In 2014, Mark Adams, founder and CEO of Anglo Arabian Healthcare, was walking through the Arab Health conference. Adams was on a mission: to find a fertility specialist that would make a good partner for Anglo Arabian, one of the fastest growing integrated healthcare providers in the UAE. His team had already spoken with a number of groups across Europe to explore partnership potential, but nothing had panned out.
The conference search, on the other hand, paid off. The team met Dr. Jared Robins, a physician with the internationally recognized Fertility and Reproductive Medicine unit at Northwestern Medicine in Chicago. Two years later, Anglo Arabian Healthcare launched Orchid Reproductive and Andrology Services, in affiliation with Northwestern Medicine.
Fertility treatment has become a big business in the UAE, where infertility issues are a common yet complex concern. The Dubai Health Authority estimates that 10 to 15 percent of couples have difficulties conceiving a child due to a broad range of causes, including ovulation disorders, trying to conceive later in life, and cervical and uterine conditions. IVF and other fertility treatments in the UAE can cost upwards of US$27,000 (Dh 100,000) before a woman gets pregnant. Coupled with cultural norms that value large families, fertility in the UAE is a complicated, loaded and costly landscape to navigate.
The costs, though, have not deterred thousands of people from undergoing treatment each year. In Dubai alone, almost 6,000 women were estimated to have sought treatment for infertility in 2015, according to a study by Dubai's Aster DM Healthcare. The IVF industry has grown considerably since the first specialized fertility clinics opened in the UAE in the early 1990s, and that growth shows no signs of stopping: The number of women seeking infertility treatment in Dubai is predicted to rise to over 9,000 by 2030.
Some fertility operations have taken to promising couples a money-back-guarantee if they don’t go home with a baby. Others have looked abroad for a way to distinguish themselves from the competition. International partnerships, especially with healthcare providers located in the U.S., have become increasingly common throughout the UAE in recent years. Elite American institutions such as the Cleveland Clinic, for instance, opened a 364-bed luxury hospital in Abu Dhabi in 2015, and the Mayo Clinic brought the American Hospital Dubai into its Mayo Clinic Care Network in 2016. This trend received institutional backing in the Government of Dubai’s “Strategic Plan 2015,” a 2007 document that laid out growth strategies across several different sectors. The plan emphasized the importance of international partnerships to “improve health system planning to ensure service availability, accessibility and quality,” and reduce the need for patients to travel abroad to receive high-quality care.
Adams and the Anglo Arabian team had been studying developments in the fertility sector for several years. They had decided that many of the fertility clinics in the United Arab Emirates were overly focused on in-vitro fertilization (IVF) treatments alone, rather than taking a more holistic approach to helping women become pregnant. “There are often things that can be done that actually are a lot less expensive, a lot less invasive, and enable pregnancy to occur naturally,” Adams says. “What we wanted to do was build something that is supportive, compassionate, very much looking at the whole range of reproductive and andrology services.”
With over 200 doctors in 38 different clinical facilities across the region, Anglo Arabian Healthcare had a base of established resources and clinical expertise. What Adams and his team wanted, however, was a partner at the forefront of comprehensive fertility treatments — as Adams describes, a group that’s “an exemplar of the world’s best practice” in fertility healthcare. The Northwestern Medicine team met that criteria. It is internationally renowned and was ranked the eighth best hospital in the U.S. by U.S. News & World Report 2016-2017. Northwestern Medicine not only boasts state-of-the-art treatment options for its clients, but it also incorporates emotional counseling and support, with psychologists on its team as well as reproductive endocrinologists. Dr. Bohaira El Geyoushi, the affable medical director of Orchid Fertility who goes by Dr. Bohaira, describes Northwestern Medicine as “kindred spirits” that share Anglo Arabian Healthcare’s vision for what to offer a diverse patient community of both locals and expats.
Developing the partnership process took time, with deliberation and an open dialogue between both parties. “Culturally, you’ve got to really make sure you both understand each other’s values, vision and what you’re trying to achieve so you don’t get a mismatch between what each party is trying to do,” Adams says. Ultimately, the decision to partner with Northwestern came from its alignment to Anglo Arabian Healthcare’s vision for the future of fertility health. “We liked the fact that it was a not-for-profit hospital in America focused on clinical excellence,” Adams says. “They were very much working on the same philosophy we had in mind to try to create a patient-centric approach to this whole subject.”
Jared Robins, Northwestern Medicine’s medical director and fertility and reproductive medicine chief, was eager to establish Northwestern’s fertility strategies internationally with an organization that shares its passion for the advancement of global reproductive health. “From the first meeting, we knew that our philosophies were the same,” says Robins. “We admired that Anglo Arabian was interested in both changing the commodification of healthcare in the UAE and in developing holistic approaches that put patients first.”
The formal agreement, which finalized both the partnership between Anglo Arabian Healthcare and Northwestern Medicine and the formation of Orchid Fertility, was signed in 2015. Orchid opened in 2016 in Dubai Healthcare City and today offers some of the same advanced treatments that Northwestern does, including intra-cytoplasmic sperm injection, intrauterine insemination, ovarian stimulation and egg freezing. To address the emotional stress of fertility treatments, Orchid offers counseling for emotional support, acupuncture for stress relief, and free consultation with a nutritionist.
Like many other IVF services around the world, Orchid offers pre-implantation genetic screening (PGS). PGS is foremost used to test for conditions like chromosomal abnormalities and consanguinity, but it can also be used to select the gender of an embryo. This is a service that Orchid highlights as an option for what it calls “family balancing.” Using genetic screening for sex selection is controversial in the U.S., but gender selection is available, though discouraged, at many U.S. fertility clinics, including Northwestern Medicine.
Unlike other IVF clinics in the area, which often sell treatment plans in bundle packages, Orchid offers transparency in line-by-line pricing and “bespoke” treatment plans, a British term used to evoke connotations of “tailor-made” and individualized service, according to medical director Dr. Bohaira. “We wanted to put patients at our focus of care,” she says. “That translates into considering physical, social and physiological issues to address each couple's chances of conceiving naturally.” Dr. Tasnim Khan, chief operating officer and group CMO of Anglo Arabian Healthcare, notes that “what may fit one patient may not fit another one. There’s no such thing as one-size fits all.”
The success of Orchid’s program will rely on its capacity to tailor the U.S.’ fertility health standards to fit the specific needs of UAE patients. Therein lies the main challenge for Anglo Arabian Healthcare and Northwestern Medicine — how should clinicians translate care across very different populations? “There might be biological reasons or clinical reasons for treating Arabic or Asian patients differently than patients in Chicago,” says Adams. “You might have to adapt and consider changes in your processes.” Robins points out that there are laws and cultural practices that must be taken into account. “In Dubai, for example, there are laws that prohibit clinicians from freezing embryos,” he says. “We currently have to change our practice a bit from what we do in the United States in order to practice in the UAE, in order to meet cultural differences.”
Orchid’s plans for the near future are to establish its processes and protocols. It hosted its first conference on fertility in January 2017. And in addition to patient care, Orchid plans to collaborate with Northwestern Medicine on research into fertility issues relevant to Middle Eastern communities, including the region’s prevalence of infertility-causing genetic diseases and high rates of breast cancer. “We want to have research for the locals, by the locals, by us, rather than just talk about research done in the west,” says Dr. Bohaira.
Longer term, the Anglo Arabian Healthcare-Northwestern Medicine partners talk about other projects across the Middle East. Robins says the Northwestern team is particularly interested in broadening its research in regional differences in patient care. “My vision is to examine how this work in the UAE can change how we practice medicine, both in the U.S. and abroad,” Robins says. “In other words, how can we use our current work to improve practices globally?”
— Megan Popkin
Megan Popkin is a freelance writer based in New York City, New York.