BEIRUT: Problems conceiving a child may never be discussed outside the doctor’s office in Lebanon, but the volume of fertility clinics shows that there’s definitely a demand for such treatment, local fertility specialists say.
But without a national law addressing this field of medicine, ethical and legal dilemmas – like gender selection and regulating sperm and egg donation – are left up to the physicians’ and patients’ disposal.
“We have around 20 clinics operating in Lebanon. But the problem in Lebanon is that we don’t have any regulation. Anyone can open an IVF [in vitro fertilization] clinic and each one has his own regulation and his own legislation,” said Dr. Ziad Massaad of fertility clinic IVF Lebanon.
Fertility treatments like in vitro fertilization have become a common procedure in Lebanon, where marriage is increasingly delayed, adoption is all but impossible and couples are sometimes apart to take advantage of countries with better work opportunities.
Massaad said the things that prompt Lebanese couples to seek fertility treatment center around general lifestyle changes, many of which are problems affecting much of the world, such as later marriages that have made conceiving naturally more difficult.
However, he also pointed to other problems that had led to an increase in the use of IVF in the Middle East generally, and Lebanon specifically: “I think nowadays with the pollution and what we eat and the stress that we are living, especially in this part of the world, we have more fertility problems.”
Research conducted by Dr. Antoine Abu Musa, an obstetrician and gynecologist at American University of Beirut Medical Center, found that the stress of conflict and war – of which Lebanon has seen plenty – has affected fertility health in the country.
In a study comparing sperm samples taken during and after the Civil War, and a separate study analyzing women’s menstrual cycles during the 1996 Israeli “Grapes of Wrath” offensive on Lebanon, it became clear stress factors related to war affect fertility in both men and women.
Abu Musa also highlighted the high percentage of Lebanese expatriates working in the Gulf, Europe and Africa, arguing that the separation has pushed some couples to freeze sperm or undergo insemination or IVF due to the impossibility or erraticism of sex while the husband is away.
Another factor behind the increase in IVF may lie in the genetically-linked male infertility caused by interfamilial marriages, mainly between cousins, in the region, Massaad said.
“When it comes to this region, I would say there is probably more male-factor infertility,” he said.
The trend is an about-turn from 20 years ago, when cultural and religious pressures weighed more heavily on patients and many men refused to undergo fertility checks because of the long-held assumption that delays in conceiving were the woman’s burden. Nowadays, that resistance has diminished, Abu Musa said.
“The number of men refusing this [fertility checks] has been decreasing since a few years back,” he said. “It’s not taboo anymore. It’s a simple procedure helping millions of people [globally].”
Oddly enough, tradition has actually pushed more people to seek fertility treatment, as the pressure to have a family still dominates society, said Dr. Ghina Ghazeeri, an obstetrician and gynecologist at AUBMC.
She said she had seen newlyweds as young as 18 years old coming into the clinic for help getting pregnant even though they were completely capable of natural conception.
“It’s because this is a priority in her life,” Ghazeeri said. “People are more aware that fertility treatments increase the chances of getting pregnant faster. Many are in a hurry, and doctors might be pushed to give treatments.”
But this acceptance of and interest in fertility treatment has not been paralleled by government regulation.
Take sperm and egg donation, for example, which requires hefty oversight in terms of legal contracts, rights of the donor and medical screenings. It also raises thorny issues like inheritance rights under religious law.
Without proper legislation overseeing such multilevel procedures, clinics like the one at AUBMC refuse to treat patients using donated sperm or eggs.
“We are really shying away because it has lots of legal implications. There’s no clear law about it and that’s why it’s better not to do it,” Ghazeeri said.
These days, the only thing governing this particular medical field are guidelines set by the Lebanese Order of Physicians. Doctors cannot, for example, inseminate an unmarried woman, either Lebanese or foreign.
Under the LOP’s guidelines for ethical practice, there is a small section about fertility treatment, but the three doctors who spoke to The Daily Star said much more needed to be done.
A law governing fertility treatment in the country, including such areas as egg and sperm donations, has been written. But passing it is impossible without a functioning government.
For now, it’s up to doctors and individual patients to decide what is ethical or legally sound, as a procedure prohibited by one clinic may be part of the standard offerings at another.
For example, AUBMC does not allow patients to choose the sex of their baby apart from in exceptional circumstances when one sex would carry a genetic disease, Ghazeeri said. Massaad’s clinic does offer sex selection, but does not offer surrogacy, a service he refers patients abroad for.
Setting a law would not only set standards for such fertility procedures, say the doctors, but might also bring in some much-needed medical tourism, as many of Lebanon's Arab neighbors have stricter rules on fertility treatment.
“I think that maybe with time, if the situation could be better here in Lebanon, if we could have some stability ... people would come from abroad to do treatments here with a cheaper price ... but with the same equipment the same expertise,” Massaad said.