Israeli experts say public funding for IVF for women over the age of 41 should be restricted – Israel News – magviral


A Ministry of Health advisory panel recommends that women under 40 get better access to in vitro fertility treatments through the public health system, while restricting treatments for women over 41, effectively ending a unique policy.

Public funding for in vitro fertilization in Israel is the most generous in the world and technology is well advanced. The public health system offers unlimited IVF treatments for every woman between 18 and 45 years of age for their first or second child and funds fertility treatments with donated eggs up to the age of 54.


The new recommendations that Haaretz has received come from the National Council for Gynecology, Neonatology and Genetics. The Council also recommends that the countrys ministry and four health organizations have women freeze their fertilized eggs as part of the publicly funded health system.

Over the years, the Department of Health has feared that limiting public funding for IVF could lead to furious protests. However, given the failure rates of older women, medical experts are increasingly recommending setting limits.

Some healthcare sources have doubts that the recommendations will be accepted. No health minister wants to be the one to sign such a move, said a high-ranking source.

Given new data on low IVF success rates in women between 43 and 45, the Council recommends lowering the maximum age for IVF from 45 to 44 years. The Israel Fertility Associations 2017 figures show an IVF success rate of only 3.8 percent for women 43 to 45, compared with 11.4 percent for women 40 to 42 and 23 percent for women 35 to 39.

About 5 percent of births in Israel about 9,000 babies a year are the result of IVF. The only country that is approaching public funding is Denmark, which funds IVF up to the age of 45, but limits it to three rounds. On average, the Israeli government spends around 400,000 shekels ($ 115,000) for every successful IVF birth of mothers 43 years and older.

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Ultimately, it is difficult for both the system and the doctors to resist the strong desire and social pressure to have a genetically related child at all costs, said Dr. Etti Semama, head of the medical technology department at the Ministry of Health.

Every year, more than 40,000 IVF treatments are carried out in Israel. The Department of Health has calculated annual costs including hormone treatments, egg extraction, laboratory fertilization, and embryo implantation at 400-500 million shekels.

Experts estimate that around 75 million shekels of this sum are used for treatments where the success rate is negligible. This includes both older women and women who have undergone a number of unsuccessful treatments.

IVF Department, Tel HaShomer Hospital, Tel Aviv, 2018Motti Milrod

The National Council has sought to meet with ministry and HMO representatives, but the successive parliamentary elections in Israel, which maintain a transitional government, have delayed these considerations.

Efforts to curb public funding are not new. In 2005, the National Council recommended that public IVF funding be limited to women up to 44 instead of up to 45 years old, and in 2013, the National Council recommended not only to lower age, but funding to three IVF cycles for women limit between 42 and 44 years. The recommendation was not accepted, with the argument that most treatments were not intended for women in this age group.

The Israel Fertility Associations 2017 figures show that 3,881 IVF treatments were given to women between 43 and 45 this year, resulting in a success rate of 3.8 percent.

Focus on the best opportunities

The National Council for Gynecology, Neonatology and Genetics consists of 36 experts with different specializations. The Councils recommendations would limit the collection of eggs from women between the ages of 41 and 42 to eight (without possible permission for further attempts, as is now possible).

For women aged 43 and over, the number of treatment cycles would be limited to six. The City Council recommends that treatments be available in quick succession and that the current 45-day waiting period between HMO treatments is eliminated.

The current policy of the HMOs is to approve no more than four to six treatment cycles per year, said Prof. Talia Eldar-Geva, member of the council and head of fertility endocrinology and genetics at the Shaare Zedek Medical Center in Jerusalem.

Prof. Talia Eldar-Geva at Shaare Zedek Medical Center, Jerusalem, January 6, 2019 Ohad Zwigenberg

Its about concentrating efforts as much as possible on the area where the prospect of pregnancy is greatest. We suggest that HMOs from 35 to 39 years of age allow for continuous treatment cycles and change the guidelines for embryo freezing. Currently, every extraction requires immediate embryo implantation. We tell the HMOs: Allow another extraction to keep the frozen embryos for a few years.

Figures from Israel and abroad show that when a woman ages 41 starts fertility treatment, the average chance of having a child is 10 percent, said Eldar-Geva.

For a woman who begins treatment at 43 years old, its at most 5 percent. After five cycles, the success rate doesnt increase with every cycle, she said, adding that pregnancy is usually within the first three IVF Cycles.

My lottery ticket

The rate of IVF treatment performed in Israel is the highest in relation to the population worldwide. This is the result of a survey published in the Israel Medical Associations Harefuah magazine in 2018 and co-authorized by Semama, head of the medical technology department of the Ministry of Health.

I still do not believe that we have been able to support these women more wisely with these treatments and to give them a better understanding of the risks and prospects. The Israeli public has great respect for a woman who is self-conscious about pregnancy and Birth is at risk, it is perceived as an almost heroic act of sacrifice, and genetic parenting is also sacred, she said.

The media have success stories of women who got pregnant at an advanced age, but they downplay the fact that this is sometimes accompanied by egg donation and ignores the high failure rate in treating older women. Ultimately, many women begin a process in which the chances of success at their age are a fraction of a percent. They say to themselves: This is my lottery ticket. Even if the chances are 1 percent, I will be that 1 percent.

Medical staff at work in the IVF department of Tel HaShomer Hospital, Tel Aviv, 2018Motti Milrod

In her magazine article, Semama and her colleagues show how the generous government of Israel keeps the status quo going. The pattern that repeats itself over and over again is that once women are 45 years old and public funding ends, they switch to the option of donated eggs and then become pregnant.

In 2014, the Ministry of Health decided that after eight unsuccessful egg extractions, the medical team had to rethink the womans case and make recommendations as to whether she should continue. A circular on the subject triggered a backlash, and the ministry quickly announced that this did not mean that further treatments could not be given.

In women, the number of IVF treatments was rarely limited. A lawsuit filed by a woman against Maccabi Healthcare Services is currently pending before a labor court.

After eight unsuccessful treatments, this woman was advised to choose an egg donation. Maccabi acted according to the Department of Healths policy and refused to continue IVF treatment before she turned 45 when public funding for those treatments ended.


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Israeli experts say public funding for IVF for women over the age of 41 should be restricted - Israel News - magviral

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