percent of Yemeni females treated for infertility having this problem, which more or less is from hormonal background and has some hereditary factors as well. Fertility in Yemen largely is the same as in other countries, which also have the unique properties previously mentioned.
Jibrel thinks more care and attention should be given to the medical profession in Yemen. “By this I mean that there should be strict evaluation of those working in this profession by both the Ministry of Health and the Yemeni Medical Syndicate. Also, evaluation of newly graduated doctors at all levels will make a big difference in Yemen,” he said.
Next step
As to where Jibrel will head next, he explained that he is content with the ARC's progress and the medical team working in it. He said, “I am happy to have started medical service that was of great value to many patients in Yemen. I am also happy that I have made a Yemeni team that I am really very proud of. I am now keen to improve this by introducing new procedures in infertility treatment.”
Jibrel's next step is more research and specialization in stem cell technology, which he believes will help many young male infertility patients. However, he pointed out that there is control over medical research, or at least the part in which he is involved. Referring to this, he said, “I make it a point to work within religious and ethical boundaries; there are limits to what can be experimented upon.”
As for the ARC, he proudly stated that the medical team is all Yemeni doctors and biologists. Jibrel feels confident that they can work on their own and are of high caliber. They have attended many international conferences in infertility treatment and management. The ARC is viewed regionally and internationally as a reputable scientific center.
Personal aspiration
Asked about his personal aspiration, Jibrel answered, “Career-wise, I would like to find enough time to write a book about my medical experience in the field of assisted reproduction and a book about my family history. Personally, I hope to find enough time to visit all Yemeni cities and live the true experience of this lovely country. My main wish is to meet all Yemeni children born after IVF treatments I have performed in those families.”
Who is Dr. Sallam Omar Jibrel?
– A Jordanian earning his first medical degree (MB.BS) from Jordan University's School of Medicine in 1981. Worked in various Jordanian hospitals after graduation.
– Moved to Saudi Arabia in 1987 to work at the Military Hospital in Kamis Mushayt.
– Obtained a master's in Obstetrics and Gynecology in 1996 and an M.D. in endoscopic surgery in 1998 from Christian-Albrecht University in Kiel, Germany.
– Returned to Jordan in 1998 to work in the assistance reproduction and infertility field, especially In-Vitro Fertilization (IVF).
– Headed the Obstetrics and Gynecology department at Jordan's National Red Crescent Hospital in Amman for three years.
– Established Yemen's first IVF program in 1999. Since then, Medical Director of the Assisted Reproduction and IVF Center, mainly specializing in IVF-ICSI, laparoscopic and hysteroscopic surgery.
– Professional interests: reproductive endocrinology, male factor infertility and its impact on infertility, tuberculosis (T.B.) and female infertility and stem-cell technology.
– Personal interests: photography and history.
– Father of three children.
– Member of:
Arab Society of Reproductive Medicine
European Society for Human Reproduction and Embryology
Middle East Fertility Society
International Society of Gynecology and Endoscopy
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[archive-e:916-v:14-y:2006-d:2006-01-30-p:health]
