Ethnical and sociocultural differences causing infertility are poorly understood—insights from the Arabian perspective

Abstract

Infertility is acknowledged worldwide as a major health concern. Although global levels of primary and secondary infertility have hardly changed between 1990 and 2010, significant regional differences have been reported. The prevalence of infertility in women has been estimated to be one in every seven couples in the western world and one in every four couples in developing countries. Male infertility may be under-reported in some regions due to an unwillingness of the male partner to undergo fertility investigations. Geographical, sociocultural/religious and ethnical dissimilarities contribute to these global variations in infertility prevalence. Infertility has a major impact on family stability in many cultures, especially in developing countries, where childlessness can impact sociocultural status. Moreover, it is important to realise that most fertility treatment protocols are based on studies performed in Caucasian population. The purpose of this opinion paper is to critically appraise the existing evidence regarding the association between infertility and relevant sociocultural factors in Middle East countries focusing on aspects such as parental consanguinity, obesity and vitamin D deficiency. There may be reason to believe that in addition to the current standard evaluation of infertile couples, region-specific counselling and treatment modalities are required.

Clinical impact of parental consanguineous marriage in idiopathic nonobstructive azoospermia

“…In another study of 62 infertile men with a family history of consanguinity, severe sperm defects including the tail defect ''stunted tail'' and the acrosome defect ''round head'' were detected in 27% of the cohort (10). A recent study suggested that severe forms of male factor infertility may be more frequent in Eastern and Muslim populations, in which the practice of consanguineous marriage is very high compared with Western countries (5). Ethnical and sociocultural differences across Middle Eastern countries may contribute to regional variations in the frequency and the severity of male factor infertility compared with other parts of the world.…”

“…The term ''consanguinity'' refers to a relationship between two people who share a common ancestor or blood. The Middle East has high rates of consanguineous marriages, with overall rates reported at 20% to 50% and up to 80% in certain regions (5). Most consanguine marriages are between first cousins.…”

“…Sharing a common genetic pool not only increases the risk of homozygotes for autosomal recessive genetic disorders but also appears to have an adverse effect on both male and female gametes (6). The prevalence of male factor infertility in Middle Eastern countries is thought to be increased compared with Western countries due to the high rate of consanguineous marriages (5,7). In a study of 120 infertile and 100 fertile men in Lebanon, the rate of parental consanguineous marriage (PCM) and family clustering in azoospermic and severe oligospermic men (<1 Â 10 6 sperm/mL) was found to be 50% and 41%, respectively (8).…”

Male Infertility Problem: A Contemporary Review on Present Status and Future Perspective

“…59 In addition to the prevailing evaluation criteria of infertile males, country-specific or region-specific counselling and treatment modalities should be established. 60…”

Vitamin D in Follicular Fluid Correlates With the Euploid Status of Blastocysts in a Vitamin D Deficient Population

“…VitD deficiency is the most common vitamin deficiency worldwide and can be found in all ethnicities and age groups. Despite the abundance of sunlight and the concealing dress code owing to sociocultural/religious habits, the highest prevalence of VitD deficiency in the world is found in the Middle Eastern Arab population (96.9%) (30)(31)(32). Moreover, this population is characterized by low anti-Müllerian hormone (AMH) levels (33,34).…”