Medical anthropologist, Dr Marcia Inhorn, told the annual meeting of the European Society of Human Reproduction and Embryology that legal adoption was not allowed in Middle Eastern Muslim countries, although children were loved and valued. As a result, IVF remained many couples' last hope of having children, and IVF centres have opened in nearly 20 nations in the Muslim Middle East, ranging from small, oil-rich Bahrain and Qatar to larger but less prosperous Morocco and Egypt.
However, Dr Inhorn, from the University of Michigan, US, told the conference that local and religious differences are affecting the way IVF is implemented in these countries. She has identified major differences in cultural attitudes toward reproductive technologies between Shi'ite Muslims in Lebanon and Sunni Muslims in Egypt. The uptake of IVF has been profoundly influenced by Islamic fatwa declarations.
Dr Inhorn, who spent many years studying social and cultural aspects of infertility in Egypt and is now working on a male infertility study in Lebanon, said that a number of Sunni Islamic fatwas, issued as early as 1980 from Egypt's famed Al-Azhar University, suggest that IVF and similar therapies are permissible so long as they do not involve any form of third-party donation of either sperm, eggs, embryos, or uteruses. "The reasoning goes that since marriage is a contract between husband and wife, no third party should intrude into the marital functions of sex and procreation. A third party donor – whether providing sperm, eggs, embryos, or a uterus – would be considered tantamount to zina, or adultery," explained Dr Inhorn.
Artificial insemination or IVF with the husband's own semen, however, is allowed in Sunni Islam, and the resulting child considered the legal offspring of the couple. In addition, advances in intracytoplasmic sperm injection (ICSI) now allow Muslim men with very poor sperm quality to use their own sperm to have children.
Yet the introduction of ICSI in the absence of donor egg technologies is leading some infertile Muslim men to reassess their marriages. "Women who have stood by their infertile husbands for many years and have grown too old to produce viable ova are now being forsaken for younger replacement wives in some cases," she said. "However, most Middle Eastern Muslim men, contrary to popular expectations and stereotypes, value their marriages more, so that infertility is not necessarily an automatic cause for divorce in Egypt or Lebanon."
Indeed, within the last five years, Ayatollah Ali Khamanei, the successor to Iran's Ayatollah Khomenei and the current spiritual leader of Lebanon's Hizbollah movement, has permitted donor egg technologies and even donor sperm to be used under certain conditions. " So, unlike Sunni Muslims, the Shi'ites are entering into a brave new era of third-party donation and surrogacy, thereby allowing middle-aged infertile couples to maintain their marriages and create new families through the use of donor technologies," said Dr Inhorn.
Abstract no: O -142 (Tuesday, 14.00hrs CET, Madrid room)
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