In vitro fertilization for…Infertility treatment in Yemen [Archives:2003/639/Health]

June 5 2003

Abdo Moqbil Al-Sabiri

Dr. Salam Omar Jibrel, a Jordanian had his first degree in medicine from the Jordan University in 1981.Then, he worked in Jordan for some time and then moved to the Military Hospital in Kamis Mushayt- Saudi Arabia to work there. After working in Saudi Arabia, he went to Germany to have his post graduate studies in obstetrics, gynecology and infertility.He finished his degree of specialty in that field in 1996.Then, he had his doctoral thesis in medicine about the Laparoscopic Surgeries.He went back in 1996 to Jordan to work in the field of assistance reproduction and infertility especially In Vitro Fertilization( IVF).
He worked in Jordan for three years as the Head of Obstetrics and Gynecology Departmental Jordan National Red Crescent Hospital in Amman .
In 1999, he started to establish the first IVF program in Yemen.this program started to work on March 2000. This is the first IVF program to be established in Sana'a.Dr .Salam Jibrel is the Medical Director of this first IVF center in Yemen.
He is the father of three children.He is interested in Photography and History.
In this regard, researches in reproductive technology should be conducted with utmost respect and consideration of the value and dignity of human life.
To know all there is to know about the infertility problems in Yemen, Mr. Abduh Moqbil Assabri, Yemen Times reporter and in the company of Mr. Hussein Saleh Al-Zubairi, doctor at Sana'a University interviewed Dr. Salam Omar Jibrel and filed the following report.


Q: As a specialist in obstetrics and gynecology, what are the infertility problems in Yemen if compared to any other neighboring countries?
A: Infertility problems in Yemen are having unique properties.
It is the same as any other country of the world. The estimate of the WHO that 15% of world population married couples are having infertility problems. In Yemen, it is more or less the same. But the type of infertility in Yemen is a little bit different. It is mainly due to the male factor infertility. The husband in 60 percent of the cases is the cause of infertility and this goes back to the setup of the Yemeni community. The male, as in any other Arab country and other Muslim countries, is always seeking treatment for himself. If the problem is from the wife, he might have another wife. But, the male factor or the husband side also in Yemen has more or less certain characteristics and the chewing of Qat in Yemen is having its own influence on the male factor infertility.
Qat for most of the time is filled with some substances such as, pesticides and insecticides or agricultural substances. These substances are used for growing the Qat very fast and to protect it from insects.
Those substances have their influence on the male side. They influence the growing sperms and their development to the mature stages. Qat can produce abnormal sperms and affect sperm motility as well .The other thing is the quality of nutrition contained in the Yemeni traditional food which affects sperms ability of fertilization. The other thing is the infection which hits the genital track of the male and sometimes passes unnoticed or maltreated. This has its impact on the male side or the male factor infertility.
In the female or the wife side of infertility, the percentage is less. It is around 15 to 30 percent of the whole number of the infertilities in Yemen. But things which attract my attention while working at infertility in Yemen are that some infections like tuberculosis are still seen in many cases of blocked tubes in Yemen. This tuberculosis' infections hit the tubes in the female and make it necessary to have an IVF treatment for such cases.
The next most common in women is called the Polycystic Ovary Syndrome.
We have noticed that at least 25 to 30 percent of the females in Yemen who are treated for infertility are having this problem which is more or less of hormonal background and it has some hereditary factors as well . By large, fertility in Yemen is the same as in other countries which have the unique properties as I have mentioned before.

Q: What is the role of the IVF center in treating infertility problems?
A: The first IVF center to be established had taken sometime because of the high technology involved in this assisted reproduction type of technology. The IVF center treats severe types and forms of infertility for both male and female infertility, and this needs high technology and high skills. This center was established in March 2000.
At the start, most of the biologists and technicians were involved in the procedures of assistance reproduction like the, Intracytoplasmic Sperm Injection( ICSI) which is considered the most advanced type of infertility treatment.In this procedure, we inject one sperm inside of the female egg. And that needs a high skill.
As I have mentioned, at the start there were biologists and technicians coming from Jordan to help us and to train the Yemeni trainees who are now taking care of all these procedures. Other technologies have been involved also like the freezing of testicular sperms, the freezing of embryos and other types of assisted reproduction technologies like the laparoscopic surgeries, the hysteroscopy surgeries and intra-uterine inseminations. All the assisted reproduction technologies help in treating different types of infertility.

Q: How many childless parents have been treated?
A: Since we have started working in this center, we have seen almost 800 couples who were coming to do assisted reproduction technologies treatment.
Of these 800 cases, we have succeeded in helping almost 250 to 300 having children or currently pregnant . Up to date, we have 93 babies born at our center. We had four sets of triplet , (three babies born at one time), and we had 25 twins born at our center and the rest were single babies.
Currently, we have at least 155 pregnant women using the reproduction technologies in the form of ICSI and in the form of intra-uterine inseminations.There are other procedures which we use to help other proportional patients that are the use of the laparoscopic surgeries and the hysteroscopy surgeries. Those patients do not need the ICSI procedures or the intra-uterine inseminations procedures.
With the help of the laparoscopic surgeries, we could release the adhesions from the abdomen. We could also proceed with some surgeries where infertile couples have become parents. Also we had what we call Ovulation induction procedures. By this procedure we give the wife the medication and we monitor the proper timing of intercourse that will end up with the pregnancies most of the time.
All in all, I can say that at least we have helped between 700 to 1000 couples since we have established our IVF center.

Q: As it seems to me that a lot of infertility cases have been successfully treated, why don't you gather all these medical accomplishments in the form of a book or a booklet?
A: This is the idea which crosses my mind. Now, I have almost finished writing a book in Arabic and that is the first book to be written about ( test-tube babies and IVF in Yemen ).
It is called IVF Babies in Yemen. And in this book, I have included all our results, researches and unique infertility problems. I hope within three months, it will be on the market for the people to read it and for the doctors to have a look at it. In the book of the IVF Babies in Yemen, I have also compared what is in Yemen with what is happening in other countries. I have mentioned those who have no clue about the test-tube babies and how those procedures have been applied, its benefits and who can get most of these procedures.

Q: Do you think that people are aware of the advantages of what you are doing here. Some people feel ashamed of coming to be treated!
A: The idea of the test-tube babies and the IVF has its obstacles in every community.
All people who have started such work in any country have been faced with the same problems. People avoid coming to such places. They are ashamed at the start. Some of them on their back of their mind that it is religiously forbidden and this is the most important point to us. Above all, nobody would like others to know about his privacy or marital life. When we have established the IVF center, the first point which crossed my mind was to talk to the Islamic religious scholars in Yemen in order to be aware of such things and to give us their Fatwa, (religious decrease) concerning this issue. It is important that this comes from the community itself. We have such Fatwa from Egypt, Jordan, and from the Saudi Arabia. But it is important that the Islamic religious scholars in the country itself approve it and they are fully aware of the issue. People themselves have asked about the Fatwa whether it is permissible or religiously allowed. So, this obstacle was quickly solved by the approval of the Islamic scholars. Still some people don't like others to know about their privacy. We respect this point and made it clear to many people that we don't allow anybody to know about their private setup and their privacy of their treatment. We still hold some records for the people and those who don't like others to know about it. It is their own business and we respect that. The other thing is the awareness of the community where we are doing. This undoubtedly, needs time. Because we have to explain this more and more and ask the media to help us. We have to go on TV and a health program to assure people that what we are doing is part of medical treatment and it is religiously approved and medically safe. That is one of the modes of infertility which was developed in the last few years.

Q: As you're experienced in your field of specialization in Yemen as well as other Arab countries, do you see any difference between males and females from biological point of view?
A: Human beings are biologically the same whether they are Yemenis, Arabs or from any other nation. There is no difference, but the only difference is the setup where we treat infertility. Let me tell you something. Infertility in Jordan, the male factor or the husband side is responsible for almost from 30 to 35 percent of infertility. The health care and the health awareness of the people about these problems are little bit more than the Yemenis. They are aware of the fact that if they have these problems at younger age group, let's say in their early twenties, they would go straightaway and seek the proper medical help. Now if someone tells another that he needs to do an IVF or other assisted reproduction procedures in Jordan, he will accept that as part of treatment. It is not shameful and therefore is a mode of treatment. The same thing doesn't apply in Yemen yet. We need at least more years to raise awareness properly to be handed over to the people.

Q: In order to raise awareness about infertility problems among the public, whose responsibility is it?
A: It is the responsibility of everybody, health educators, the ministry of health, schools, the duty of doctors who have patients coming everyday and the responsibility of parents to take care of their children. One of the things which attract my attention that still in Yemen is that we are seeing what is called undescended testis. The testicles are not in their proper place in males. Some of those patients are above thirty. This should be treated as early as two years of age. This is the responsibility of parents and of school doctors if they have school health programs.
Those children should be screened. It is the responsibility of the first physician who is seeing this patient. The first time we notice such a thing, we should treat this patient, we should insist on treatment. Because at this age, it is too late and sometimes and it might be having cancer.

Q: Have the media responded to raise awareness of infertility problems in Yemen?
A: We have asked the media all the time. Every body should be aware of the infertility problems. In one of the conferences, I have talked about the impact of the infertility on the Yemeni community after two generations. The male factor infertility is growing to the extent that it will affect the fertility of the community after two generations. After two generations, with the continuous use of Qat which is full of insecticide and pesticides, we are depriving the males of normal development of their fertility. I have noticed that these days, young Yemeni chaps are chewing Qat as early as ten years of age and this is the dangerous part. Let me tell you how I concluded that the male infertility is having bad prognosis on the community after two generations. Let's go back to twenty years; the Yemenis were not chewing Qat if they were younger than twenty or twenty five years of age. The same generation, the male Yemenis were getting married younger at about 16 or 18 years of age. By the age of thirty, they would have had some children. Nowadays, the Yemenis are getting married at around 25 to 30 years of age. By this time they have been chewing Qat for 15 years, definitely, they will have bad effect on the development of their fertility and their testicular tissue. With this, they are going to have problems in having children. In two generations, the fertility will drop in Yemen. Unless, this issue of infertility problems is having proper campaigns to let people be aware of this problem. We are going to face big challenges later on.

Q: For how long have you been working in Yemen?
A: I have been here for the last four years. I think in those four years, I have gathered information about infertility in Yemen, the things which I hadn't imagined in my life. It will be much influential on the infertility of the Yemeni people.

Q: What are your main contributions?
A: My contributions in scientific lecturing in the field of infertility in Yemen was mainly directed to the academic staff . I have been twice to Aden university in the last 2 years . I delivered lectures in the field of infertility in the first and second obstetrics and gynecology conference of Aden University during the years 2002 and 2003.
I delivered in each conference three to four lectures about infertility in Yemen.
I have contributed to the first obstetrics and gynecology conference in Sana'a in 2000.
I also contributed to the science and technology university annual medical conferences.
I'm also participating as well on the next conference of the University of science and Technology which is to be held within the next week.
I have contributed in the Middle East Fertility Society Conferences in Bahrain, Beirut, and in Cairo for the last three years regarding the infertility problems in Yemen and treatment for such infertility problems.
I also contributed to the Yenini science conference which was held by the Scientific Community held in Sana'a in 2002.

Q: But how do you help those who have more than a wife?
A: The most important part of infertility treatment is prevention. With prevention, we help to have the family setup properly growing. I think those who have more than one wife for the sake of having children are helped more by proper treatment for their infertility problems of their first wife.

Q: Could impotent people be treated by using an IFV treatment?
A: Impotence is one cause of infertility. We are not treating impotent people by doing an IVF for them. Impotence most of the time is a psychological problem and those people are helped by the psychiatrists or neurologists more or less. Impotent people don't need assisted reproduction in the form of IVF. They need psychotherapy and if some doctors are thinking that this impotence is only treated by assisted reproduction they are mistaken.
Impotence is the cause of infertility, because the husband unable to cope with the marital act or the intercourse. This can be solved medically and treated by psychotherapy. If in these two cases, they are not helpful, we can use other procedures of assisted reproduction but not necessarily the IVF. Those who are doing the IVF are potent people and this has nothing to do with impotency at all. They are potent people and need the help of getting their sperms fertilizing eggs of their wives . They are totally potent and they don't have any problems with impotency.

Q: Does the center treat similar cases from other countries?
A: Since we have established the IVF center, we have some people coming from the United States, all of them from Yemeni origin. They trust the center more than other centers in the United States. We are strictly abiding by the Islamic rules and approval of the IVF and assisted reproduction procedures. We have some patients coming from Saudi Arabia, United Arab Emirates, Oman, Djibouti, Somalia, Ethiopia and Sudan as well. All those have heard about the IVF center and they are currently being treated at the center for the problems of infertility.

Q: How does the center help increase the foreign currency?
A: Actually, the center has helped people saving their currency in their own country.
Instead of spending their money, traveling abroad, taking foreign currency with them, now they have spent their money inside their country. They have saved money, because, if they do try and have the IVF treatment in Yemen, it is almost one third or one quarter of its expanses spent outside Yemen. On top of that, those who are coming for treatment in Yemen, they bring with them foreign currency to be spent here. After all, those people who are being treated for infertility problems inside Yemen are not taking vacations; they will not stop their work. They come just for the sake of treatment and they are still working in their places. They don't lose their work or jobs from long absence from work. They are still productive in their own country.

Q: Any concluding comment you would like to convey through the Yemen Times?
A: First of all, thanks to the Yemen Times. They have been so helpful in the past. Two interviews have been made with me before. They were so helpful in explaining what is going on in the test-tube babies and assisted reproduction as well. What I would like to mention is that we are in need of continuous focusing on infertility problems in Yemen.
We are in need of the Yemen Times' enthusiasm to focus on this issue continuously every now and then to remind people that this is a serious problem. This could be first prevented by certain proper procedures which could be treated in Yemen the same as outside Yemen. These technologies and procedures are available in Yemen. People can be helped in their own countries using highly sophisticated technologies in Yemen.
Thanks again for the Yemen Times.