Skip to main content

Regional clinical practice patterns in reproductive endocrinology: A collaborative transnational pilot survey of in vitro fertilization programs in the Middle East

Abstract

Background

This research describes current clinical and demographic features sampled from reproductive endocrinology programs currently offering in vitro fertilization (IVF) in the Middle East.

Methods

Clinic leadership provided data via questionnaire on patient demographics, demand for IVF services, annual cycle volume, indications for IVF, number of embryos transferred, twinning frequency, local regulations governing range of available adjunct therapies, time interval between initial enrollment and beginning IVF as well as information about other aspects of IVF at each center.

Results

Data were received from representative IVF clinics (n = 13) in Cyprus, Egypt, Iran, Israel, Jordan, Lebanon, Qatar, Saudi Arabia and Turkey. Mean (± SD) age of respondents was 47.8 ± 8 yrs, with average tenure at their facility of 11.2 ± 6 yrs. Estimated total number of IVF programs in each nation responding ranged from 1 to 91. All respondents reported individual participation in accredited CME activity within 24 months. 76.9% performed embryo transfers personally; blastocyst transfer was available at 84.6% of centers. PGD was offered at all sites. In this population, male factor infertility accounted for most IVF consultations and the majority (59.1%) of female IVF patients were < 35 yrs of age. Prevalence of smoking among female IVF patients was 7.2%. Average number of embryos transferred was 2.4 (± 0.4) for patients at age < 35 yrs, and 2.9 (± 0.8) at age > 41 yrs. For these age categories, twinning (any type) was observed in 22.6 (± 10.8)% and 13.7 (± 10.4)%, respectively. In 2005, the average number of IVF cycles completed at study sites was 1194 (range 363–3500) and 1266 (range 263–4000) in 2006. Frozen embryo transfers accounted for 17.2% of cycles at these centers in 2005. Average interval between initial enrollment and IVF cycle start was 8 weeks (range 0.3–3.5 months).

Conclusion

This sampling of diverse IVF clinics in the Middle East, believed to be the first of its kind, identified several common factors. Government registry or oversight of clinical IVF practice was limited or nonexistent in most countries, yet number of embryos transferred was nevertheless fairly uniform. Sophisticated reproductive health services in this region are associated with minimal delay (often < 8 weeks) from initial presentation to IVF cycle start. Most Middle East nations do not maintain a comprehensive IVF database, and there is no independent agency to collect transnational data on IVF clinics. Our pilot study demonstrates that IVF programs in the Middle East could contribute voluntarily to collaborative network efforts to share clinical data, improve quality of care, and increase patient access to reproductive services in the region.

References

  1. 1.

    Panek RC, Deloney LA, Park J, Goodwin W, Klein W, Ferris EJ: Interdepartmental problem-solving as a method for teaching and learning systems-based practice. Acad Radiol. 2006, 13: 1150-4. 10.1016/j.acra.2006.06.003.

    Article  PubMed  Google Scholar 

  2. 2.

    Wofford JL, Singh S: Exploring the educational value of clinical vignettes from the Society of General Internal Medicine national meeting in the internal medicine clerkship: a pilot study. J Gen Intern Med. 2006, 21: 1195-7. 10.1111/j.1525-1497.2006.00596.x.

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Hebert RS, Wright SM: Re-examining the value of medical grand rounds. Acad Med. 2003, 78: 1248-52. 10.1097/00001888-200312000-00013.

    Article  PubMed  Google Scholar 

  4. 4.

    Testart J, Plachot M, Mandelbaum J, Salat-Baroux J, Frydman R, Cohen J: World collaborative report on IVF-ET and GIFT: 1989 results. Hum Reprod. 1989, 7: 362-9.

    Article  Google Scholar 

  5. 5.

    Howles CM, Loumaye E, Giroud D, Luyet G: Multiple follicular development and ovarian steroidogenesis following subcutaneous administration of a highly purified urinary FSH preparation in pituitary desensitized women undergoing IVF: a multicentre European phase III study. Hum Reprod. 1994, 9: 424-30.

    Article  CAS  PubMed  Google Scholar 

  6. 6.

    Platteau P, Smitz J, Albano C, Sorenson P, Arce JC, Devroey P: Exogenous luteinizing hormone activity may influence the treatment outcome in in vitro fertilization but not in intracytoplasmic sperm injection cycles. Fertil Steril. 2004, 81: 1401-4. 10.1016/j.fertnstert.2003.09.077.

    Article  PubMed  CAS  Google Scholar 

  7. 7.

    Imhorn MC: Making Muslim babies: IVF and gamete donation in Sunni vs. Shi'a Islam. Cult Med Psychiatry. 2006, 30: 427-50. 10.1007/s11013-006-9027-x.

    Article  Google Scholar 

  8. 8.

    Birenbaum-Carmeli D: Cheaper than a newcomer: on the social production of IVF policy in Israel. Sociol Health Illn. 2004, 26: 897-924. 10.1111/j.0141-9889.2004.00422.x.

    Article  PubMed  Google Scholar 

  9. 9.

    Reynolds MA, Schieve LA, Jeng G, Peterson HB: Does insurance coverage decrease the risk for multiple births associated with assisted reproductive technology?. Fertil Steril. 2003, 80: 16-23. 10.1016/S0015-0282(03)00572-7.

    Article  PubMed  Google Scholar 

  10. 10.

    Pratt KT: Inconceivable? Deducting the costs of fertility treatment. Cornell Law Rev. 2004, 89: 1121-200.

    PubMed  Google Scholar 

  11. 11.

    Collins J: An international survey of the health economics of IVF and ICSI. Hum Reprod Update. 2002, 8: 265-77. 10.1093/humupd/8.3.265.

    Article  PubMed  Google Scholar 

  12. 12.

    Serour GI, Aboulghar MA, Mansour RT: Bioethics in medically assisted conception in the Muslim world. J Assist Reprod Genet. 1995, 12: 559-65. 10.1007/BF02212574.

    Article  PubMed  CAS  Google Scholar 

  13. 13.

    Fadel HE: The Islamic viewpoint on new assisted reproductive technologies. Fordham Urban Law J. 2002, 30: 147-57.

    PubMed  Google Scholar 

  14. 14.

    Inhorn MC: Religion and reproductive technologies. IVF and gamete donation in the Muslim world. Anthropol News. 2005, 1-4.

    Google Scholar 

  15. 15.

    Sinclair DB: Assisted reproduction in Jewish law. Fordham Urban Law J. 2002, 30: 71-106.

    PubMed  Google Scholar 

  16. 16.

    Schenker JG: Assisted reproductive practice: religious perspectives. Reprod Biomed Online. 2005, 10: 310-9.

    Article  PubMed  Google Scholar 

  17. 17.

    Simoes E, Bauer S, Schmahl FW: Registries as a method to promote quality improvement–an investigation based on the example of assisted reproduction. Gesundheitswesen. 2003, 65: 516-25. 10.1055/s-2003-42390.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

The authors are grateful to the clinical and support staffs from the centers participating in this study. Additionally, we appreciate the coordinating input from Consular officials and U.S. Embassy medical office personnel who helped facilitate this research.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Eric Scott Sills.

Additional information

Competing interests

The author(s) declare that they have no competing interests.

Authors' contributions

ESS, HSQ, ZB, AVTD, AR, SC, IAJ, GS, ME, MAK, AD, KT, PO, AMF, BAL and AE provided data and editorial comment; all authors read and approved the final manuscript. BAL provided statistical oversight. ESS and AE conceptualized the project, coordinated drafts and organized the research.

Rights and permissions

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Reprints and Permissions

About this article

Cite this article

Sills, E.S., Qublan, H.S., Blumenfeld, Z. et al. Regional clinical practice patterns in reproductive endocrinology: A collaborative transnational pilot survey of in vitro fertilization programs in the Middle East . J Exp Clin Assist Reprod 4, 3 (2007). https://doi.org/10.1186/1743-1050-4-3

Download citation