After seven years of continuous treatment efforts, Amira embarked on a grueling journey from doctors to hospitals, undergoing numerous medical tests, starting with surgical endoscopy, costly injections, and dye imaging, all in the hope of finding a cure to fulfill her dream of motherhood. Like other women suffering from infertility, she faces additional challenges, including drug shortages and soaring prices.
Although the required treatments are incredibly expensive, Amira had no choice but to sell her jewelry to finance her treatment. “The fear of losing hope and the huge financial costs haunt me every day,” Amira says, emphasizing that the absence of medication in the market worsens her suffering.
This story is one of thousands of women in Egypt facing infertility challenges amid drug shortages, reflecting a larger healthcare crisis. This crisis requires serious intervention to address the causes of drug shortages and provide treatment in an organized and secure manner, especially given the lack of sufficient support for female breadwinners in various regions.
Between Drug Shortages and Social Pressures
Zeinab El-Shafie, a resident of Qalyubia Governorate, starts her day at 3 AM searching for the injection she needs to treat infertility. Her daily journey is long, consuming her time, money, and effort, but it often ends in disappointment. “I leave my house very early because of the shortage of the injection in the market, but with each trip, the psychological pressure from society grows,” Zeinab says.
Zeinab lives in a rural environment that adds another burden to her struggles. The constant questioning by neighbors about why she leaves at odd hours increases her embarrassment, but she fears revealing the reasons behind her daily trips due to the social stigma that may follow her. What she hoped would be a quick and effective treatment journey has been hindered by the unavailability of essential drugs.
Eight months ago, Zeinab began experiencing severe cramps and other concerning symptoms, prompting her to undergo medical tests. She was diagnosed with polycystic ovary syndrome (PCOS), which affects her ability to conceive. Over time, her condition worsened, and she realized that delayed treatment was not only affecting her body but also her personal and social life. “I didn’t know these symptoms were related to the illness, and the situation only became harder as treatment remained unavailable.”
Zeinab faces a daily struggle to obtain the injections needed to treat her PCOS, which affects her ability to conceive. According to the World Health Organization, one in five women worldwide suffers from this hormonal disorder, which causes irregular menstrual cycles and difficulty in conceiving.
Weeks ago, Zeinab began visiting the Al-Esaaf Pharmacy daily and was finally able to obtain one “Merional” injection after a long wait. However, she still needs the “Decapeptyl” injection, which is also unavailable. “When I return home without the full treatment, my husband and his family begin asking questions, and sometimes their words are hurtful,” Zeinab says.
While Zeinab continues her pursuit of the necessary treatment, her suffering remains compounded by the drug shortages and the embarrassment and social pressure from those around her.
Dr. Ahmed Abdel-Haq, a consultant in obstetrics and infertility, confirms that the “Decapeptyl” injection is a critical step in IVF procedures, as it helps regulate the timing of egg release from the ovaries, thereby improving the chances of success. He also notes that the success of IVF depends on several crucial factors, such as adhering to dosage schedules, maintaining proper nutrition, and the wife’s age, which can raise the procedure’s success rate to 70–80%.
Dr. Rasha El-Gendy, a sociology professor at Beni Suef University, explains that childbirth expectations differ between rural and urban areas in Egypt. In rural areas, society expects women to give birth early, while in major cities, childbirth may be delayed until the age of thirty. However, all communities share the perception that a woman unable to conceive is incomplete, subjecting her to social stigma. This cultural heritage intensifies the social pressure many women face.
Amira recounts her experience: “I live in a society that measures a woman’s femininity by her ability to bear children, and unfortunately, I have not yet been able to conceive.” She describes the pressures from her husband and his family, as her life turned into a constant wait for treatment results and repetitive, embarrassing questions from everyone. “It has reached the point where my husband’s relatives ask about the details of my private life, such as the frequency of intimacy and my menstrual cycle, which made me feel an extreme invasion of my privacy.”
Amira adds: “No one realizes the impact of these hurtful questions, which add to the constant psychological pressure I experience, especially since the treatment has not achieved the desired success.” She also expresses her fear of being unable to afford upcoming IVF treatments, saying: “We have already spent more than EGP 46,000 on ovarian stimulants alone, and I cannot gather the amount required for the next phase.”
Psychological Impacts and Systemic Shortages
Recent psychological studies, including a Danish study, found a link between infertility and increased suicide risk. The study examined 106 women suffering from infertility, revealing that women who could not conceive, or struggled repeatedly, experienced higher levels of depression, guilt, and increasing isolation.
Psychiatrist Dr. Hossam Hassan explains that psychological pressures worsen when combined with drug shortages or an inability to afford treatment. He states: “Any disruption in treatment outcomes due to financial constraints or drug unavailability increases the risk of severe depression, which can escalate into suicidal tendencies.”
In Egypt, where society views childbirth as a key measure of a woman’s success in marriage, societal pressure deepens the psychological suffering of infertile women. Hassan highlights that societal expectations place an immense psychological burden on women, exacerbating the social and mental toll of infertility.
No Alternatives in the Market
With the ongoing drug shortage crisis, Zeinab asked her doctor for an alternative treatment, but no substitutes are currently available.
Health Minister Khaled Abdel Ghaffar argues that the crisis stems not from a shortage of medications but from a “cultural issue,” claiming alternatives exist for all drugs. However, key infertility drugs such as “Merional” and “Decapeptyl” have no available substitutes, as confirmed by Samih Nabil, a member of the Pharmacists Division at the Chambers of Commerce.
Infertility drugs also lack the priority given to medications for chronic diseases such as hypertension, cancer, and heart conditions. Consequently, they are not included in women’s health units or the national health insurance system, further deepening the crisis, Nabil says.
Walaa Khaled, a 21-year-old woman, shares Amira and Zeinab’s frustration with Egypt’s healthcare system. She describes her exhausting daily trips to Al-Esaaf Pharmacy, where she faces humiliating situations, such as separating infertility patients into specific queues and rejecting prescriptions older than 30 days.
Although one of her relatives helps send medications via travelers, airport restrictions complicate matters. Despite providing stamped hospital prescriptions and documents proving her medical condition, the medications were denied entry because the traveler was not the patient.
In front of Al-Esaaf Pharmacy, stories continue to unfold between Zeinab, Amira, and Walaa about rising injection prices and fears of further price increases. Previously, the government announced a price hike for over 1,000 drug products suffering from severe shortages. This decision followed recommendations from Ali Auf, head of the Drug Division, who believes that adjusting prices is key to addressing the shortages.
Mahfouz Ramzy, head of the Drug Committee at the Pharmacists Syndicate, tells Zawia3 that the Drug Division speaks on behalf of pharmaceutical companies and prioritizes their interests, particularly as company profits declined after the currency devaluation in 2022. The Egyptian market faced a dollar crisis in February 2022, with the rate reaching EGP 70 on the black market before stabilizing at around EGP 48 in March 2024. Despite this improvement, the market continues to experience successive crises, including shortages of vital drugs and rising prices.
Ramzy attributes the shortage of infertility drugs to several factors, primarily bureaucratic delays in releasing raw materials from customs. Ahmed Farouk, former secretary-general of the Pharmacists Syndicate, adds that infertility drug shortages are a recurring issue beyond the dollar crisis, as these medications are not included in subsidized treatment lists, allowing companies to hike prices excessively.
The Egyptian Drug Authority continues to review company requests to increase the prices of medications persistently unavailable in the market, while many women struggle to obtain suitable treatment due to its high costs.
