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

  • Eric Scott Sills
  • Hussein S Qublan
  • Zeev Blumenfeld
  • Ahmad VT Dizaj
  • Ariel Revel
  • Serdar Coskun
  • Imad Abou Jaoude
  • Gamal Serour
  • Mamdoh Eskandar
  • Mohammad Ali Khalili
  • Aygul Demirol
  • Krinos Trokoudes
  • Pelin Ocal
  • Abdul Munaf Sultan
  • Benjamin A Lotto
  • Adele El-Kareh
Open Access



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


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.


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).


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.



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.


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© Sills et al; licensee BioMed Central Ltd. 2007

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 (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Authors and Affiliations

  • Eric Scott Sills
    • 1
  • Hussein S Qublan
    • 2
  • Zeev Blumenfeld
    • 3
  • Ahmad VT Dizaj
    • 4
  • Ariel Revel
    • 5
  • Serdar Coskun
    • 6
  • Imad Abou Jaoude
    • 7
  • Gamal Serour
    • 8
  • Mamdoh Eskandar
    • 9
  • Mohammad Ali Khalili
    • 10
  • Aygul Demirol
    • 11
  • Krinos Trokoudes
    • 12
  • Pelin Ocal
    • 13
  • Abdul Munaf Sultan
    • 14
  • Benjamin A Lotto
    • 15
  • Adele El-Kareh
    • 16
  1. 1.Reproductive Endocrinology Division, Department of Obstetrics and GynecologyVassar Brothers Medical CenterPoughkeepsieUSA
  2. 2.Department of Obstetrics and GynecologyRoyal Jordanian Medical ServiceAmmanJordan
  3. 3.Division of Reproductive Endocrinology, Department of Obstetrics and GynecologyRambam Medical Center/Technion Faculty of MedicineHaifaIsrael
  4. 4.Royan InstituteTehranIran
  5. 5.Department of Obstetrics and GynecologyHadassah Medical Center and Hebrew University-Hadassah Medical SchoolJerusalemIsrael
  6. 6.Department of Obstetrics and GynecologyKing Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
  7. 7.Center for Reproductive Medicine and GeneticsBeirutLebanon
  8. 8.Egyptian IVF Center, Al-Azhar UniversityCairoEgypt
  9. 9.Maternity and Child Hospital, The Saudi Center for Assisted Reproduction, King Khalid University College of MedicineAbhaSaudi Arabia
  10. 10.Research and Clinical Center for InfertilityShahid Sadoughi University of Medical SciencesYazdIran
  11. 11.Women's InfertilityIVF and Health ClinicAnkaraTurkey
  12. 12.Pedieos IVF CenterNicosiaCyprus
  13. 13.IVF-ET Unit, Department of Obstetrics and Gynecology, Cerrahpasa Medical FacultyIstanbul UniversityIstanbulTurkey
  14. 14.Assisted Conception UnitWomen's Hospital, Hamad Medical CorporationDohaQatar
  15. 15.Department of MathematicsVassar CollegePoughkeepsieUSA
  16. 16.Department of Obstetrics and GynecologyVassar Brothers Medical CenterPoughkeepsieUSA

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