Bridging the Gap: barriers to infertility treatment in the Middle East and North Africa (MENA) region and expert recommendations for enhanced access

Abstract

Infertility is a common yet underrecognized public health issue in the Middle East and North Africa, affecting up to 30% of couples in some countries. Although advances in assisted reproductive technologies have improved treatment outcomes globally, access to infertility care across the region remains uneven and limited. Understanding the barriers that prevent timely and equitable access to care is essential to improving reproductive health outcomes. This structured narrative review synthesizes evidence from published literature identified through a systematic search of major electronic databases (PubMed, MEDLINE, Scopus, and Google Scholar), and integrates expert-informed perspectives from fertility specialists across the region on financial, sociocultural, healthcare system, and policy-related barriers to infertility care. The systematic search identified 81 records, of which 76 remained after duplicate removal and underwent title and abstract screening. Following full-text assessment of 24 articles, 7 studies met eligibility criteria and were included in the final synthesis. Financial constraints emerged as the most significant obstacle, driven by high out-of-pocket costs and limited or absent insurance coverage for fertility treatments. Sociocultural factors, including stigma, gendered blame, and misconceptions surrounding infertility, further discourage care-seeking, particularly among women. Limited awareness of infertility and its treatments, combined with educational gaps among patients and healthcare providers, contributes to delayed presentation, poor treatment adherence, and unrealistic expectations. The psychological burden of infertility is substantial, with many individuals experiencing anxiety, depression, and marital strain, often compounded by the lack of structured counseling and psychosocial support within fertility services. Expert perspectives consistently highlighted the need for systemic reforms to address these interconnected financial, social, and healthcare system challenges. Conclusion These findings demonstrate that barriers to infertility care in the Middle East and North Africa are multifactorial and interrelated, encompassing financial, sociocultural, healthcare system, and regulatory dimensions. These factors contribute to substantial inequities in access to infertility services across the region. Graphical Abstract Barriers to infertility care in the MENA region