Dr. Ramya Raj, Specialist Obstetrician and Gynecologist

International Modern Hospital Dubai

Official statistics released by the Ministry of Health and Prevention show a significant decline in the number of births among Emirati citizens over the past decade, prompting concern from a parliamentary committee about the long term demographic and social implications.

Data obtained by Emarat Al Youm indicate that the number of births to UAE citizens fell by 13.55 per cent between 2014 and 2023, from 34,618 in 2014 to 29,926 in 2023.

1)Reasons

1.Later marriages-“Behind every data point is a young couple making decisions about marriage … A working mother balancing ambitions with nurturing. A father wanting to give more time but stretched by economic pressures. These are not only social realities – they are policy challenges, and more importantly, national opportunities.”

2.Health issues-  “Even among younger patients, we’re seeing low ovarian reserves, obesity, diabetes and poor nutrition. These all impact fertility. We’re also seeing a sharp rise in secondary infertility among men, often linked to smoking or the use of unregulated performance-enhancing substances.”

3.Lifestyle changes-including increased consumption of processed foods, widespread vitamin D deficiency associated with limited sun exposure, and lifestyle patterns that contribute to hormonal imbalance and conditions like PCOS,Endometriosis.

4.Thoughts on Family size-very personal andcan vary alot depending on values,circumstances,lifegoals. In the past, most Emirati families had five or more children. Now, most couples want two or three. It may seem reasonable, but if you compare it to previous generations, the demographic impact is significant,”

2)yes for sure-“Ten years ago, most of our patients were under 35 and already married,” he said. “Today, we see women in their late thirties and early forties coming in to freeze eggs – not necessarily because they have fertility issues, but because they’re not ready to marry. They’re busy with work or studies.”

3)Fertility declines with advancing age, beginning as early as the middle of the third decade. Women who do conceive at an advanced maternal age (traditionally defined as age 35 years or older) are at greater risk of early pregnancy-related complications including miscarriage, aneuploidy, and ectopic pregnancy. Other obstetric complications linked to older age include gestational diabetes, hypertension, preeclampsia, placenta previa, placental abruption, dysfunctional labor, cesarean delivery, postpartum hemorrhage, and maternal mortality; fetal complications include congenital anomalies, prematurity, growth restriction, macrosomia, and stillbirth. Increased paternal age is also associated with lower fertility, an increase in pregnancy-associated complications and an increase in adverse outcome in the offspring.

4)US data on delayed motherhood are the effect of a strong social pressure: a constant economic and social pressure to delay pregnancy without any perspective to invert this trend . This is a paradox. On one side scientific literature more and more clearly says that the less risky range of maternal age to bear babies is 20-30 years  as it is associated with a lower likelihood of non-chromosomal problems in babies and on the other side, people perceive they should postpone pregnancy.Thus, the best age to become parents is a compromise between two poles, and women as well as couples find it hard defending their right to having babies when young.

5)Modern lifestyle refers to the contemporary ways of living, characterized by factors such as sedentary behavior, poor dietary habits, stress, and exposure to environmental pollutants, which can impact reproductive health and fertility.1.A poor diet can significantly impact female fertility. Consuming low amounts of fruits and vegetables can disrupt hormone regulation and ovulation due to the lack of essential nutrients, antioxidants, and fiber. Additionally, a high intake of processed foods can lead to insulin resistance, inflammation, and hormonal imbalances, all of which can negatively impact fertility. Inadequate omega-3 fatty acids can also affect hormone production, ovulation, and embryo implantation. Furthermore, excessive caffeine and sugar intake can disrupt hormone balance, ovulation, and fertility.2. A sedentary lifestyle can lead to insulin resistance and metabolic disorders, which can disrupt hormone regulation and ovulation. However, physical inactivity can lead to chronic inflammation, which can negatively impact fertility and reproductive health.3. Stress can also significantly impact female fertility. .4 .Exposure to environmental pollutants can also significantly impact female fertility. Endocrine-disrupting chemicals (EDCs), such as BPA and phthalates, can mimic or interfere with hormones, disrupting ovulation and fertility. Air pollution, particularly particulate matter (PM), has also been linked to reduced fertility, increased risk of miscarriage, and birth defects. Furthermore, exposure to heavy metals, such as lead and mercury, can disrupt hormone regulation, ovulation, and fertility

6) yes, Long working hours can significantly have impact on fertility by disrupting harmonal balance and leading to various reproductive health issues. Chronic Stress can disrupt hormone production, including cortisol, insulin, and thyroid hormones, which can impact ovulation and fertility. Chronic stress can also delay or prevent ovulation, making it challenging to conceive. Stress can also disrupt the balance of the gut microbiome, which is essential for hormone regulation, immune function, and fertility. In Men its associated with low sperm quality.

7). Despite medical progress, Misinformation around natural conception keeps many couples from conceiving naturally. Busting these misconceptions can help couples identify real pregnancy delay reasons and take the right steps early.

1.Many couples think that having sex at any time can lead to pregnancy. This misunderstanding can lead to disappointment when pregnancy does not happen, even with regular sexual activity.

Fact: Conception only occurs during ovulation, about 12 to 14 days before the next period begins. The fertile window lasts about six days: the five days before ovulation and the day of ovulation.

2.Couples often assume that increasing intercourse frequency directly increases conception probability. This leads to scheduled sexual activity that creates stress and reduces spontaneity.

Fact: Daily intercourse may lower sperm quality and reduce sperm count per ejaculation. Sperm concentration and motility remain optimal with intercourse every two to three days during the fertile window.

 3.Popular culture suggests that some positions, especially those that allow deeper penetration or gravity assistance, can increase the chances of fertilisation. Couples often spend time and energy trying these methods that lack clear evidence.

Fact: No medical evidence links sexual positions to conception rates. Sperm reaches the cervix within seconds of ejaculation, regardless of position during intercourse.

4.The common advice to “just relax” implies that psychological stress is the primary pregnancy dilemma. This oversimplification dismisses legitimate medical causes of infertility.

Fact: Stress can affect hormones, but rarely causes infertility on its own in healthy individuals.  Managing stress through rest and balanced living supports overall well-being, but does not guarantee conception.

5.Cultural biases and old beliefs place most of the responsibility for fertility on women. This leads to women undergoing extensive testing, while their male partners face little to no evaluation.

Fact: Male factors account for up to 50% of infertility cases. Common male issues include low sperm count, poor sperm motility, abnormal sperm morphology, and complete absence of sperm in the ejaculate. Both partners should undergo evaluation when conception delays occur beyond the expected timeframe.

6.Women experiencing a delayed period no pregnancy often assume conception has occurred. This leads to confusion when pregnancy tests return negative results.

Fact: A delayed period could stem from hormonal imbalance, stress, thyroid issues, or diet changes that affect the menstrual cycle, Polycystic ovary syndrome ,Premature ovarian insufficiency, excessive exercise, substantial weight fluctuations, and certain medications also disrupt menstrual regularity.

 7.The widespread belief that fertility ends abruptly at 35 causes panic and hasty decisions. Women abandon attempts at natural conception prematurely based on this arbitrary age marker.

Fact: Fertility decreases with age, but pregnancy is still achievable naturally with healthy habits and timely medical guidance. Egg quantity and quality decline progressively from the late 20s onward, with acceleration after 35 and more decline after 40.  Many women achieve successful pregnancies in their late 30s and early 40s without medical intervention.

8.Internet sources promote various home remedies to get pregnant quick, from specific foods to herbal supplements. Couples invest money and hope in unproven methods based on anecdotal claims.

Fact: Remedies like herbal teas or special diets can support reproductive health, but do not guarantee conception on their own. No natural fertility remedies have rigorous scientific evidence proving they cause pregnancy or increase conception rates. While good nutrition supports overall reproductive health by providing sufficient vitamins and minerals, supplements

8)couples advised to Consult Specialist for Medical evaluation is important for couples who experience delay in getting pregnancy longer than 12 months, or six months for women over 35.

9)Assisted reproductive technologies (ARTs):

 The landscape of ARTs has undergone transformative changes driven by innovations such as in vitro fertilization (IVF) and egg freezing. These advancements have emerged as powerful tools, granting individuals unprecedented control over their reproductive timelines. ARTs can sometimes inadvertently contribute to a delay in childbearing.

1. For instance, IVF combines eggs and sperm outside the body, enabling fertilization before transferring embryos to the uterus. It can also assure individuals that they can conceive at a later age. This confidence may lead some people to delay starting a family, believing they can always turn to IVF when ready.

2.Similarly, Egg Freezing  technique involves extracting a woman’s eggs, freezing them, and storing them until a later time. This innovation is particularly significant for individuals facing medical treatments that may compromise their fertility, such as chemotherapy, or those navigating career trajectories that necessitate delaying childbearing. Egg freezing, a pivotal aspect of ARTs, empowers women by allowing them to preserve their eggs at a younger age when fertility potential is higher. These preserved eggs can be thawed, fertilized, and implanted, offering women a means to extend their childbearing years and pursue life goals before embracing. However, this option can inadvertently encourage women to postpone childbirth while focusing on career advancement or other life pursuits, assuming their fertility remains preserved. In practical terms, consider a scenario where a woman in her late twenties decides to freeze her eggs to ensure her fertility.

 With this safety net in place, she may delay starting a family and instead invest more time in her career or personal development, knowing she can rely on her preserved eggs later. While this is a valuable choice, it exemplifies how ARTs, like egg freezing, can influence the timing of childbearing decisions.

By leveraging the advances in reproductive science, these technologies have allowed individuals to conceive beyond what nature’s timeline might otherwise allow. This extension of the biological clock is flexible, as fertility naturally declines with age. However, technological strides have created an avenue for individuals to pursue parenthood later in life, blurring the lines of traditional age-related constraints and offering new horizons for those who wish to optimize their reproductive potential.

10)Early Screening and Medical Consultation to Protect Future Fertility

For individuals planning to delay pregnancy, early screening and medical consultation are crucial to protect future fertility.

•            1.Fertility Testing: It’s recommended to seek fertility testing if you have been trying to conceive for a year or more without success. Early diagnosis can lead to quicker solutions and reduce emotional stress.

•            2.Signs to Seek Evaluation: Look for signs such as irregular or absent periods, painful periods or intercourse, or a history of miscarriages. These could indicate issues with ovulation, hormonal imbalances, or other reproductive conditions.

•            3.Preconception Counseling: Preconception counseling can help women prepare physically, emotionally, and medically for a future pregnancy. It includes a detailed medical review, fertility and cycle discussion, condition management, lifestyle and nutrition guidance, vaccination and infection screening.

•            4.Genetic Testing: Mandatory genetic testing will be introduced as part of the premarital screening program for Emiratis planning to marry, starting early January 2025. This will help identify potential risks of passing on genetic disorders.

•            11)Health awareness before marriage is essential for several reasons:

•            1.Preventive Measures: It allows couples to take preventive measures for potential health risks, ensuring a healthier future together.

•            2.Family Planning: It aids in informed decisions about family planning, including the use of assisted reproductive technologies.

•            3.Early Detection: It enables early detection of health issues, which can lead to prompt medical intervention and management.

4.Genetic Testing: In some regions, genetic testing is part of the premarital screening process, which can significantly improve family planning by reducing congenital disabilities.

•            5.Public Health: In the UAE, premarital screening is mandatory to protect public health by detecting and addressing infectious and hereditary diseases before marriage.

Couples should consider these factors when deciding to undergo premarital health screening to ensure a healthy and informed marriage.

•            12)Young couples trying to balance work and starting a family can benefit from the following advice:

•            1.Communicate openly: Discuss work and family needs with your partner, listen with empathy, and create joint routines that deepen trust.

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•            2.Prioritize quality time: Make time for regular, quality time together and small, shared moments that reinforce love, safety, and closeness.

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3.Set boundaries: Establish boundaries for work to avoid being overwhelmed and to ensure both partners feel supported.

4.Limit nonessential activities: Minimize time spent on activities that do not contribute to your work or family responsibilities.

5.Learn to say no: Be prepared to say no to tasks that may take away time from work or family.

By implementing these strategies, young couples can create a harmonious balance that allows both to thrive in their careers and personal lives.

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