Israel's Health Ministry limiting number of subsidized IVF cycles
New rules strike balance between reproductive rights and public health considerations, minister says.
The Health Ministry has begun restricting the number of in vitro fertilization treatments to which women are entitled under the national health insurance program.
Until now, women up to age 45 who don’t yet have two children have been entitled to unlimited state-funded IVF treatments. But a new directive issued by the ministry on Tuesday imposes limitations, in line with the recommendations of the National Council for Gynecology, Neonatology and Genetics.
Most women will now be restricted to eight IVF treatment cycles. The directive also states that after four consecutive cycles in which the embryo failed to implant, or eight cycles that failed to produce clinical pregnancy, the woman should meet with her medical team and a social worker to discuss options for continued treatment. Clinical pregnancy is defined as occurring when the existence of the gestational sac has been confirmed by ultrasound.
Women over 42, however, will be restricted to three IVF treatment cycles in which the embryo failed to implant. The Health Ministry explained that based on the medical literature worldwide, the chances of a successful pregnancy occurring after three consecutive failures are near zero at that age.
Nevertheless, attempts to implant fertilized eggs that were frozen during previous treatments will be allowed as they will not be considered separate treatment cycles, the ministry added.
The new directive also allows women aged 39 or over to begin IVF treatments immediately. Until now, women who sought to undergo IVF were first required to try other types of fertility treatments, such as pills or injections. Only if these treatments failed repeatedly could women proceed to IVF.
The ministry explained that this rule wasted precious time for women who were nearing the end of their peak fertility years, since after 40, fertility falls sharply. Allowing these women to start IVF immediately will thus increase their chances of getting pregnant.
One council recommendation that the ministry didn’t accept, however, was to lower the maximum age for IVF to 44.
“We didn’t insist on lowering the age to 44, because the serious flood of patients is mainly at lower ages,” said Prof. Eliezer Shalev, who chairs the national council. “But at these ages, the chances of getting pregnant through in vitro fertilization are negligible. A situation in which a woman of 45 gets pregnant through in vitro fertilization and gives birth to a healthy child – according to the medical literature, [the chances] are zero. At age 44, we’re talking about a two percent chance.
“On this issue, there’s deception,” he added. “The public reads in the papers about a woman who got pregnant at age 45, but they don’t report that this was from an egg donation, not via in vitro fertilization. Women’s attempts to perform a large number of treatment cycles at these ages are like a lottery without a chance of winning. This leads to situations in which women are hospitalized with psychological problems, or in which people sell their houses to finance all this.”
The national council published its recommendations in May 2013. Israel’s previous policy of unlimited treatments had no parallel worldwide, both because of the expense and because statistically speaking, the more treatment cycles a woman undergoes, the smaller her chances of a successful pregnancy are.
Yet despite the diminishing odds of success and the physical discomfort of IVF, many Israeli women opt to go through numerous treatment cycles – sometimes even dozens. At a recent professional conference on the issue, one doctor said it’s not uncommon to find women who have gone through 20 cycles, and he even met one woman who had gone through 56 cycles without success.
In 2011, more than 38,000 IVF treatment cycles were performed in Israel, up 11 percent from 2010.
After announcing the ministry’s adoption of the council’s recommendations on Tuesday, Health Minister Yael German lauded the new rules. “These recommendations regulate the issue of in vitro fertilization treatments, and thereby enable women to realize their right to motherhood and parenthood on one hand, and on the other hand to take care of their health,” she said.
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