Four. Sixteen. Nineteen.
Those are how many Jewish women in Israel donated eggs in 2012, 2013, and 2014, respectively, since the Israeli government allowed compensation for the process, in order to encourage women to have it done.
Yet supply cannot meet demand in Israel and each year, hundreds of Israeli women who cannot conceive using their own oocytes (eggs) must travel abroad to purchase eggs donated by other (usually younger) women, and transfer the embryos – fertilized with their partner’s or a donor’s sperm -- into their wombs. (The younger the egg, the better the chance of a healthy pregnancy, irrespective of the age of the mother carrying the baby, up till about age 45.)
In 2010 the Knesset enacted laws to regulate egg donation. In 2013, hoping to encourage oocyte donation, an amendment was passed, increasing the money an egg donor receives per egg-donation cycle to NIS 20,302 (roughly $5,000) – of which roughly half is actual payment by the egg recipient, and half is reimbursement of the donor's costs.
Any unmarried woman aged 21 to 35 may donate eggs; or any woman (outside that age range) who is undergoing IVF, the Health Ministry says. Before the process can start, a hospital committee will interview the potential donor to ensure she is embarking on donation of her own free will. A preliminary interview with a psychologist is also mandatory.
A married woman may donate eggs, with special permission, and with the stipulation that she not be related to the egg recipient (or designated father). The donor must also agree in advance to having her personal information included in a Health Ministry database.
No more than three cycles of egg retrieval may be done, with a gap of 180 days between each "donation" cycle. And finally, the donor may not be advised who will be getting her eggs, barring special circumstances.
Still dependent on foreign eggs
Yet Israeli women remain dependent on "foreign" eggs. In 2005 the Health Ministry approved six foreign clinics working in conjunction with Israeli hospitals and medical centers, to provide egg donation services (retrieve the ova, combine with provided sperm, then transfer the resultant embryos in their Israeli patients). Three of these foreign clinics are in Ukraine, two in the Czech Republic, and one in New Jersey.
Exact figures of how many women undergo this procedure, and its success rates, are not tallied. There is also no general registry of Israeli children born from donor eggs.
Since a single "cohort" of eggs retrieved from a one donor may be shared between two to three women, Israel could have genetically related children who don't even know it. (Egg-donor doctors say the chances of that are tiny.)
The cost of the entire process, from paying the donor, to retrieval, to embryo transfer and travel too may run anywhere from $8,000-$12,000 per cycle; Israel's national health insurance covers part of the cost for two donation-embryo implantation cycles, for qualifying citizens.
But cultural opposition in Israel to donating eggs might be hard to change, partly because of past scandals.
In 2000, police investigated claims that certain Israeli doctors were over-stimulating the ovaries of patients to induce over-production of eggs, which they then sold without permission. One doctor was suspended, another reprimanded.
Israeli doctors have also been associated with scandals overseas: in 2009 and 2013 Romania charged Israeli doctors, in two separate incidences, of exceeding the boundaries of their local operating permits and illegally trading in human eggs, harvesting them without permits from Romanian women for sale to other women, including Israelis. Both times, doctors denied any wrongdoing.
Payment per cycle
Egg donation laws vary enormously by country: In Germany, Italy, Norway and Austria it's illegal. In France, it’s only legal if it’s anonymous and gratuitous—without any compensation for the egg donor.
In Canada it’s legal only if it’s non-anonymous and gratuitous, meaning free and the donor is known.
In Spain, the Czech Republic and South Africa, it’s legal only if it’s anonymous, but egg donors may be compensated. In the UK donors may be compensated, but it’s legal only if it’s non-anonymous. And in the U.S. it’s legal whether or not it is anonymous, and egg donors may be compensated – the American Society for Reproductive Medicine mandates between $5,000-$10,000 for the donor (not including travel or medication).
In countries where compensation is permitted, it is for the medical procedure rather than the eggs, since the sale of body parts is illegal in much of the world. Put otherwise, donors are paid for their cycles, regardless of how many eggs are produced.
Quest for a Jewish egg
Cost, time and anonymity of donors may present barriers for women around the world who want to use egg donors. Information on the donor may be sparse. In the U.S., and in foreign clinics used by Israel, donor profiles are quite in-depth, providing everything from IQ, psychological profile, baby pictures and family history, instead of just the basics, like eye and hair color, age, blood type and profession.
Cost can be a barrier too. In the U.S. the procedure can cost more than $20,000. (Egg donor compensation cannot exceed $10,000 but the clinic itself costs thousands of dollars).
Eggs from Jews, like from other sought-after groups such as Ivy League graduates, can cost a premium. For example, A Jewish Blessing, a U.S. nurse-run organization matching Jewish egg donors and surrogates to parents, charges a $7,000 matching fee, in addition to the $8,000 fee to the donor, and another $2,000-5,000 in various expenses, including a Beit Din - rabbinical court to confirm the donor is Jewish.
Religious leaders in Israel would like to see more Israeli Jews donate eggs, especially since the halachic status of egg donor babies is disputed. Meanwhile, since it's all but impossible to get a "Jewish egg" in Israel, some rabbis hold that only the woman actually carrying the baby needs to be Jewish for the baby to be Jewish.
Traveling for donated eggs
Meanwhile, since egg donation in Israel remains so rare, Israeli clinics must resort to foreign eggs, and different clinics handle their foreign programs differently.
Typically, Israeli clinics handling egg donation take groups of women abroad for the procedure. Sperm is collected, frozen and sent in advance to fertilize the eggs retrieved from the foreign donors. Israeli women receiving the eggs may travel abroad for 2-3 days, with hotel and ground transportation arranged by the Israeli clinic.
Some, like Dr. Jacob Levron, take over the local (Ukrainian) clinic one weekend a month. He brings his own embryologist, and performs the embryo transfer himself. Others, like the doctors at Hadassah Medical Center, oversee the local (Czech) clinic, but do not perform procedures.
Most clinics offer six donor eggs for about $10,000 dollars, but some (like Levron) offer a guarantee that there will be enough for two embryo transfers, if the first transfer does not result in a viable pregnancy.
For an additional fee, a woman can buy the entire "cohort" – i.e., all the eggs retrieved from a donor during one particular cycle to use for future use. (Although this is no guarantee she has exclusivity over the donor’s eggs: a donor can do up to three cycles with one clinic.)
In recent years, Israeli doctors have been able to transport fresh embryos back to Israel, to perform the implantation procedure in Israel. (These embryos, transported in a CO2 incubator, are not frozen, but are considered fresh, almost equivalent to being in situ.) In an October, 2014 paper, Levron and his partner Prof. David Bider concluded that transporting human embryos using portable a CO2 incubator is safe and does not jeopardize their developmental potential.
Egg donation is not a guarantee for a baby – although it usually offers a higher success rate than an older woman using her own eggs. Levron estimates the success rate at 40%-50%. Prof. Ariel Revel of Hadassah Medical Center cites a 47% live baby rate.
In 2012, the Society for American Reproductive Technology cited a 56.6% live birth rate using fresh embryos, and 37.2% for frozen embryos (which are easier to coordinate, because the donor and recipient do not need to be coordinated together).
Of course women seeking cheaper options outside their home countries can go directly to any clinic they choose, and deal directly with the local staff; or they can undergo their procedures in approved clinics under the wing of an Israeli practitioner, says Revel, head of Ovum Donation (Fertility) & Egg Preservation at Hadassah, the only public hospital approved for IVF (Shaare Zedek Medical Center doctors work with Hadassah).
“We’ve had patients from the U.S. and Canada, Australia, France and Russia,” he says. “They want the expertise of Hadassah and its long tradition of IVF,” he said, noting the Israeli prices are cheaper than going directly through the Czech Republic clinic.
To tell, or not to tell
Israeli clinics do their best to match donor characteristics with the parents’ request – including height, weight, hair color, eye color, age, profession, education and blood type. But the available pool of donors is constrained by their region of origin. Ukraine may not have too many olive-skinned brunettes, for instance.
In Israel, egg donor information is private – only the clinics know the donor, which cannot be disclosed to the parent or child. This however is not always the case overseas - for instance, in England. “We get a lot of patients from the U.K. because at the age of 18 children can find out who their genetic parents are, by law,” said Dr. Jacob Levron.
When it comes to telling the child, opinions differ again. In America, fertility organizations recommend disclosure when conception involves a donor (sperm donor, egg donor, embryo donor, surrogate, etc). “With few exceptions, in the best interests of your child and your family as a whole, it is best if your child grew up with the knowledge that they are not genetically related to one (or both) of their parents but still loved,” Resolve, an American infertility association advises, noting that secrets can be damaging, and can lead to feelings of betrayal.
But in Israel, many prefer to keep it secret, Revel says, although he personally recommends disclosure.
“Why would you tell anyone?” one egg donation nurse coordinator says. “That’s between you and your husband. Israel is not like America. People can be very judgmental.”
This is Part 5 of Fertile Ground, Haaretz's series on IVF in Israel. For the rest of the project, click here.