Will the US Finally Catch Up to Israel in Fertility Care Access?

Following the recent executive order by President Trump calling for an expansion of access to IVF while bringing down costs, will the U.S. begin to catch up to Israel in fertility care access?

Access to fertility care is universal in Israel, but, to the surprise of most Israelis, this is not globally the norm. As illustrated by the following graph, Israel is the world leader in terms of IVF per capita, doing over 6X the relative amount than the US which lags far behind most of the rest of the western world.

Benjamin J. Peipert, M.D. Eli Y. Adashi, M.D., M.S., Alan Penzias, M.D., Tarun Jain, M.D.

Israel has truly been an outlier, providing IVF coverage to all. Indeed, one of the true meeting points of all of Israel's different walks of life (Jewish and Arab, rich and poor, secular and religious) is the fertility ward.

But, while Israeli patients might envy the higher success rates of US clinics, there is no comparison to the impact of Israel's umbrella medical insurance coverage for all aspiring parents.

In the United States, however, with only 500 fertility clinics spread across the entire country, and almost exclusively in major urban centers, there is an unprecedented gap between demand and supply and the need. Each year, a relatively small number of around 60 new fertility doctors are added to the American health care system, while a comparable number of docs retire. The grim data translates into one fertility doctor for every 62,000 women in the United States. This disparity results in a medical system that fails to make the necessary resources available to couples seeking fertility treatments. In fact, it is estimated that as low as 10% of the patients who need fertility treatments today actually receive care.

Currently, approximately 350,000 fertility treatments are performed annually in the United States. The number might sound high, but in reality it is a drop in the ocean, as the data show that an average of three and a half cycles are required for IVF to succeed. A 2022 white paper by a group of leading fertility researchers identified a need of over 2,000,000 treatments just to meet the existing demand.

In a reality where demand far exceeds supply and the costs of fertility treatments skyrocket, it is only the fortunate few who have the substantial financial means necessary to have a child through IVF.

From a personal struggle to start a family to establishing a start-up
A group of entrepreneurs, Josh Gottesman and Dana Averbuch, decided to change this bleak reality. Apart from their entrepreneurial and technological experience, they share over ten years of experience as fertility patients and saw the creation of Embie as a mission.
For Gottesman, cofounding Embie came after no less than six years of persistent and relentless struggle to expand his family, a story he talks about candidly.
"My wife and I unfortunately have gone through many, many miscarriages. We started the process in Israel with artificial insemination treatments and later with IVF. During the long years, we were exposed to a number of challenges, including the need for greater individualization of care and a byzantine bureaucratic process."
Gottesman says that he had an epiphany when he continued the IVF process in the United States. "We were unspeakably grateful for the quality of care (and the treatment that ultimately resulted in our son) but we are deeply conscious of how fortunate we were. The vast majority of people who need care are not so lucky.
"For a very long time I knew that my goal was to look for ways to improve the world of fertility treatment. This is a huge field that is growing at an unprecedented rate, with a market value of about $35 billion as of two years ago, and which will reach more than $62 billion in the next decade. And yet, something still doesn't work properly, and it leaves many individuals, couples and families in an exhausting process, both physically and mentally and without a baby in their arms," he says.

Gottesman says that the team decided to focus on increasing the availability of fertility treatments, which he considers to be the greatest barrier to accessing care. Therefore, Embie, the start-up he cofounded, is developing an innovative, AI-based system that makes it possible to significantly expand the scope of fertility treatments through distributed care management. They want to enable a shift from only 500 fertility clinics to engaging the over 50,000 obstetrician gynecologists across the country.
"The system we developed accompanies the patients and their partner as part of a complete fertility package that "holds the hand" of patients and supports them throughout the entire process. At the same time, the system makes the fertility clinics much more efficient. Through the system, the medical team can make data-driven decisions, in real time, and increase the amount of fertility treatments that are performed."
Remote Treatment Approach – For a More Fertile Society
The vision that Embie champions focuses on turning any gynecology clinic into a satellite fertility clinic, breaking down geographical barriers to care and improving the patients' experience.

By including gynecologist offices, including physician assistants and nurses, in the process, Embie is leading a revolution based on a remote treatment approach, which Gottesman says can lead to increased supply and access to fertility treatments. "Embie was created with the goal of helping more fertility patients become parents.

"Embie enables the 500 fertility clinics in the United States to more than double the amount of treatments they can perform," Gottesman explains, "By integrating with existing medical systems and not requiring them to change, Embie enables existing caregivers - including Physicians Assistants and Registered Nurses - to become satellite fertility providers.

Embie has also developed a dedicated patient app that guides patients through their journey and is based off of their direct-to-consumer app which has been downloaded by more than 80,000 patients to date. This app serves as personal assistants for patients and their partner throughout the treatment process.
"Embie gives patients the personalized touch they deserve without overtaxing clinical staff," says Gottesman. "The patient receives personalized notifications and all the information they need directly in the app, on their smartphone, at any time or place. The app saves the fertility nurse valuable time that they can devote to more complex tasks that require their professional training."

To what extent does the information in the app and its accessibility affect the success of IVF?
Gottesman: "From a study we conducted among patients who downloaded and used the direct-to-consumer app, regardless of the clinical protocol they followed, the success rate of giving birth to a healthy baby increased by 44% and the percentage of canceled treatment cycles decreased by 84%, compared to the average in the United States. This is not a study that can explain causality, but we hypothesize that with the support they received through Embie's app, it was easier for them to follow and adhere to the required treatment protocol. These are nothing short of amazing data, which give us a lot of hope. Embie really allows patients to be much more active and engaged within the process, receiving clearer guidance than before and dealing with much less bureaucracy."

Has the war affected your activity?
"There is no doubt that the entire period of the war was very challenging. Some of our staff or their partners were called up into the reserves, and given the reality on the ground and the world's attitude towards Israel, it was not an easy time on every possible level. Looking back, I can say that we managed to get through these months with blood, sweat and tears. We are currently in the status of having paying customers and a positive sales process, along with broad interest from new markets, all driven by a real need in the market. The idea is not to be complacent, but to constantly follow a path of renewal, to expand the availability of fertility treatments as much as possible."

Where will we see Embie in five years?
"Our aim is clear – make more babies! In five years Embie will be helping aspiring parents access fertility care on at least 3 continents and planning for the 4th!!"

Do you feel a sense of mission in your activity?
"Absolutely, yes. Fertility treatments are hard in the best of circumstances. We want to make them as painless as possible for patients while giving as many people as possible the chance to become parents."

In collaboration with Embie Clinic