From the Midwife’s Desk: Infertility and Faith

“And those who say, ‘Our Lord, grant us from among our wives and offspring comfort to our eyes and make us a leader [i.e., example] for the righteous.’" 

(Surah Al-Furqan, 25:74)

It has happened, you have found your partner, Alhamdulillah. You are married, and now you are hoping for children. For many Muslim couples this is the dream. Not only is marriage a way to protect ourselves from unlawful sexual acts, but it is a way to have our own offspring. It is such a desired and naturally human activity that Allah provides us with stories of parents and children and couples wanting children throughout the Quran.

While most couples may be granted an easy path to conception, some, like our beloved Prophet Ibrahim, peace be upon him, and his wife Sara, may Allah be pleased with her, will struggle with infertility. This of course can become distressing to the couple. While we will not all be fertile, fertility is an overall desired characteristic in Islam.  

It was narrated by Anas ibn Maalik, may Allaah be pleased with him, that the Messenger of Allah, peace and blessings be upon him,  said: 

“Marry the one who is loving and fertile, for I will feel proud of your large numbers before the other Prophets on the Day of Resurrection.” 

Narrated by Ahmad (12202)

This emphasis on fertility in Islam can make some couples dealing with infertility feel depressed and incomplete. Allah, in His mercy, not only stresses the importance of childbearing and rearing in the Quran, but also lets us know about the issue of infertility and how we can approach it as Muslims. 

In this article we will cover the meaning of infertility, medical causes, and some options available to help couples conceive. 

My Lord, grant me from Yourself a good offspring. Indeed, You are the Hearer of supplication."

(Surah Ali ‘Imran, 3:38)

What is infertility? 

Technically speaking, infertility is the inability to become pregnant after 1 year of regular unprotected sexual intercourse for women under the age of 35. Each month, a healthy couple has a 20-25% chance of conceiving. Since fertility reduces with age, women 35 and older may be considered to be dealing with infertility after 6 months of regular sex. “Regular sex” means that sex is not infrequent. 

Impaired fecundity is also a form of infertility. This is when women have difficulty getting pregnant or have difficulty carrying a pregnancy to term or to the delivery of a viable infant. 

Infertility can be female or male based. We will pursue this further later in the article. 

Here are some answers to frequently asked questions.

How common is infertility? 

According to the CDC, about 1 in 5 women of reproductive age (15 to 49) will deal with infertility. That is about 19% of women. Infertility can also occur to women who have had one or more children, however, the statistical odds are much less. About 6% of women who have previously had children will deal with infertility. As Muslims we understand that we bear children by the will of Allah. This does not make it haram though to try to find ways to conceive that have been deemed as halal.  

What general factors impact infertility? 

There are many factors that can contribute to infertility for both men and women. They include:

1. Age
2. Being over or underweight
3. Sexually transmitted infections
4. Lifestyle issues – stress, poor diet, intense athletic training, smoking, excessive alcohol and drug use
5. Medical conditions causing hormonal imbalance or disruption in reproductive organs
6. Exposure to radiation
7. Male or female sexual dysfunction, for example erectile dysfunction in men or dyspareunia (painful sex) in women
8. Frequent exposure of the testes to high temperatures for instance hot tub or sauna use. Exposure to steroids, certain medications, environmental toxins, and/or testosterone

What does it take to get pregnant? 

Though it may seem simple for some to become pregnancy, many steps need to occur in order for pregnancy to be achieved. Infertility can occur when one or several of the steps don’t occur or receive interference.

1. An egg must be released from the ovaries (ovulation).
2. Sperm must join the egg (fertilization).
3. A fertilized egg must travel through the fallopian tubes and to the uterus (migration).
4. The embryo needs to implant itself into the lining of the uterus (implantation).

An interruption in these steps can be associated with the female, male or both.

What causes female infertility? 

In order to achieve a pregnancy, a women must have properly functioning ovaries, fallopian tubes, uterus and hormonal balance. There are a variety of medical causations for female infertility including: 

• Polycystic Ovarian Syndrome (PCOS) is the leading cause of infertility for women during the reproduction years. It is a hormone imbalance problem that can interfere with ovulation. Women with PCOS may not ovulate monthly. A sign of this is very irregular or infrequent menstrual periods. For instance, a woman with PCOS may only experience menstrual bleeding every few months or suddenly stop having periods all together without being menopausal. 
• Diminished Ovarian Reserve is when a woman has less eggs than what would be expected of a woman during her reproductive years. Women with this condition may be able to conceive naturally, but it may not happen as quickly due to the reduced quantity of eggs.
• Primary Ovarian Insufficiency (POI) is another cause of infertility. This is when the ovarian reserve of a woman is lower than normal before the age of 40. This can also cause a lack of periods due to the ovaries not functioning properly.
• Physical causes include blocked fallopian tubes, absence or abnormality of the uterus.  Fallopian tubes can become blocked due to infection, endometriosis, or if a women has previously had surgery due to an ectopic pregnancy.  
• An ectopic pregnancy is one in which an embryo does not migrate to the uterus and instead gets stuck in the fallopian tubes. As the fallopian tubes are not large enough to carry a pregnancy this condition is life threatening to the mother and embryo and may need a medication or surgical response to remove the embryo. The surgical response sometimes can cause scarring that can damage the fallopian tubes or necessitate the removal of one of the entire tubes. This can interfere with fertilization and cause infertility.  
• Painful sex can contribute to infertility. When sex is painful, women may not be able to tolerate sex long enough for their partner to achieve ejaculation. Painful sex can also be an indicator to other problems with the pelvis or uterus that can interfere with fertility, such as pelvic inflammatory disease, endometriosis or physical abnormalities of the uterus or vagina.
• The uterus or lack thereof, can also contribute to infertility. Some women may have fibroids, which are non-cancerous masses that can be found in the uterus. While many women may still get pregnant with fibroids present, some may experience infertility due to the masses blocking implantation of a fertilized egg. A woman who has previously needed a partial or full hysterectomy due to abnormal uterine bleeding, or concern for cancer will also face infertility.  

This is by no means an exhaustive list of causes of female infertility but covers some of the most common reasons. Please see your medical provider if you are experiencing a lack of periods, very heavy or painful periods, or painful sex. Even if you do not desire a pregnancy these can all be signs of medical conditions that should be managed.

What causes male infertility? 

As in the case of women there can be a variety of reasons for male infertility. They include genetic conditions, developed health conditions, problems with sperm and physical causations:

• Problems with sperm can be a causation for infertility.  A sperm analysis can give answers about the condition of the sperm produced by a man. Analysis looks at the quantity of sperm, the ability for the sperm to swim or move well, the shape or condition of the sperm, and how any issues with the sperm could be contributing to infertility.  

Physically there could be a few issues as well.  

• A physical condition called varicocele can impact fertility. In this condition the veins of a man’s testicles are too large allowing for overheating of the testicles. This can negatively impact sperm. If a man has sustained injury to the reproductive system, sperm can be blocked in the body or reduced in number and therefore never meet an egg to fertilize. Sometimes men are born with conditions that cause impediment of sperm as well. There can often be a surgical response to unblock sperm and allow for pregnancy.
• If one or both testicles have been removed due to cancer treatment or injury, conception odds would be reduced if not impossible. 
• Medical conditions such as diabetes, hormonal disorders and hypertension can also contribute to infertility. 

What can you do about infertility? 

First, when you think you are ready to attempt a pregnancy it is a good idea for both partners to visit their respective health care providers and review your history to see if there could be any conditions that could possibly hinder pregnancy or cause problems with a pregnancy. Your health care provider should counsel you to avoid lifestyle choices that can increase your risk for infertility, take proactive steps for a healthy pregnancy, such as taking a prenatal vitamin, and perhaps recommend genetic testing. 

For women, your midwife, nurse practitioner or obstetrician-gynecologist may discuss tracking your period and becoming familiar with your fertile days. There are many apps that can make it easy to do this. They will discuss how to target your fertile days to increase your chance for pregnancy. Here is a great resource to help with that: Calculating Your Monthly Fertility Window.

If you are having difficulty finding a pattern to your ovulation or getting pregnant even with regular periods, ovulation kits can be a handy tool to help pinpoint when you are actually ovulating and when you should have sex. You can purchase ovulation kits online or in the drug store.

Once you have been trying for a year (or 6 months if 35 and older), it is time to talk to your health care provider about infertility. They will likely refer you to a fertility specialist.

Conception for the infertile couple

Abu Huraira narrated that the Prophet, peace and blessings be upon him, said: 

"There is no disease that Allah has created, except that He also has created its treatment." 

(Sahih Bukhari, Volume 7, Book 71, Number 582)

According to Al-Bar in a 2015 article on the Islamic perspective on reproductive technology, it is halal to seek a remedy to infertility as long as all of the products of conception and the pregnancy itself involve only the married couple. This means that the pregnancy cannot be achieved through donated sperm or egg or through surrogacy. You can find the article here: Chapter 11 Assisted Reproductive Technology: Islamic Perspective.  

This still leaves viable options for infertile couples.

If ovulation is the issue, couples may be offered medication that can help to initiate ovulation once other causes of infertility have been ruled out. If the problem cannot be easily resolved, there are other steps that can be taken to conceive. 

• Artificial Reproductive Technology or ART offers successful procedures to produce pregnancies for infertile couples. According to the CDC, in 2018 there were a total of 203,119 ART procedures resulting in 81,478 infants born. ART accounts for about 2% of all infants born in the US. 
• In-Vitro Fertilization or IVF is one type of ART that can be modified in different ways to cause conception.  In general IVF is a procedure in which an egg is fertilized outside of the body and then placed inside of the woman’s body to create a pregnancy. 

Walking the Difficult Path 

For Muslims dealing with infertility, it’s important to lean on Allah, seek help in patience and prayer, make dua and seek out comfort in supportive family, friends, and support groups.  While some couples may decide to seek assistance in achieving pregnancy, some couples may decide to accept the condition that Allah has placed on them and not pursue ART to achieve pregnancy. It is a really personal decision that should be respected and accepted. 

While there are viable options out there, the road to conception can be long and arduous.  However, it can happen. I have personally sat with couples who were unable to achieve pregnancy through spontaneous and ART means and then suddenly, they spontaneously conceive.  

Allah, in the Quran gives us insight into the hardship that Prophets Ibrahim and Zakariyah, peace be upon them, and their wives felt due to their infertility and the joy they felt upon learning of their conceptions. Couples dealing with infertility can take heart and hold onto hope whether choosing to pursue assistance with fertility or choosing to accept the condition as it is. 

May Allah bless us with righteous children and the patience to bear them and raise them. Ameen. 

Melissa Fleming is a wife, mother of four, daughter, sister and auntie. She is a Nurse-Midwife and an International Board Certified Lactation Consultant in Maryland. Melissa is a founding board member and health services director for Faith Families of African-Descent Meeting for Marriage & Parenting Support (FFAMM, Inc.), a service organization focused on helping Africans of the diaspora connect with the African continent through travel and service. She has been working on maternal/child and women’s health care issues in The Gambia through this collaboration. You can learn more about this project here: FFAMM Projects. Melissa is active in her local community with service and youth groups.