An unfortunate truth about infertility: It’s all too often the woman who is blamed when a couple is unable to conceive a child — despite the fact that more than half of fertility issues stem either partly or fully from the male partner. This is more or less a worldwide phenomenon, but in cultures such as those in the Middle East, where virility is often seen as a key component of masculinity, that misplaced blame can be nothing short of devastating.
“If a man knows he doesn’t get his wife pregnant, he’s always upset,” a Middle Eastern woman named Shahira told researchers. “And if you’re pushing him all the time, and he’s the reason for the problem, he feels like giving up, because there are no children to keep in the house. In my husband’s case, he preferred to divorce [his first wife] because their relationship became bad. They had different attitudes and behaviours, and in this case, the major reason for the divorce was that he knows he’s the reason for no pregnancy.”
Infertility can damage marriages in any part of the world, but one factor that makes it particularly damning in the Middle East is that adoption is stigmatised there. This means that women like Shahira (and her husband’s first wife), who unfairly bear most of the burden for these issues, have strong motivation to try out reproductive technologies that could increase their chances of conception.
But seeking out reproductive assistance can be tricky for these women, because their religion may outlaw technologies that would help them have their own children. And when that challenge arises, something you might have thought was unthinkable can happen: Sunnis and Shiites come together to make a baby.
Islam is the most popular religion in the Middle East, and most Muslims there are Sunnis. And when it comes to fertility, the Sunni denomination — which is predominant in countries such as Egypt, Turkey, and Syria — has some relatively strict rules. Sunnis who want to boost their odds for conception through artificial insemination or in-vitro fertilisation are only allowed to use their own gametes (i.e. eggs and sperm), and they must be married before they can use these techniques. So if Shahira was a Sunni and her husband had poor sperm quality or a very low sperm count, she may be out of luck if she wanted to have a child (up to 50 percent of infertile men in some regions have an uncorrectable condition), since she wouldn’t be allowed to use donor sperm.
But for Shiites, the rules are different. As new reproductive technologies sprang up throughout the 1990s, several Shia jurists interpreted the Qur’an to favour the permissibility of using other people’s gametes.
Medical practitioners relied on the rulings of these jurists and set up clinics that allow visitors to use other people’s eggs and sperm. But the clinics that provide this kind of service in the Middle East are only allowed in Shia-majority countries like Iran and Lebanon. This means that someone in Shahira’s position would have to venture to a Shia-controlled area to get the reproductive assistance she wants.
Considering how time-consuming, expensive, and stressful it must be to travel to another country (and break your religion’s rules) to receive medical treatment, it’s hard to imagine going to such an extreme. But in many Muslim societies, parenthood is expected and childlessness is unthinkable — so couples with the means are willing to give it a shot, despite the challenges.
That’s partly because the available alternatives aren’t exactly a cake walk, either. Infertile Sunni couples in the Middle East generally face four tough options if they forgo using other people’s eggs and sperm: They can remain together without children. They can foster an orphan. They can add more partners to their marriage, and pursue polygamy rather than monogamy in hopes of increasing their reproductive probabilities. Or they can divorce so they can attempt to have children with other partners.
All of these options present their own stigmas. But for those who are willing to sidestep religious rules — and have the money for expensive treatments — secretly using sperm and eggs from people of different faiths provides another option that in some ways is more socially desirable, because it doesn’t involve sex with new partners, adoption, or divorce. While most infertile couples in these regions cannot afford to treat their reproductive issues this way, those who are able to can prevent their reputations, marriages, and livelihoods from being damaged due to an inability to meet social expectations.
“Clearly, the [social] importance of reproducing is paramount for individuals, who are prepared to go to any length to demonstrate that they have fulfilled their reproductive duties and to secure their rightful place in society,” writes Oxford anthropologist Soraya Tremayne. “For those who do not wish to reveal their infertility, even to the close members of the kin group, [reproductive technologies] have provided the perfect way out.”
Of course, even those Sunni couples who are willing and able to seek treatment in Shiite regions have to face a universal fact about reproductive technology: It’s still no guarantee. Though recent decades have seen remarkable developments in reproductive science, even in Western medical centres IVF attempts fail 70 percent to 80 percent of the time. That’s about the same failure rate as the average woman in her 20s trying to conceive without the help of reproductive technology, but it’s certainly not the silver bullet couples with infertility may be wishing for.
One factor that makes [infertility] particularly damning in the Middle East is that adoption is stigmatised there.
It’s also worth recognising that these services are unaffordable for many people, and the procedures are much more invasive for women than they are for men. “I take all these injections, I come to the hospital every day, I prepare for the operation, I see the anaesthesia, the doctors,” Shahira said. “It’s frightening. My husband — they just take the semen from him.”
If a couple does successfully conceive using a sperm donor, another pain point may appear: Anecdotal research shows that some fathers in Middle Eastern countries are apt to show hostility toward their children if the children are conceived using another man’s sperm. This is “consistent with patriarchal values,” according to Tremayne. The inadequacies that male infertility can provoke aren’t automatically erased just because modern technology makes it easier for people to have their own children. (Of course, this isn’t true for every couple, and happy Sunni families have certainly been created thanks to these treatments.)
Although there are drawbacks for the Middle Easterners who rely on other people’s sperm and eggs in order to conceive, these techniques can still benefit people like Shahira who wish to avoid the stigma that’s associated with not having children.
“The introduction of donor technologies has been described as a ‘marriage saviour,’ helping to avoid the ‘marital and psychological disputes’ that may arise if the couple’s case is otherwise untreatable,” writes medical anthropologist Marcia C. Inhorn, PhD.
The women who have to jump borders to receive reproductive assistance are confronting conflicts between religion, science, politics, and social expectations. Coincidentally, they demonstrate how cultural diversity can be especially beneficial when you take matters into your hands. However, there’s clearly still a long way to go before attitudes catch up with the technology.
As one man traveling to Lebanon with his wife to obtain other people’s gametes put it: “We’re doing it very secretly… We’ll have to tell people that we did this operation from her eggs and my [sperm], so people will believe this is our child.”
Ross Benes is the author of The Sex Effect: Baring Our Complicated Relationship With Sex, from which this article was adapted. He has also written for The Wall Street Journal, Esquire, Rolling Stone, Vice, and Slate. You can follow him on Twitter @RossBenes and reach him through rossbenes.com.