By Dr. Monika Chawla
Fertility rates in the Middle East region are becoming increasingly impacted by widespread vitamin D deficiency combined with rising obesity rates, which stem from regional-specific lifestyle factors. There is now an increased requirement to develop educational public health strategies for couples, in order to raise public awareness about the impact of these issues on female fertility.
Vitamin D deficiency is considered to be one of the primary causes contributing towards a reduced likelihood of impregnation and an increased risk of pregnancy complications. Lack of the vitamin can also contribute towards a decreased reserve of eggs in women, by influencing AMH (Antimullerian Hormone) levels, which can affect egg quality and pregnancy rates.
There is a range of different factors in the Middle East which contribute to the low sun exposure which leads to low vitamin D levels in women of reproductive age. A high prevalence of vitamin D deficiency is extensive scientific evidence confirming the significance of sunlight exposure in vitamin D synthesis. Middle Eastern countries have the highest vitamin D deficiency rates in the world, ranging from 67% in Iran, 55%–83% in Jordan, 84% in Lebanon, and up to 90% in Saudi Arabia. Other than clothing, vitamin D deficiency has also been associated with insufficient dietary intake of vitamin D, environmental conditions, and key population characteristics, as well as increased time spent on indoor activities, such as computers and television.
Specific proposals aiming to counteract these factors have been suggested for populations in most Middle Eastern countries, including Lebanon, Jordan, Saudi Arabia, Turkey and Iran. These measures include vitamin D fortification of milk, dairy products and other foods and beverages, use of multivitamin tablets and encouraging a more active outdoor lifestyle.
Another key factor contributing towards an increased risk of infertility is an elevated body mass index (BMI) (>30 kg/m2), which can cause hormone abnormalities and ovulation dysfunction. Menstrual irregularities, anovulation, and low conception rates in particular have all been associated with obesity through its effect on the hypothalamic pituitary ovarian axis.
Experts suggest that obese women undergoing IVF treatment are significantly more likely to respond inadequately to controlled ovarian hyper stimulation (COH) and to fail in achieving pregnancy compared with non-obese women. Increased BMI is also associated with a greater need for fertility hormones such as gonadotropins, lower pregnancy rates (PRs), fewer eggs, and higher miscarriage rates amongst women undergoing assisted reproductive technique (ART). A reduction in endometrial (uterine lining) quality represents a further outcome which can compound the effect of obesity on fertility.
Particularly in the Gulf Cooperation Countries including Bahrain, Kuwait, UAE, Oman, Qatar, and Saudi Arabia, there is an extremely high prevalence of obesity, which has arisen from rapid regional economic advancement resulting in increased food access, consumption, and lifestyle changes. Sedentary behaviour, family history, urbanisation, lack of physical activity, and high-calorie diets, are further contributory factors towards female obesity in the regions.
To combat the high levels of vitamin D deficiency and obesity in the gulf, multidisciplinary actions such as stress management, social support exercising, and lifestyle modification are recommended and should be used together in order to effectively manage the problem of obesity in Middle Eastern countries.