In the United States, one in ten couples is diagnosed with some form of infertility, while in Britain and Canada, the rate is suspected to be as high as one in six. Some couples seek help from science, which has made enormous strides forward since the first "test tube baby." But in vitro fertilization, the process of creating an embryo outside the body, is physically and financially onerous. IVF treatment in the U.S. can run anywhere from $12,000 to $30,000 a round, leading some couples to seek the procedure in technologically advanced but cheaper places. Such as Israel.
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In Israel, a cycle of private treatment usually runs between $6,000 to $7,000. Also, returning Israelis get the process for free for the first two children up to age 45, if they kept up their health insurance payments.
There are cheaper options than Israel around the world, notably in eastern Europe and Asia. But among Israel’s advantages are its developed-country status with all the conveniences that entails, its advanced medical facilities, and for Jews at least, the comforting sense of being home with the tribe.
For Israeli couples, Israel provides free IVF for the first two children up to age 45 and at the discretion of the medical team and insurance, which has helped make the country a major world hub for the procedure.
There is no central source of information for pursuing IVF in Israel. Nor are there official estimates of how many women come to Israel for IVF. Some come in a private capacity and some are Israelis living abroad who are taking advantage of their right to free IVF under Israel’s universal healthcare laws. New immigrants and returning immigrants who have not kept up with health insurance payments must undergo a waiting period of 150 days even if they redeem their health insurance in a lump sum (the mandatory waiting period applies to both IVF and organ donation).
There are a number of factors to take into consideration before committing to treatment in Israel. From financial to emotional to practical, patients and experts share their tips and concerns.
1. Do an exploratory trip
If feasible, it helps to come to Israel on an exploratory trip to find a doctor and clinic you like in a location that’s convenient.
While there is no official Israeli “center” for IVF visitors, there are a few places that specifically cater to English-speaking tourists, especially those just flying in and out for treatment (one advertises, “Your Vacation and IVF Treatment in Israel”).
“I kept asking around and this one doctor’s name kept coming up,” said Meirav, a 44-year-old single mom from the midwest who came to Israel just for treatment. She moved with her son to Tel Aviv but plans on returning to America when she gets pregnant. She sees a doctor in Ra’anana. “She’s the doctor that got all my friends pregnant.”
2. Consider the total cost
While IVF is cheaper in Israel than in the U.S. – and quicker than in places like England and Australia, where it’s often covered by the government but there are long wait times – it’s important to consider the entire cost of treatment, including travel, time off from work and other disruptions to life.
Shani and Avi, two Israelis who established themselves professionally in New York, decided not to come back to Israel for treatment, even though they purchased medicine in Israel on their Israeli health insurance. (Most people recommend checking your health plan abroad to see if the meds are cheaper out of country, especially if you’re paying privately.)
“IVF was so disruptive to life even staying home, that I think completely disrupting life—both of us taking off from work, traveling, etc.— was too much to contemplate,” said Shani, 40. She said the cost of them leaving their jobs and travel wouldn’t be worth it. “We also knew it could take several tries. That’s the thing with fertility stuff—you just don’t know when it will end, so you can’t make an informed decision ahead of time.”
3. Make sure you can communicate with your clinic
While most of the doctors are fluent in English, some of the support staff are not, including in medical terminology that you might need for your treatment. “There was a language barrier,” said Lori, a 39-year-old Australian who came to Israel for her fiance’s job just as she’d begun preparing for IVF back home. “I don’t speak Hebrew and my hospital’s ‘foreign language’ was Russian.” Her doctor did speak English but others, like the nurses and secretaries, did not. “Even getting an appointment was really hard,” she said.
Pamela had to bring her Israeli husband to all her appointments. “They’re not very English-friendly so I’m very limited in information,” said the 41-year-old, who lives in Los Angeles but flies in every six months with her husband for private treatment. “I miss out on a lot of important information, and my husband will know more than I do, which is very rare in this situation.”
4. Brace for a straightforward manner
Aviva, 30, had already moved her with her husband from Northern California when she discovered they were both carriers for a rare genetic disease that would require them to do genetic testing with IVF to find healthy embryos. “Are you siblings?” one doctor asked, when she told them about her condition. “It’s tactless. Someone else asked if we’re getting divorced,” she said.
Pamela wasn't used to the bedside manner in Israel. “In the American healthcare system, doctors and nurses go overboard to make you feel secure through the process, they walk you through everything before you’ve even spent a dollar,” Pamela said.
But on the other hand, the fact that IVF is a rote procedure here is sometimes good. “Because it’s so readily available to its citizens in Israel, they don’t make as big a deal if it doesn’t work," says Pamela. "They go at it like it’s all business: ‘If it didn’t work this time, we’ll see you next month.’”
Pamela's husband Danny, who grew up in Israel, had a different point of view. “It’s straightforward: someone’s guiding us in the most basic way, where to be and what to do. But they know what they’re doing.” He added: “I would recommend doing it here - I would just be very prepared.”
5. Close encounters of another kind
Some American patients may be surprised by the degree of intimacy between patients and caretakers in Israel. While an American doctor or nurse would almost never give out their phone number, in Israel they well might. Aviva was surprised that her doctor gave her his cellphone number. “I text him and he texts me – it’s a relief that he gets back to me pretty fast,” she said, adding that it makes the treatment less anxiety-provoking.
Tali was afraid to administer the hormone shots, and one of the nurses who lived in her neighborhood came by to help her.
Even Pamela had a better experience her second time around. “Once we had a relationship with the nurses, they would go the distance. They went out of their way to get us coffee, making sure everything is okay.” One nurse also gave Pamela her cellphone number.
6. Get ready for bureaucracy and balagan
Some "prep work" can be done in one’s home country, such as starting the cycle back home (taking shots). Most women come at the beginning of their cycle, and some stay through either the embryo transfer or the pregnancy test 10-12 days later. The shortest feasible stay is about two weeks. Ideally you want to be here by day three of your cycle. But the more of the process you do here, the more potential there is for hassle.
In some cases - “You might have to go for your blood tests in one place, your ultrasound in another and your treatment somewhere else – even if you go privately,” said Sharon Kastoriano, a fertility acupuncturist in Tel Aviv who among other things helps guide women through the fertility system.
In addition to bureaucracy, some have a hard time with the balagan, the chaotic Israeli style, which may involve a lack of orderly lines, misfiled paperwork, and people cutting in front of you. “There’s a much more relaxed attitude,” Pamela said. She was surprised that there was no waiting room in her clinic, “but it was efficient anyway.”
7. Don't be shy
“You have to be on top of things here,” said Tali, who did treatment in New York first. “Come as an educated client. Be able to speak up and state your opinion—especially if you’re coming with experience.”
Tali, who experienced treatment in both the U.S. and Israel, feels that the American way is more coddling. “You have to understand that when you come to Israel, you’re not the only one, and you’re never going to get that individualized feeling,” she says.
There’s not always a lot of information available about treatment. “Sometimes my clients leave their doctor’s appointments without a clear explanation of what will happen next. They’ll have ultrasounds and the technician will tell them their follicle size, but they don’t know what that means,” said Kastoriano, who trained in New York and Beijing (the timing of egg retrieval is based on follicle size.)
If you have questions, don’t be shy to ask them. Meirav said that her doctor told her, “You ask more questions than any patient I’ve had.”
8. Make sure you have an emotional support system
“When you’re doing this process anywhere, it’s very important that you have emotional support,” said Rachi Hain, director of Merkaz Panim, a non-profit in Jerusalem that offers women and couples emotional and physical support through fertility, including social work counseling, massage, yoga and guided imagery. “If you’re far from home, where your support system may be, it’s very important to build a support system,” she said. “Also, if you’re coming from another country, that’s the reason you’re here: it’s very challenging to find out what else you can be doing with your time, instead of just waiting for your next blood test, your next ultrasound.”
She advises to try and make sure your life is well-rounded, and try to have things other than treatment.
9. Enjoy Israel’s dedication to fertility
Among the positives to treatment in Israel is the fact that the system really wants you to have a baby – that’s why they offer it free to citizens, and at a relatively low cost to private patients.
Doctors want to go the distance for their patients. When she was in Australia, Lori had been waiting for her hormone level to go down before doctors there would treat her under the public healthcare system. “They’re very strict about FSH levels in Australia,” she said, referring to the Follicle Stimulating Hormone that measures the quality of a woman’s eggs and her chances of responding well to hormonal stimulation. “We don’t even worry about that here,” her (private) Israeli doctor told her. “I quickly noticed the whole approach is very different here. They don’t muck around,” she said. She was grateful she was able to start right away.
Pamela was pleasantly surprised by the child-friendly society in Israel. “No matter where you look, you see a baby stroller,” she said. “Israel is so pro-family, it’s in the business of making babies, and that can be encouraging to someone coming from another country.”
10. Hidden benefits
Some people come to Israel for IVF because of the cost, but that’s hardly the only reason, since there are other countries that provide treatment for even less. (In the Czech Republic, for instance, a round of IVF can run at about $3,000, not including meds and travel.)
Yet many Jewish couples prefer Israel as their IVF venue for emotional reasons. “I want to go somewhere where it’s not just a business,” said 36-year-old Danielle, an Australian-Israeli living in the States who is considering coming to Israel for treatment. “In America, it’s an enterprise – the prices are unbelievable; they’re making so much money, it’s sick. I feel like it’s much less of a business for Israel -- it’s more of a calling. I think in Israel people are really interested in making babies.”
Leah had been trying to have a baby for five years in London. She’d been through multiple rounds of IVF there, but then decided to travel to Israel. “The technology was better [in Israel],” she said, noting that she was using frozen embryos – which only had a 50% success rate of unfreezing in England, but over 90% in Jerusalem. She got pregnant on her first try in Israel, with twins – and moved to Israel after they were born. “There was just something about being in Israel that made me happy. I felt right at home.”
This is Part 1 of Fertile Ground, Haaretz's series on IVF in Israel. For the rest of the project, click here.