One thing Aimee and Kevin Southgate were absolutely sure of when they said ‘I do’ to each other in 2011 was that they wanted to expand their family right away.

They had known each other for six years, were sure of their relationship and having just moved to Dubai to join Aimee’s parents’ flourishing business, they did not see any point in waiting to have a baby of their own.

But six months into their new life, there was still no sign of a baby. Aimee, who was 23 at the time, had never had any health issues which would’ve set off alarm bells. And 30-year-old Kevin too had always been a healthy guy. ‘It must be the stress of wanting a baby really badly’ the couple thought as they dealt with disappointment every time the pregnancy test came out negative.

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The couple then consulted a gynaecologist who after conducting a few tests told Aimee that she had polycystic ovary syndrome (PCOS), which was responsible for their inability to have kids. ‘I was shocked at first as I never showed any symptoms of having PCOS – no facial hair, excess weight or irregular menstruation. But the doctor was very positive. She said that the syndrome had only reduced my chances of having a baby – they were not zero. She was sure that I would become a mother once I was able to manage the condition successfully.’

And Aimee did. Now, there is a new Southgate in the house. Almost a year old, in fact, Kevin and Aimee’s son Mason has just learnt how to walk, and gurgles every time he is able to reach or pull at things that catch his fancy. This little cherub clearly rules the Southgate home in Dubai’s Reem Community. ‘When we were battling infertility, people told us “take heart, when it happens, you’ll say it was worth all the blood, sweat and tears.’’ And it has been,’ says Aimee as she picks Mason up and perches him on her hip, giving him a kiss.

It’s been 39 years since the birth of Louise Brown, the first baby to be conceived in Petri dish, but the discussion about infertility has never been more relevant, even as it still gets the elephant-in-the-room-treatment.

Battling infertility can be traumatic, leaving emotional scars and corroding confidence every time a couple is told ‘sorry, not this time’. The Southgates had their fair share of it during their five-year-long emotional roller coaster ride. From intrusive questions by acquaintances asking them why they don’t have a baby yet, to tests and treatments that resulted in negatives, the Southgates went through a phase where they felt fragile and quite alone in their battle.

‘Quite often when couples come to us looking for help, they believe everyone around them is having a baby with ease, except them,’ says Dr Diana Kayal, specialist in reproductive medicine and infertility at Dubai’s Bourn Hall Fertility Centre, the clinic that treated the Southgates. ‘So when I tell them the fact that one in five couples in the UAE faces the same problem as they do, there is a certain relief in knowing that they are not alone.’

While in-vitro fertilisation (IVF), one of the most common forms of assisted conception, may be regarded as something used by older couples, in fact 43 per cent of the couples who underwent IVF treatment in 2016 belonged to the age bracket of 18 to 34 – traditionally considered to be the most fertile age group. That’s an increase of 36 per cent over the previous year.

Globally, Dr Human Fatemi, medical director of IVI Middle East Fertility Clinic and a reproductive medicine expert, points out, 8 to 12 per cent of all couples are affected by infertility. ‘And of all cases, 40 to 50 per cent are due to male infertility.’

The Southgates were a part of that statistic, too. After a year of being on medication to manage Aimee’s PCOS did not result in them having a baby, the couple went to a fertility specialist for tests, and that is when they came to know that Kevin had an extremely low sperm count. ‘Along with my persisting PCOS issue, it basically meant that we would not be able to have kids without help,’ recalls Aimee.

Sperm count, according to a study recently published by American Society of Andrology ‘has declined by 50 per cent in last four decades in North America, Europe and Australia.’ While the average sperm concentration was 99 million per millilitre in 1973, it had dropped to 47 million per millilitre in 2011. That, the study concludes, is the disturbing fact, especially since World Health Organization says those with sperm levels lower than 40 million are considered to have an impaired chance of conceiving.

Such phenomenal growth in levels of infertility implies assisted conception too, will see a sharp increase. According to a recent study conducted by IVI Middle East Fertility Clinic, the UAE’s IVF market is expected to reach Dh5.5 billion by 2020. That’s 5.5 per cent of the world market – although the UAE’s population is just 0.12 per cent of the global total.

Dr David Robertson, group medical director at Bourn Hall explains. ‘Young couples understandably expect that a pregnancy will be achieved quite easily, especially if they see their peers and family members are having children. No matter the reason, infertility is often accompanied by a feeling of failure – at a personal level, but also with regard to families’ expectations. In this region, there is usually great family pressure to have children and infertility can lead to family conflict.’

Apart from talking about the social stigma, Dr Eset Dzeygova, specialist obstetrician and gynaecologist at Dubai Herbal and Treatment Centre, believes that the discussion needs to include lifestyle factors, as the latter have a significant role to play. ‘Stress, obesity, lack of physical exercise, changes in eating habits and pollution, and medical disorders like diabetes,’ says the doctor, are common causes of infertility.

What makes the problem even worse in the UAE, Dr Human adds, is that a large percentage of the population has Vitamin D deficiency. ‘Among women, it results in reduced number of eggs at a very young age, which causes infertility,’ he explains. Another reason is smoking. ‘If a couple wants to improve their chances of having a have a baby, they must give up smoking,’ he adds. Putting a number to that diagnosis, Dr Eset says that 13 per cent of all female infertility in the UAE is due to smoking. What’s worse, according to a study conducted by Priority Research Centre in Chemical Biology at the University of Newcastle in New South Wales, Australia, if a pregnant woman exposes her unborn baby to the effects of smoking, she is damaging the baby’s chances of being a parent, as well.

Another factor that has led to decreased fertility rates in the Middle East is marriage between first- or second-degree relatives. ‘Apart from genetic disorders, studies have proven that daughters of consanguineous couples have extremely low ovarian reserve. While normally the phenomenon is found in women from the age of 40, in girls of consanguineous couples, it happens when they’re half that age,’ says Dr Human.

PCOS and endometriosis are said to be the two most significant factors of infertility among young women. ‘It is estimated that the incidence of PCOS among Arab women is as high as 60 per cent,’ says Dr David.

While for many couples, treatment of these conditions results in a successful pregnancy, it wasn’t so for the Southgates. ‘We underwent two unsuccessful IVFs over two years before we got lucky,’ says Aimee. But, once Aimee was pregnant with Mason, the journey was almost trouble-free. ‘Apart from slight spotting in the first trimester which made us anxious, we did not have any other scary episodes,’ she says.

Mason’s birth on August 9, 2016, proves that infertility is a condition that, in many cases, can be cured or circumvented. ‘However, there is no way to measure the success rate, since a successful pregnancy depends on a number of factors – the woman’s age, the health of the couple, the quality of eggs and sperm and genetic issues,’ warns Dr Diana.