Shafaq News/ In a small clinic in Baghdad, 37-year-old Noor Ahmed cradles her newborn twins, her cheeks glistening with tears of joy. After five long years of infertility and three grueling rounds of in vitro fertilization (IVF), Noor's dream of becoming a mother has finally come true. "It was our last chance," she says, her voice trembling. "We poured our savings into this, and it worked. We are so grateful."

But just across the city, Sarah Al-Saadi shares a very different experience. Eleven years ago, she underwent three IVF cycles, only to be left heartbroken. "The first procedure cost me 13 million dinars (about $10,000), and the second 12 million," she recalls. "I didn't get the motherhood I dreamed of; all I got was pain and disappointment."

These two contrasting stories reflect the stark duality of IVF in Iraq, a journey marked by soaring hope and crushing despair. For some, it is a medical miracle that turns years of longing into a new chapter of life. For others, it is an emotional and financial burden with no guarantee of success. This emotional rollercoaster, intertwined with cultural perceptions, evolving medical practices, and significant challenges, paints a vivid picture of the IVF landscape in Iraq, one of hope, heartbreak, and the relentless pursuit of parenthood.

I. Historical and Medical Overview of IVF

IVF technology was first successfully implemented in 1978 with the birth of Louise Brown in the UK, marking a ground-breaking advancement in reproductive medicine. This achievement demonstrated that fertilization could occur outside the human body, offering hope to millions struggling with infertility. Since then, the procedure has evolved significantly, with global success rates ranging from 40% to 60%, depending on factors like maternal age, egg quality, and underlying fertility issues.

The IVF process involves several critical steps. It begins with ovarian stimulation, where hormonal medications encourage the ovaries to produce multiple eggs instead of the single egg typically released each cycle. Once mature, these eggs are retrieved through a minimally invasive procedure and then fertilized in a laboratory, either through conventional insemination or intracytoplasmic sperm injection (ICSI), where a single sperm is directly injected into an egg. The resulting embryos are monitored for several days before one or more are transferred into the uterus. Excess embryos can be cryopreserved for future use, with modern cryopreservation techniques like vitrification significantly improving survival rates.

Innovations such as preimplantation genetic testing (PGT) have further advanced IVF outcomes by allowing embryos to be screened for genetic abnormalities before implantation. By 2023, the global IVF market was valued at $18.3 billion, with the Middle East contributing significantly due to rising infertility rates and increased demand for gender selection.

II. The Current State of IVF in Iraq

In Iraq, IVF was introduced in the 1990s but initially faced poor outcomes due to outdated equipment, limited expertise, and insufficient resources. The country's first successful IVF procedure was recorded in the Kurdistan Region in 2009, marking a major milestone for reproductive medicine in Iraq. Since then, IVF centers have proliferated, particularly in Baghdad, Erbil, and Basra. By 2015, Iraq had over 20 fertility clinics, with the number surpassing 30 by 2024. Baghdad alone hosts 15 clinics, while Erbil and Basra follow closely.

Beyond infertility treatment, IVF has gained significant attention in Iraq for gender selection, driven by societal norms and inheritance customs that prioritize male offspring.

The Kurdistan Region, which pioneered Iraq's first IVF success, remains a hub for such services. However, despite the growing popularity of IVF, Iraq’s fertility sector continues to grapple with infrastructure gaps and the need for more specialized training. As Dr. Atheel Al-Ali, a Baghdad-based IVF specialist, explains, "Our clinics are progressing, but we still need to enhance staff training and adopt more advanced laboratory techniques to improve success rates."

Although Iraq's IVF services have grown remarkably, many clinics continue to face equipment shortages and inconsistent success rates. These challenges have significantly impacted success rates, which remain below international benchmarks.

Globally, IVF success rates average 45% for fresh embryo transfers and 35% for frozen embryos, whereas Iraqi clinics report success rates of 40% and 34.7%, respectively. According to Dr. Al-Ali, "Our clinics have the latest equipment, but staff training and follow-up care need improvement."

II. Societal and Cultural Perspectives

Parenthood in Iraq is deeply tied to societal and cultural norms, with the ability to have children often seen as essential to family life. Infertile couples frequently face social stigma, which compels many to pursue IVF despite its financial and emotional toll. Traditional beliefs about lineage and family continuity place immense pressure on couples to conceive, especially within the first few years of marriage.

Gender selection has become increasingly popular, largely due to cultural preferences for male offspring, who are seen as heirs to family names and inheritance. A 2023 study found that 65% of Iraqi couples undergoing IVF opted for gender selection.

Sociologist Dr. Zainab Al-Dabbagh from Baghdad University explains, "In many communities, a son is seen as a guarantee of family name continuity and inheritance stability. This belief drives many couples to choose the gender of their child when possible."

Religious views also shape public attitudes toward IVF. While most religious scholars in Iraq permit IVF when performed within marriage, procedures involving donor sperm or eggs remain strictly prohibited due to concerns about lineage.

A 2022 survey by Al-Nahrain University revealed that 78% of respondents supported IVF as a legitimate medical intervention but opposed any form of gamete donation. As Sheikh Ahmed Al-Tamimi, a religious scholar, notes, "Islam permits medical intervention to aid conception, but altering lineage through donor materials crosses a clear ethical line."

Cultural norms further influence the demand for IVF services. In conservative communities, childlessness can sometimes be grounds for divorce or polygamy, adding to the emotional distress faced by couples. "I was under constant pressure from my in-laws," says Rasha Abdul, a 35-year-old woman from Mosul who underwent IVF in 2023. "They believed that without children, our marriage was incomplete."

Despite these challenges, there are signs of shifting attitudes. Educational campaigns and increased media coverage have fostered more open discussions about infertility and reproductive technologies. The Iraqi Fertility Association reported a 20% rise in IVF consultations between 2020 and 2023, suggesting that awareness efforts are gradually reducing stigma.

IV. Challenges and Obstacles

* Medical and Technical Barriers

Iraq's fertility sector faces significant medical and technical challenges that hinder the success rates of IVF treatments. Many clinics operate with outdated equipment and insufficient technical expertise, preventing them from meeting international standards. A 2021 Ministry of Health report revealed that 45% of IVF centers in Iraq lacked modern cryopreservation tools, which are essential for preserving embryos for future use. Without these tools, embryo viability is compromised, reducing the chances of a successful pregnancy.

Dr. Hanan Al-Jubouri, a reproductive endocrinologist at Baghdad Fertility Centre, explains, "The absence of advanced equipment, such as AI-driven embryo grading systems, significantly affects success rates. Many clinics still use manual grading methods, which rely heavily on subjective human judgment. In contrast, clinics in Europe and North America utilize artificial intelligence to identify the most viable embryos with greater precision."

Laboratory conditions present another critical challenge. A 2022 review conducted by the Iraqi Society for Reproductive Medicine assessed 25 fertility centers and found that 30% struggled to maintain optimal incubation temperatures, which are crucial for embryo development. These inconsistencies lead to higher failure rates and diminished patient confidence in domestic clinics. For instance, incubators must maintain a temperature of 37°C with minimal fluctuations, yet several clinics reported temperature deviations of up to 2°C, directly impacting embryo viability.

Additionally, the shortage of specialized embryologists further exacerbates these issues. According to a 2023 workforce survey, Iraq has only one embryologist per 500,000 residents, compared to one per 150,000 in neighboring Jordan. Many professionals seek employment abroad due to better compensation and access to modern equipment, leaving local centers understaffed.

* Lack of Follow-Up Care

Post-procedure care is a critical component of IVF success, yet it remains insufficient in many Iraqi clinics. Patients often report receiving minimal guidance after embryo transfer, a phase where lifestyle choices and medical protocols can significantly influence outcomes.

Ali Al-Sarai, a Baghdad resident who underwent IVF for gender selection, shares his experience, "After the embryo transfer, we were sent home without clear instructions on what to do next. We didn't know if my wife needed bed rest, dietary changes, or medication. When the procedure failed, we had no information to understand why, and the clinic refused to provide follow-up support."

The World Health Organization (WHO) emphasizes the importance of structured follow-up care, estimating that comprehensive post-transfer protocols can improve pregnancy rates by up to 20%. Best practices include scheduled check-ups, hormonal monitoring, and personalized lifestyle recommendations. However, a 2022 survey of 40 IVF centers across Iraq indicated that only 35% offered routine post-transfer consultations.

The lack of follow-up care not only affects success rates but also leaves patients feeling abandoned and confused. Legal protection for patients seeking accountability is limited. The Iraqi Medical Association received 120 formal complaints related to IVF treatments in 2023, with many concerning insufficient post-procedure guidance.

* Legal and Regulatory Restrictions

Iraq's legal and regulatory framework surrounding IVF treatments presents significant challenges for both clinics and patients. Current laws prohibit the use of donor eggs, sperm, and surrogacy, limiting options for individuals with fertility issues. As a result, many couples seek treatment abroad, particularly in Turkiye and Iran, where these practices are legal and widely available.

Aslan Elhami, an advisor at an infertility center in Tehran, observes, "We see hundreds of Iraqi couples every year, primarily seeking egg donation or surrogacy. IVF treatments in Iran cost between $2,500 and $6,000, depending on the clinic and services required. Approximately 70% of our Iraqi patients request donor eggs due to Iraq's legal restrictions."

The absence of robust regulatory oversight further complicates the situation. A 2023 parliamentary committee report disclosed that 40% of Iraq's fertility centers were operating without proper licenses. This lack of regulation results in inconsistent service quality, unstandardized treatment protocols, and, in some cases, fraudulent practices. For example, investigators discovered clinics advertising high success rates without transparent data to support their claims, misleading hopeful couples.

* Economic Disparities

The financial burden of IVF treatments in Iraq presents one of the most significant obstacles for couples seeking fertility assistance. Costs typically range from $3,000 to $6,000 per cycle, depending on the clinic, procedure complexity, and additional services like preimplantation genetic testing. For many Iraqi families, this expense is prohibitively high, often exceeding their annual household income.

According to the World Bank, Iraq's poverty rate stood at 25% in 2023, with some provinces, such as Diyala, exceeding 30%. In these areas, access to fertility treatments is almost non-existent due to financial limitations. The average monthly salary in Iraq hovers around $500, translating to $6,000 annually, barely enough to cover a single IVF cycle. In more rural, agriculture-dependent regions, the income gap becomes even more pronounced, leaving IVF entirely out of reach for most residents.

The lack of insurance coverage for reproductive health services further exacerbates these economic disparities. Unlike some neighboring countries, such as Turkiye, where public health insurance partially covers fertility treatments for married couples, Iraq offers no financial assistance. As a result, many couples resort to borrowing money, often at high interest rates, or selling assets to finance their procedures.

A 2022 study conducted by the Iraqi Fertility Association revealed that 64% of couples pursuing IVF had taken out loans or borrowed from family members to cover expenses. Dr. Rasha Al-Khafaji, a gynecologist in Basra, confirms this trend, "Many of my patients tell me they have to choose between undergoing IVF or maintaining their financial stability. I've seen families sell cars, land, and even jewelry, only to face the emotional toll of an unsuccessful cycle."

V. Future Prospects and Recommendations

To improve IVF services in Iraq, several key strategies should be implemented to address medical, social, and economic challenges. Investing in modern medical infrastructure is essential, particularly in upgrading equipment like advanced imaging devices and embryo-freezing technologies, which are critical for increasing success rates. According to the Ministry of Health's 2024 plan, $50 million has been allocated for these upgrades, with a focus on introducing AI-driven embryo selection techniques to improve pregnancy outcomes. Collaborations with international fertility centers could further enhance staff training and procedure efficiency.

Public awareness campaigns are equally important to dispel myths and reduce the stigma surrounding infertility. A 2023 initiative in Karbala led to a 15% increase in IVF consultations, demonstrating the potential impact of educational efforts.

Dr. Zainab Al-Rubaie, a Baghdad-based IVF specialist, emphasized the need for these campaigns, noting that "many patients seek treatment abroad unnecessarily, despite Iraq having advanced laboratories."

Establishing a clear and enforceable legal framework can also foster public trust by ensuring clinics adhere to international standards. A 2023 parliamentary report revealed that 40% of Iraq’s fertility centers operated without proper licensing, highlighting the urgent need for regulatory reforms.

Additionally, the high cost of IVF remains a significant barrier for many families. Introducing insurance coverage or government subsidies could provide much-needed relief, especially for low- and middle-income households. Iraq could take inspiration from Jordan, where a subsidized IVF program in 2022 increased access to treatment by 30%. As Dr. Atheel Al-Ali noted, "IVF success depends not just on medical factors but also on societal support and financial accessibility."