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

Eric Scott Sills¹ , Hussein S Qublan² , Zeev Blumenfeld³ , Ahmad VT Dizaj⁴ , Ariel Revel⁵ , Serdar Coskun⁶ , Imad Abou Jaoude⁷ , Gamal Serour⁸ , Mamdoh Eskandar⁹ , Mohammad Ali Khalili¹⁰ , Aygul Demirol¹¹ , Krinos Trokoudes¹² , Pelin Ocal¹³ , Abdul Munaf Sultan¹⁴ , Benjamin A Lotto¹⁵ and Adele El-Kareh¹⁶

¹Reproductive Endocrinology Division, Department of Obstetrics and Gynecology, Vassar Brothers Medical Center, Poughkeepsie, New York USA

²Department of Obstetrics and Gynecology, Royal Jordanian Medical Service, Amman, Jordan

³Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Rambam Medical Center/Technion Faculty of Medicine, Haifa, Israel

⁴Royan Institute, Tehran, Iran

⁵Department of Obstetrics and Gynecology, Hadassah Medical Center and Hebrew University-Hadassah Medical School, Jerusalem, Israel

⁶Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia

⁷Center for Reproductive Medicine and Genetics, Beirut, Lebanon

⁸Egyptian IVF Center, Al-Azhar University, Cairo, Egypt

⁹Maternity and Child Hospital, The Saudi Center for Assisted Reproduction, King Khalid University College of Medicine, Abha, Saudi Arabia

¹⁰Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

¹¹Women's Infertility, IVF and Health Clinic, Ankara, Turkey

¹²Pedieos IVF Center, Nicosia, Cyprus

¹³IVF-ET Unit, Department of Obstetrics and Gynecology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey

¹⁴Assisted Conception Unit, Women's Hospital, Hamad Medical Corporation, Doha, Qatar

¹⁵Department of Mathematics, Vassar College, Poughkeepsie, New York USA

¹⁶Department of Obstetrics and Gynecology, Vassar Brothers Medical Center, Poughkeepsie, New York USA

author email corresponding author email

Journal of Experimental & Clinical Assisted Reproduction 2007, 4:3doi:10.1186/1743-1050-4-3


Published:	28 August 2007

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.