Ethnical and sociocultural differences causing infertility are poorly understood-insights from the Arabian perspective.

Infertility is acknowledged worldwide as a major health concern. Although global levels of primary and secondary infertility have hardly changed between 1990 and 2010, significant regional differences have been reported. The prevalence of infertility in women has been estimated to be one in every seven couples in the western world and one in every four couples in developing countries. Male infertility may be under-reported in some regions due to an unwillingness of the male partner to undergo fertility investigations. Geographical, sociocultural/religious and ethnical dissimilarities contribute to these global variations in infertility prevalence. Infertility has a major impact on family stability in many cultures, especially in developing countries, where childlessness can impact sociocultural status. Moreover, it is important to realise that most fertility treatment protocols are based on studies performed in Caucasian population. The purpose of this opinion paper is to critically appraise the existing evidence regarding the association between infertility and relevant sociocultural factors in Middle East countries focusing on aspects such as parental consanguinity, obesity and vitamin D deficiency. There may be reason to believe that in addition to the current standard evaluation of infertile couples, region-specific counselling and treatment modalities are required.