Lack of funds, social obstacles hinder infertility treatment in northern Syria

A Caesarean section operation (Canva)

A Caesarean section operation (Canva)


Enab Baladi – Sakina Mahdi

“When they found out about my illness, which delayed my pregnancy for eight years after my marriage, my mother and father tried to comfort me, but my husband’s family did not accept the matter, and they held me fully responsible because they want to see their grandchildren and make their son happy,” says the 26-year-old Reem al-Ramadan, describing her distress at the interference and constant pressure of her husband’s family in northern Idlib region.

After her visit to the gynecologist, al-Ramadan discovered that she had severe infections and weakness that led to her inability to have children.

The young woman, who hails from Maarat Misrin town, began looking for solutions and faced obstacles she was trying to overcome, according to what she told Enab Baladi.

Delayed childbearing causes anxiety for women and men, and the pressure multiplies with the passage of time, which increases the fear of the spouses and pushes them to visit doctors to diagnose the physical problems that delayed the occurrence of pregnancy and to try to solve them in every possible way to relieve many pressures from the local community under the pretext of checking on their health.

These pressures are exacerbated by the deterioration of the financial situation amid the high costs of treatment in northwestern Syria.

According to a report by the United Nations World Health Organization (WHO) published in April, 17.5% of the world’s total population is affected by infertility, meaning that the rate reaches one out of every six people in the world.

Infertility, according to the WHO, is “a disease that affects the male or female reproductive system and is defined by the inability to reach the result of pregnancy after 12 months or more of regular intercourse without methods of contraception.”

The WHO says infertility can cause “psychological stress, stigma, and financial distress affecting people’s physical and psychological well-being.”

Social pressures on women

Al-Ramadan said that her husband’s mother began interfering with her life after her delay in childbearing because she wanted to see her grandson soon, and every day the pressure and inconvenience from her husband’s family increased, and the verbal harassment and defamation multiplied to respond to that harassment, saying that the matter is not in her hands and it is in the hands of God alone and she has no solution.

Al-Ramadan’s friends and relatives tried to help her in various ways. Some of them resorted to folk medicine, known as Arabic medicine, using a herb to speed up pregnancy.

Some of them advised a specific drink or medicine, but “every day I follow someone’s advice, my misery multiplies instead of alleviating it, as I tried all methods to no avail. I was left disappointed every time,” al-Ramadan added.

The gynecologist reassured al-Ramadan that there is great hope, and in the event that medical treatments do not work, she can resort to embryo transplantation as the last solution.

The doctor’s words doubled al-Ramadan’s tension and did not make her feel at ease because of the pressure of everyone around her and the burden of a sin she did not commit.

According to a report by the American Academy of Family Physicians (AAFP), living with infertility is emotionally difficult, and the disappointment of not getting pregnant after trying every month can be stressful, especially when seeing friends and strangers having children.

Hormone-stimulating drugs may also cause psychological problems in women and thus affect their physical health, with the possibility of breast and ovarian cancer.

Women accept treatment more than men

“Despite the proper medical tests that we performed and the good health that my wife and I enjoy, pregnancy did not occur, and we told our family about that as soon as we left the gynecological clinic that examined me. They were supportive of us and stood beside us so that we do not lose hope,” described Bassel Sultan, 30. After a year and a half of marriage, he is unable to have children.

Sultan said that he took a sexual tonic drug prescribed to him by the doctor, and his wife also took a treatment that stimulates ovulation for five months, and then they stopped treatment due to the burdens of displacement to the town of Harbanoush to escape the bombing.

Sultan had explained to the doctor his health condition, as he underwent a kidney transplant previously and had two chronic diseases, blood pressure, and diabetes, but the doctor confirmed that these two diseases were not related to childlessness.

Nihal, 43, a pseudonym for social reasons, from the southern countryside of Aleppo, told Enab Baladi that after five years of her marriage without pregnancy, she went to the doctor with her husband.

However, the obstacle was her husband, who suffers from impotence, according to the doctor’s diagnosis.

“My husband rejected all the doctor’s advice and refused treatment, denying that he has a problem that prevents him from having children. His health condition worsened. Even smoking, which the doctor strongly urged him to quit, did not stop, which affected his health and his sexual ability with the passage of time.”

Nihal said that she “tolerated” her husband for about 20 years and was patient with that situation, hoping that he would respond to the doctor and submit to treatment one day, but their differences increased with his insistence on his opinion, so they eventually divorced, and “I am now at an age that does not allow me to have children, even if I tried.”

The gynecological surgeon Mahmoud al-Bawab, of SAMS Hospital for Maternity and Child Care in al-Dana town told Enab Baladi that women accept treatment more than men, and there are men who refuse to perform tests, especially those who have children from a second wife or have had children from the previous wife.

Financial burdens

The expensive medicine prompted Bassel Sultan and his wife to stop treatment after five months, as he was not working during that period.

Sultan had two options that the gynecologist put before him, “either to perform an egg fertilization operation in a private hospital in Idlib or to continue with the drug treatment, and the first option was not as available as the second, but its financial cost was greater,” he said.

As for Reem al-Ramadan, she talks about the cost of treatment, saying that when she was in her village with her husband, it was easy to secure the cost of treatment, as her husband used to work there.

But now he is sick and without work, in addition to the high price of medicine and the inability to secure it, and the last solution after a long treatment was the process of microscopic insemination, as her doctor said.

Gynecologist Mahmoud al-Bawab, of the Syrian American Medical Society (SAMS) said the drug for infertility treatment is a drug that stimulates the ovum, and the price of one treatment protocol amounts to more than $100, and according to the current situation in northern Syria, “most patients cannot afford the cost of treatment,” he said.

Patients who reach the stage of advanced infertility, we send them to the IVF center because of the ineffectiveness of routine drug treatment, according to al-Bawab, who added that the cost of the IVF operation reaches $3000, which is extremely expensive for the patients of northwestern Syria.

Medical readiness

The gynecological surgeon pointed to the severe shortage in the number of private medical centers specialized in treating infertility and delayed childbearing. There are few in the area, and there are no free treatment centers, according to him.

Infertility patients are referred to hospitals supported by international organizations because there are no infertility hospitals that offer free treatment.

However, the hospitals supported by the organizations in the northwest are “ambulatory care” hospitals whose mission is primarily to receive critical emergency cases, and infertility is classified as a non-urgent case, according to al-Bawab.

In addition, overcrowding in public hospitals leads to a lack of good and sufficient follow-up on infertility patients. Priority in the hospital is for patients with fractures and bleeding cases and for other emergency cases.

Dr. al-Bawab said that the detection of infertility mainly requires laparoscopic operations for the abdomen and uterus, pointing out that the first is available, but the second is not available in all regions, although the endoscopy is very simple.

The doctor listed some challenges, most notably the lack of preparation of hospitals in the region to receive infertility patients and the lack of ultrasound scans for the treatment and diagnosis of infertility.

In addition to the high price of the required tests, especially hormone tests and hysterosalpingography, and the inability to carry out IVF operations in public hospitals due to the lack of financial support for them.

Dr. al-Bawab is currently forced to postpone some appointments and give appointments for a period of more than a month due to the presence of only one endoscopy device in the hospital, adding that patients who visit other hospitals are being transferred to this hospital because there are no endoscopy devices.

The doctor stressed the need to allocate centers for the diagnosis and treatment of infertility in northwestern Syria and the importance of securing funds and support for that.

However, he expressed his disappointment, as “most organizations do not prefer to fund centers in order to help infertility patients, and do not see the need to take measures to treat this disease.”



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