{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T06:45:00Z","timestamp":1782801900859,"version":"3.54.5"},"update-to":[{"DOI":"10.12688\/f1000research.168014.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000}},{"DOI":"10.12688\/f1000research.168014.2","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000}}],"reference-count":22,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"Background Infertility is an increasing global health concern, including in Saudi Arabia. This study aimed to explore patients\u2019 perceptions of infertility and in vitro fertilization services, focusing on knowledge, experiences, and barriers to treatment among couples in Khobar and Dammam. Methods This study employed a descriptive phenomenological qualitative method, specifically using a hybrid thematic analysis approach that incorporates both deductive and inductive coding. The data triangulation method was used to ensure the accuracy of the data. Therefore, participants were categorized into three groups: patients, physicians, and administrative staff at IVF centers. Data was collected through interviews. Data saturation was achieved with fifteen participants. Results Three main themes emerged: perceptions of infertility, perceptions of infertility services, and barriers to treatment. Participants perceived infertility, particularly male infertility, to be increasing; however, the lack of a national registry limits an accurate prevalence estimate. Key barriers included financial burden due to limited insurance coverage, societal influences, lengthy treatment processes, and limited awareness. Conclusions Expanding insurance coverage, providing financial assistance, and implementing awareness initiatives may help improve access to infertility treatment and reduce stigma. Establishing a national registry could also support better planning and improvement of infertility services.<\/ns5:p>","DOI":"10.12688\/f1000research.168014.3","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T06:04:09Z","timestamp":1782799449000},"page":"1130","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Exploring Infertility in Saudi Arabia: Qualitative Insights into IVF Treatment Services and Policy Recommendations"],"prefix":"10.12688","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-6855-4016","authenticated-orcid":false,"given":"Ameina Ahmed D.","family":"Alshallali","sequence":"first","affiliation":[{"name":"Public Health Dammam Eastern Province Imam Abdulrahman Bin Faisal University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4571-3832","authenticated-orcid":false,"given":"Deema Saad","family":"AL Shawan","sequence":"additional","affiliation":[{"name":"Public Health Dammam Eastern Province Imam Abdulrahman Bin Faisal University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2026,3,31]]},"reference":[{"key":"ref2","article-title":"World Bank Open Data.","year":"cited 2023 Apr 25"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"326-327","DOI":"10.1016\/j.xfre.2023.06.005","article-title":"Global in vitro fertilization utilization: How does the United States compare?","volume":"4","author":"B Peipert","year":"2023 Jun 30","journal-title":"F S Rep."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1537-1544","DOI":"10.1177\/0300060517749329","article-title":"Demographic determinants and outcome of in vitro fertilization (IVF) services in Saudi Arabia.","volume":"46","author":"F Almaslami","year":"2018 Apr","journal-title":"J. Int. Med. Res."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"237-240","DOI":"10.1016\/j.mefs.2015.02.001","article-title":"Prevalence of primary and secondary infertility from tertiary center in eastern Saudi Arabia.","volume":"20","author":"H Al-Turki","year":"2015 Dec 1","journal-title":"Middle East Fertility Society Journal."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"330-334","DOI":"10.1093\/humrep\/15.2.330","article-title":"Public perception on infertility and its treatment: an international survey.","volume":"15","year":"2000 Feb 1","journal-title":"Hum. 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Steril."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"43-50","DOI":"10.22192\/ijcrcps.2023","article-title":"Infertility: Prevalence and Consequences.","volume":"10","author":"E Obeagu","year":"2023","journal-title":"Int. J. Curr. Res. Chem. Pharm. Sci."},{"key":"ref10","first-page":"68-80","article-title":"The effect of social coping resources and growth-fostering relationships on infertility stress in women.","volume":"24","author":"D Gibson","year":"2005 Jan 1","journal-title":"J. Ment. Health Couns."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"77-101","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology.","volume":"3","author":"V Braun","year":"2006 Jan 1","journal-title":"Qual. Res. Psychol."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"545-547","DOI":"10.1188\/14.ONF.545-547","article-title":"The use of triangulation in qualitative research.","volume":"41","author":"N Carter","year":"2014 Sep","journal-title":"Oncol. Nurs. Forum."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"533-544","DOI":"10.1007\/s10488-013-0528-y","article-title":"Purposeful sampling for qualitative data collection and analysis in mixed method implementation research.","volume":"42","author":"L Palinkas","year":"2015","journal-title":"Adm. Policy Ment. Health."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"2654-2662","DOI":"10.1001\/jama.2015.17296","article-title":"Live-birth rate associated with repeat in vitro fertilisation treatment cycles.","volume":"314","author":"A Smith","year":"2015 Dec 22","journal-title":"JAMA."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"3007-3014","DOI":"10.1007\/s10815-020-01997-y","article-title":"Self-reported barriers to accessing infertility care: patient perspectives from urban gynecology clinics.","volume":"37","author":"I Insogna","year":"2020 Dec 1","journal-title":"J. Assist. Reprod. Genet."},{"key":"ref17","first-page":"45-53","article-title":"Women\u2019s Lived Experiences of Female Infertility.","volume":"13","author":"F Fahami","year":"2010 Sep 23","journal-title":"The Iranian Journal of Obstetrics, Gynecology and Infertility."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1186\/s12958-015-0032-1","article-title":"A unique view on male infertility around the globe.","volume":"13","author":"A Agarwal","year":"2015 Apr 26","journal-title":"Reprod. Biol. Endocrinol."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"661-666","DOI":"10.1056\/NEJMsa013491","article-title":"Insurance Coverage and Outcomes of in vitro Fertilization.","volume":"347","author":"T Jain","year":"2002 Aug 29","journal-title":"N. Engl. J. Med."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"64.e1-64.e8","DOI":"10.1016\/j.ajog.2022.03.003","article-title":"Impact of comprehensive state insurance mandates on in vitro fertilization utilization, embryo transfer practices, and outcomes in the United States.","volume":"227","author":"B Peipert","year":"2022 Jul","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"315.e1-315.e14","DOI":"10.1016\/j.ajog.2022.10.046","article-title":"Association of state insurance coverage mandates with assisted reproductive technology care discontinuation.","volume":"228","author":"J Lee","year":"2023 Mar","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref22","doi-asserted-by":"crossref","article-title":"Assisted reproductive technology in Saudi Arabia.","author":"H Abduljabbar","DOI":"10.15537\/1658-3175.4680"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1-8","DOI":"10.1155\/2022\/1968313","article-title":"Case Management Improves Satisfaction, Anxiety, and Depression of Patients with Pregnancy Loss after in vitro Fertilization and Embryo Transfer.","volume":"2022","author":"X Wu","year":"2022 Apr 7","journal-title":"Comput. Math. Methods Med."}],"container-title":["F1000Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/f1000research.com\/articles\/14-1130\/v3\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/14-1130\/v3\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/14-1130\/v3\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T06:04:10Z","timestamp":1782799450000},"score":1,"resource":{"primary":{"URL":"https:\/\/f1000research.com\/articles\/14-1130\/v3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,31]]},"references-count":22,"URL":"https:\/\/doi.org\/10.12688\/f1000research.168014.3","relation":{"has-version":[{"id-type":"doi","id":"10.12688\/f1000research.168014.2","asserted-by":"subject"},{"id-type":"doi","id":"10.12688\/f1000research.168014.1","asserted-by":"subject"}],"has-review":[{"id-type":"doi","id":"10.5256\/f1000research.197540.r482012","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.197540.r482012","asserted-by":"object"}]},"ISSN":["2046-1402"],"issn-type":[{"value":"2046-1402","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,31]]},"assertion":[{"value":"Indexed","URL":"https:\/\/f1000research.com\/articles\/14-1130\/v3#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.5256\/f1000research.185167.r438620, Asmaa Alyaemni, King Saud University, Riyadh, Riyadh Province, 16 Dec 2025, version 1, 1 approved","URL":"https:\/\/f1000research.com\/articles\/14-1130\/v1#referee-response-438620","order":0,"name":"referee-response-438620","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.196152.r460091, Emmanuel Ifeanyi Obeagu, Africa University, Mutare, 02 Mar 2026, version 2, 1 approved, 1 approved with reservations","URL":"https:\/\/f1000research.com\/articles\/14-1130\/v2#referee-response-460091","order":1,"name":"referee-response-460091","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"Deema AL Shawan<\/b>; \nPosted: 08 Mar 2026<\/i>; Dear reviewer, Thank you for your valuable input. Blew, please find  point-by-point responses to your comments regarding our abstract and introduction section accordingly.\n <\/b> \nComment: \u201c Background<\/b> The background section is overly broad and descriptive, lacking a clear articulation of the specific knowledge gap this study addresses. While infertility prevalence is mentioned globally and nationally, the abstract does not sufficiently justify \nwhy<\/i> patients\u2019 perceptions and barriers in Khobar and Dammam warrant focused investigation, nor how this study advances existing literature. The authors should explicitly state the unmet research gap and the study\u2019s unique contribution.\u201d \nResponse:<\/b> This was done as well as I could without exceeding the word limit of the abstract, which is three hundred words. \nComment: \u201c Objectives Require Greater Clarity and Analytical Focus<\/b> The study aims are stated in a generalized manner and conflate perceptions, service evaluation, and barriers without clearly distinguishing primary and secondary objectives. The abstract should clearly specify whether the central focus is patient perception, service accessibility, systemic barriers, or policy implications, and how these components are analytically linked.\u201d \nResponse:<\/b> There are two objectives (aims) to the study, both of which have been edited to make them more concise and briefly explained in the background section of the abstract. \nComment \u201cMethodological Description Lacks Rigor and Transparency<\/b> The methods section is insufficiently detailed for a qualitative study. The term \u201cqualitative, hybrid thematic analysis\u201d is vague and not adequately explained. The abstract should briefly clarify what is meant by \u201chybrid\u201d (e.g., inductive\u2013deductive), the data collection method (e.g., interviews, focus groups), and the rationale for including three distinct participant groups. Additionally, justification for the small sample size (n=15) and its adequacy for thematic saturation is absent.\u201d \nResponse:<\/b> The recommended information has been added to the methods section, but was kept brief due to the concise nature of the abstract and further elaborated in the manuscript. \nComment \u201c Results Section Is Incomplete and Conceptually Inconsistent<\/b> There is an inconsistency in the reporting of themes: the abstract states that \nfour<\/i> themes were identified but lists only \nthree<\/i>. This is a major structural flaw. Furthermore, the results are presented at a superficial level, largely restating common assumptions (e.g., financial burden, societal influence) without highlighting novel, context-specific insights. The authors should succinctly articulate the most salient and distinctive findings emerging from the data.\u201d \nResponse:<\/b> Thank you for highlighting the error it was corrected and further elaboration were added to the results in the abstract. \n\u201cConclusions Are Overgeneralized and Not Fully Grounded in the Results<\/b> The conclusions section introduces policy recommendations (e.g., case management, insurance coverage) that are not clearly tied to the reported findings within the abstract. The authors should ensure that conclusions logically flow from the stated results and avoid introducing new concepts not previously mentioned. The implications should be framed cautiously, reflecting the qualitative nature and limited sample size of the study.\u201d \nResponse:<\/b> In accordance with this recommendation, the conclusion section in the abstract  was edited accordingly. \nComment:<\/b> \u201c\nLanguage, Structure, and Technical Accuracy Require Improvement<\/b> The abstract contains grammatical errors (e.g., \u201chis study\u201d instead of \u201cThis study\u201d) and stylistic inconsistencies that detract from clarity and professionalism. The abstract should be carefully edited for language precision, coherence, and alignment with standard structured abstract conventions. \n\u201c<\/b> \nResponse:<\/b> Thank you for your feedback.  All grammatical errors have been corrected. \nComment\u201d Introduction<\/b> Improve the introduction by expanding. Add the following references in the introduction to improve the background with recent findings: Ref 1, 2 and 3.\u201d \nResponse:<\/b> I thoroughly read the three references and found them very insightful. I have included Reference 2 since it is most relevant to our study.","URL":"https:\/\/f1000research.com\/articles\/14-1130\/v3#referee-comment-15607","order":2,"name":"referee-comment-15607","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"Deema AL Shawan<\/b>; \nPosted: 19 May 2026<\/i>; Thank you for your valuable feedback, please refer to our response in our previous reply. Kindly let us know if you have further comments, we are still looking forward to your response.","URL":"https:\/\/f1000research.com\/articles\/14-1130\/v3#referee-comment-16234","order":3,"name":"referee-comment-16234","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.197540.r482012, Lucy Khofi, University of the Witwatersrand, Johannesburg, 30 Jun 2026, version 3, indexed","URL":"https:\/\/f1000research.com\/articles\/14-1130\/v3#referee-response-482012","order":4,"name":"referee-response-482012","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":5,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}