Infertility in Saudi Arabia: Hidden Causes, Neglected Tests, and Treatment Costs - Your Complete Guide Before and After Marriage

Introduction: A Silent Crisis Affecting Thousands of Saudi Families

In our Saudi society where family and childbearing hold a central place in people's lives many couples suffer in silence from delayed conception. Recent statistics reveal that the fertility rate in the Kingdom has dropped from 3.8 children per woman in 2011 to 2.7 in 2024 according to the General Authority for Statistics. More alarmingly infertility rates in Gulf countries reach 35 to 40 percent which is more than double the global average of 15 percent.

This comprehensive guide reveals the scientific facts about the causes of infertility in our society, the tests most people neglect before marriage, the impact of delayed marriage on fertility, available treatment options and their real costs. The goal is for you to be fully informed whether you are about to get married, planning to start a family, or currently experiencing delayed conception.

Part One: Understanding the Problem of Infertility

The World Health Organization defines infertility as the inability to conceive after 12 months or more of regular marital relations without using contraception. But we must understand that infertility is not always the woman's problem as many believe in our society. Scientific studies confirm that the male factor is present in 50 percent of infertility cases and that 22.6 percent of men in the Middle East and North Africa region suffer from fertility problems.

Types of Infertility

Primary infertility means the couple has never had a child before and represents about 44 percent of cases in Saudi Arabia. Secondary infertility means the couple has previously conceived but is having difficulty conceiving again and represents 56 percent of cases. A recent study from Imam Abdulrahman Bin Faisal University Hospital found that the average age of women visiting infertility clinics is 33.6 years and the average duration of infertility is about 5 years meaning many couples wait a long time before seeking medical help.

Part Two: The Real Causes of Infertility in Saudi Arabia

There are multiple factors contributing to the high rates of infertility in our society. Some are related to modern lifestyle and some are related to treatable medical factors.

Obesity: The Silent Epidemic Destroying Fertility

Saudi Arabia is suffering from a real obesity crisis. According to the General Authority for Statistics for 2024, 23.1 percent of Saudis over 15 years suffer from obesity and 45.1 percent are overweight. The World Obesity Federation 2024 report ranks Saudi Arabia fifth globally with 78 percent of Saudi women being overweight or obese.

The impact of obesity on women's fertility is very serious. Obesity causes hormonal disorders, ovulation dysfunction, increased insulin resistance, higher miscarriage rates, and lower IVF success rates. For men obesity leads to decreased testosterone, poor sperm quality, erectile dysfunction, and testicular function problems. Research confirms that obese men have a significantly higher likelihood of infertility compared to those with normal weight.

Vitamin D Deficiency: The Saudi Paradox

Despite the Kingdom enjoying abundant sunshine throughout the year vitamin D deficiency has reached epidemic levels. Studies indicate that 60 percent of Saudi women of reproductive age suffer from vitamin D deficiency rising to 86 percent among pregnant women. Reasons include limited sun exposure due to high temperatures, staying indoors, working in indoor environments, and not taking vitamin D supplements.

Vitamin D deficiency is directly linked to fertility problems including increased risk of polycystic ovary syndrome, higher rates of gestational diabetes, increased likelihood of miscarriage, and poor egg quality. In men vitamin D deficiency affects sperm quality and motility.

Polycystic Ovary Syndrome PCOS

PCOS is the most common endocrine disorder among women of reproductive age. A recent systematic review covering Gulf Cooperation Council countries found that 30 percent of women suffering from infertility in the Gulf have PCOS meaning 3 out of every 10 women visiting infertility clinics have this problem.

Symptoms of PCOS include irregular menstrual cycles, increased hair growth on the face and body, acne, weight gain especially in the abdominal area, and difficulty conceiving. The relationship between obesity and PCOS is circular where obesity increases the severity of PCOS symptoms and PCOS makes weight loss more difficult. The Saudi Ministry of Health confirms that more than 50 percent of women with PCOS develop type 2 diabetes before age 40 if they do not adhere to treatment.

Male Factors: The Neglected Side

In our society the blame is often placed on women in cases of delayed conception but the scientific reality is completely different. The male factor is present in about half of infertility cases. Causes of male infertility include low or absent sperm count, poor sperm motility, sperm morphology abnormalities, varicocele, genital tract infections, hormonal imbalances, and genetic factors.

A recent Saudi study found that 27.7 percent of men visiting infertility clinics have a sperm count less than 15 million and 68.5 percent of them suffer from complete absence of sperm. These are alarming numbers that confirm the importance of testing men with the same seriousness as testing women.

Anabolic Steroids: A Hidden Danger in Gyms

One of the neglected causes of male infertility among Saudi men is the use of anabolic steroids and hormones for muscle building. These substances have spread widely in gyms and many young men use them without awareness of their danger to fertility.

Anabolic steroids work by deceiving the brain into thinking the body is producing sufficient testosterone which leads to the testicles stopping natural hormone production. The result is a sharp decrease in sperm count that can reach zero, shrinkage of testicle size, and decreased sexual desire and erection. Studies confirm that 90 percent of steroid users suffer from fertility problems. The good news is that most of these effects are reversible after stopping use but recovery may take from 3 months to 3 years and in some cases the damage may be permanent.

Modern Lifestyle

Lifestyle in the Kingdom has changed dramatically in recent decades. Physical inactivity where 80 percent of adults do not engage in any regular physical activity. Unhealthy diet with increased consumption of fast food, soft drinks, and sugars. Smoking which negatively affects the fertility of both men and women. Chronic psychological stress from modern life demands. Lack of sleep and using electronic devices for long hours. All these factors combined contribute to declining fertility rates.

Part Three: Neglected Premarital Tests

The premarital screening program in the Kingdom is mandatory and focuses on genetic diseases such as thalassemia and sickle cell anemia and infectious diseases such as hepatitis and AIDS. But there are very important fertility tests that most people getting married do not request despite their great importance.

Neglected Fertility Tests for Women

AMH hormone test or Anti-Mullerian Hormone is the most important test for evaluating a woman's egg reserve. This test gives a clear picture of the number of eggs remaining in the ovary and helps in planning for conception. The normal level ranges between 1.3 and 6.25 nanograms per milliliter but the optimal level depends on age. This test can be done at any time during the menstrual cycle because its levels do not change much during the month.

Day 3 hormone tests include FSH hormone, LH hormone, and prolactin hormone. These hormones provide information about ovarian function and ovulation regularity. Thyroid function test is important because thyroid dysfunction whether overactive or underactive directly affects fertility and the ability to maintain pregnancy. Vitamin D level test given the widespread deficiency in the Kingdom should be a routine test for every woman about to get married.

Neglected Fertility Tests for Men

Semen analysis is the basic and most important test for evaluating male fertility. It measures sperm count, motility, morphology, semen volume, and acidity. Unfortunately many men refuse to take this test due to social embarrassment which leads to delaying diagnosis and treatment for years.

Testing testosterone hormone, FSH hormone, and LH hormone helps identify the cause of weak sperm. Sperm DNA fragmentation test is an advanced test that measures the integrity of genetic material in sperm. A Saudi study found that 15 percent of men who have normal semen analysis suffer from high DNA fragmentation which affects the chances of pregnancy and IVF success.

Why Are These Tests Important Before Marriage?

Conducting these tests before marriage gives you enough time to treat any problem before it worsens. Discovering low egg reserve early allows for proper planning whether by hastening conception or freezing eggs. Discovering sperm problems allows for early treatment before it becomes complete infertility. Knowing about vitamin D deficiency or thyroid dysfunction allows for simple treatment before it affects pregnancy.

Part Four: Impact of Delayed Marriage on Fertility

In recent decades the average age of marriage in the Kingdom has increased significantly. This delay has a direct impact on fertility especially for women.

The Biological Clock: Scientific Facts That Cannot Be Ignored

A woman is born with a limited number of eggs ranging from one to two million eggs. This number decreases with each menstrual cycle and cannot be replaced. In the twenties the chance of natural pregnancy is 85 percent within one year of trying. At age 30 the chance drops to 75 percent. At age 35 it drops to 66 percent. At age 40 it drops to only 44 percent.

After age 35 not only does the number of eggs decrease but their quality also declines. The percentage of eggs containing chromosomal defects rises from 20 percent in the early thirties to 60 percent at age 40. This explains the increased rates of miscarriage and Down syndrome with advancing maternal age.

Impact of Age on Fertility Treatment Outcomes

Even with the use of assisted reproductive technologies such as IVF age remains the most important factor in treatment success. IVF success rates range between 35 and 40 percent for women under 35 years. They drop to 25 percent between 35 and 37 years. They drop to 15 percent between 38 and 40 years. And they reach less than 10 percent above 40.

What About Men?

Male fertility is also affected by age but less severely than women. After age 40 sperm quality gradually decreases, the time needed for conception increases, and the rate of genetic abnormalities in children rises. But men remain able to conceive until an advanced age unlike women whose fertility stops completely with menopause.

Message for Young Men and Women

These facts are not meant to scare or pressure you but to make you aware of the biological reality so you can make your decisions based on correct information. If you want children it is better not to delay too much especially if you are a woman. If you must delay for educational, professional, or economic reasons consider the option of freezing eggs or sperm. Get fertility tests early to know your real situation.

Part Five: Treatment Options and Their Costs in Saudi Arabia

The good news is that most cases of infertility are treatable. The Kingdom has more than 35 specialized centers for infertility treatment and assisted reproduction providing world-class services.

Initial and Simple Treatments

Lifestyle change may be sufficient in many cases. Losing 5 to 10 percent of weight can significantly improve fertility especially in women with polycystic ovary syndrome. Moderate exercise, improving diet, stopping smoking, and avoiding steroids are all important steps.

Drug treatment includes ovulation stimulation drugs such as clomiphene, metformin to treat insulin resistance, and supplements of vitamin D, iron, and folic acid. The cost of these treatments is relatively simple ranging from 100 to 500 SAR per month.

Intrauterine Insemination IUI

In this procedure processed sperm is inserted directly into the uterus to shorten the distance between it and the egg. It is suitable for cases of mild sperm motility weakness, cervical problems, and unexplained infertility. Success rate ranges between 10 and 20 percent per attempt. Cost ranges between 2000 and 5000 SAR per attempt.

In Vitro Fertilization IVF

This is the most effective treatment for most cases of infertility. The ovary is stimulated to produce several eggs then they are retrieved and fertilized in the laboratory with sperm then the resulting embryos are transferred to the uterus. Cost ranges between 15000 and 25000 SAR per cycle in private hospitals. Medications cost an additional 3000 to 6000 SAR. Success rate is about 35 percent for women under 35 and decreases with age.

Intracytoplasmic Sperm Injection ICSI

Similar to IVF but a single sperm is injected directly into the egg. It is suitable for cases of severe sperm weakness or absence from semen with surgical extraction from the testicle. Cost ranges between 25000 and 35000 SAR. Fertilization success rate reaches 80 to 85 percent.

Egg Freezing

An important option for women who wish to delay conception for personal or professional reasons or who will undergo chemotherapy that may affect fertility. The ovary is stimulated and eggs are retrieved and frozen for later use. Cost ranges between 15000 and 20000 SAR in addition to annual storage fees.

Insurance Coverage and Government Support

In the Kingdom some government hospitals provide infertility treatment services free of charge to citizens who meet the conditions. Conditions usually include that the infertility is primary or secondary with only one child and that the woman's age is less than 43 years. Private insurance usually does not cover infertility treatments but some companies have started adding them as an additional option.

Part Six: Practical Tips to Improve Fertility

Regardless of your current situation there are steps you can take to improve your fertility and increase your chances of conception.

For Women

Maintain a healthy weight with a body mass index ideally between 19 and 25. Take folic acid 400 micrograms daily at least three months before pregnancy. Check your vitamin D level and take supplements if it is low. Exercise moderately such as walking 30 minutes daily. Avoid smoking and secondhand smoke. Reduce caffeine to less than 200 mg daily which is about two cups of coffee. Sleep 7 to 8 hours daily. Reduce stress by practicing relaxation techniques.

For Men

Maintain a healthy weight because obesity reduces testosterone and sperm quality. Stop immediately any steroids or hormones for muscle building. Avoid smoking which reduces sperm count and motility. Reduce heat around the testicles by avoiding saunas, hot baths, sitting for long periods, and placing laptops on thighs. Eat foods rich in zinc such as meat, seafood, and nuts. Avoid alcohol completely. Exercise moderately but avoid overexertion which can harm fertility.

For Couples Together

Learn about ovulation days because the fertile period extends from 5 days before ovulation until the day of ovulation. Use cycle tracking apps or ovulation measurement devices. Do not wait long before seeking medical help. If the woman's age is under 35 see the doctor after a year of trying. If her age is over 35 see the doctor after 6 months. If her age is over 40 see the doctor immediately. Communicate openly and support each other because the conception journey can be emotionally exhausting. Do not hesitate to seek psychological support if needed.

Frequently Asked Questions

When Should I Worry About Delayed Pregnancy?

If the woman's age is under 35 it is recommended to wait a full year of regular trying before worrying. If her age is between 35 and 39 it is recommended to see the doctor after 6 months. If her age is 40 or older it is recommended to see the doctor immediately because time is a decisive factor.

Does the Mandatory Premarital Screening Replace Fertility Tests?

No. The mandatory premarital screening in the Kingdom focuses on genetic and infectious diseases and does not include fertility tests such as semen analysis or AMH hormone. These are additional tests that must be requested separately.

Does Obesity Completely Prevent Pregnancy?

Obesity does not completely prevent pregnancy but it significantly reduces chances and increases the risks of pregnancy and childbirth. Losing 5 to 10 percent of weight can significantly improve fertility even before reaching ideal weight.

Does Polycystic Ovary Syndrome Mean I Cannot Have Children?

Definitely not. Polycystic ovary syndrome is one of the most treatable causes of infertility. Many women with PCOS conceive naturally or with the help of simple medications. The key is early diagnosis, appropriate treatment, and maintaining a healthy weight.

How Much Does a Complete IVF Cycle Cost?

The total cost ranges between approximately 20000 and 35000 SAR including the procedure, medications, and follow-up. You may need more than one cycle to succeed. Some hospitals offer packages or payment facilities.

Do Steroids Cause Permanent Infertility?

In most cases the effects are reversible after stopping use. Recovery usually takes from 3 to 12 months and may reach 3 years in cases of long-term use. But in some rare cases the damage may be permanent especially with excessive use for years.

Is Egg Freezing Safe?

Yes egg freezing is a safe and scientifically proven technique. Eggs can remain frozen for many years without their quality being affected. But you should know that success rates depend on your age at the time of freezing not at the time of use.

Conclusion

Infertility and delayed conception are challenges facing many Saudi couples but in most cases they are treatable. The key is awareness, early diagnosis, and quick action. Do not wait years before seeking help and do not place the responsibility on one party as the problem may be from the man or woman or both.

Start by changing your lifestyle for the better, get appropriate tests, and seek medical help when needed. Remember that the conception journey can be long and difficult sometimes but modern medical developments have made hope real for most couples. And most importantly remember to support your life partner in this journey because you are in it together.