Jerusalem — The Health Ministry’s recent announcement that it will no longer automatically fund unlimited IVF treatments is causing a great deal of concern among Israelis struggling with infertility.
The new regulations, which went into effect in late January, mean that infertile women and couples will no longer automatically receive free fertility treatments through the second live birth.
Instead, all women under 42 dealing with infertility will be given up to eight free IVF cycles; if all the treatments fail (“failure” is defined as producing no eggs or embryos viable enough to survive in the uterus), they and their physicians must discuss the possible impediments to conception and try to determine their cause; if a specific problem is found and there is no solution, the government will no longer pay (through the Israeli version of health maintenance organizations) for additional treatments.
Women aged 42 to 45 must have the sit-down talk with their doctors after three failed IVF cycles.
The new regulations “are extremely nerve-racking,” said Dina Pinner, a co-founder of Kayama, a support group for religious single women in Israel. “We all know women who suddenly had a child after 11 tries, 15 tries” of IVF, who had babies at 44 or 45 with their eggs. Having to discuss the situation after a certain amount of tries is brilliant, but forcing women in Israel, who earn so little money as it is, to pay for treatments if the first ones fail just isn’t fair.”
Prof. Eliezer Shalev, chairman of the Ministry of Health’s advising committee that formulated the new regulations, told The Jewish Week that they enable women aged 39 or older to immediately undergo free IVF treatments; previously, women had to try other procedures before being approved for IVF.
“This will save valuable time,” the physician said.
Shalev, who is the dean of the faculty of medicine at the Technion, said it would be extremely difficult but not impossible for a woman who has been turned down for additional treatments to find another Israeli fertility clinic willing to treat her, even at her own expense.
Shalev insisted the goal of the new regulations is to protect women’s health, not save taxpayer money.
“For me as a physician, it is horrible to see women under so much emotional and physical distress due to fertility treatments that you know, 100 percent, won’t succeed.” By requiring a frank conversation following failed treatments, “a woman will sit with her doctor to examine all the issues involved, such as problems with the embryo or the oocytes [eggs] or the endometrium. Perhaps they can find a treatment to improve the chances.”
If the problem is of unknown origin and the woman’s hormones and other indicators are within normal range, treatments can continue, Shalev said. But if it is identified and irreversible “instead of trying again and again and again, that’s when IVF should end.”
The next step could involve conception via egg donation, or adoption.
Fertility experts, who felt compelled by the previous regulations to provide as many as 20 IVF cycles to some women, are lauding the decision. According to the Society for Assisted Reproductive Technologies, as many as 40 percent of women under 35 eventually have a live birth via IVF, versus just 12 percent of women 41 and 42.
“There is a limit to the number of hormonal stimulations a woman should undergo,” said prof. Ariel Revel, director of the fertility preservation and egg donation program at the Hadassah Medical Center.
“At a certain age, even eight cycles is a large number, and the chances of conceiving are slim.”
Revel believes the old regulations “actually put pressure on some women because the funding existed for an unlimited number of cycles, even though medically it didn’t make sense.” In the U.S., where fertility treatments are terribly expensive and often not covered by insurance, “patients make their calculations and, more often than not, move on to something else that will deliver more for their investment.”
Though egg donation is often the only option, other than adoption, available to infertile women who have failed to get pregnant via IVF with their own eggs, there are almost no egg donations performed in Israel due to a lack of egg donors, despite legislation permitting it. Relatives and friends are prohibited from donating to a specific woman, and unrelated donors receive very limited compensation for a procedure that carries risks.
For this reason Israeli women seeking an egg donation almost always undergo the procedure abroad. Hadassah, for example, has an egg donation program in the Czech Republic.
Ofra Balaban, chairwoman of the Chen Patient Fertility Association, an advocacy group for women with fertility problems, welcomed the new regulations.
“For the last 10 years we have been urging the health ministry to regulate the enormous number of IVF cycles. When you get something free, you keep doing it and the doctors want to fulfill their patients’ dreams of parenthood.”
Balaban said it is vital to sit back and examine why, exactly, a woman isn’t conceiving and, if there is no solution, to explore other options. Her organization is lobbying for legislation that would encourage egg donation and, for the first time, permit the donation of embryos created during IVF but never implanted.
“The goal is not to do one cycle after another just because you can.”
A woman who spoke on condition of anonymity said she is deeply upset by the new regulations, because she fears they could limit her chances of becoming pregnant. She is planning to undergo her first IVF treatment in the coming weeks.
“For many women who still have good [hormonal] numbers, it’s really unfortunate to see these kinds of changes made,” the woman, who declined to provide her age, said. “One of the great things about living in Israel is that you’ve traditionally had this confluence of excellent fertility technology and socialized medicine and a traditional culture that considers having children a life or death issue.
“It’s really painful to be in the position of someone who wants to have children but could be cut off” due to the new regulations. “The wealthy will be able to continue treatments while others, like me, won’t have that option,” she said.