The Israels Women's Network - Assisted Reproduction

Israel Women's Network - Leading Social Change

Health Fertility - Assisted Reproduction

Taken from: Women’s Health in Israel 1999: A Data Book, Hadassah, and Israel Women’s Network, 1999

Israel has one of the highest ratios of assisted reproduction facilities per population in the world. There are at present 22 assisted-fertility centers, and between 1981-1996, more than 8,000 live deliveries had been achieved with the aid of IVF techniques. The pregnancy rate is approximately 14% per treatment cycle, and the live delivery rate is about 10.1% per treatment cycle. These proportions have not changed significantly since 1989. The number of deliveries achieved with assisted reproduction techniques has increased almost four-fold between 1990-1996. In 1996 there were 1,950 deliveries, resulting in the birth of 2,562 IVF babies. These comprised 2.1% of all births.

Assisted reproduction frequently results in multiple pregnancies, in Israel as in other countries and this contributes to higher rates of complications of pregnancies, preterm deliveries and perinatal mortality. The National Registry of the Israeli Association for Fertility Research reported in 1992 that 23.6% of IVF deliveries between 1982-1989 were multiple births, and 28.6% were pre-term. At delivery, 23.8% of newborns weighed less than 2,500 grams, and a significantly greater rate of low birth weight was found in multiple births. Perinatal mortality rates were 22.8 per 1,000 live births, which was double the ratio found in the general population. These rates increased considerably for multiple births. During the process of the IVF treatment, 23% of the pregnant women were hospitalized due to pregnancy complications, and almost half (47%) of the births were by Caesarean section.

The main determinant of negative outcomes in IVF babies is multiple pregnancy. A recent controlled study of 260 consecutive IVF singleton pregnancies matched with 260 naturally conceived singleton controls found that for singleton IVF births, rated of prematurity, low birth weight, maternal and fetal complications were not higher than in the control population; however, these births were associated with a high rate of caesarean sections: 41.9% as compared with 15.5% in the controls. For both elective and emergency caesarean deliveries, rates were significantly higher in the IVF group, and given the comparable rates of complications reported in the two groups, this was seen to be at least in part, a reflection of the increased anxiety surrounding the management of IVF pregnancies.

Assisted reproduction is an expensive process, as reflected by the live delivery rate of approximately 10% per treatment cycle: this implies the need for repeated attempts until a successful pregnancy and delivery is achieved. In keeping with Israel’s strong pronatalist policy, the costs of in-vitro fertilization are at present entirely covered in terms of the National Health Insurance Law, up to and including the birth of two children. However, the issue of infertility and whether and to what extent its treatment should be part of the basic “basket” of health services is still in dispute. A 1995 cost analysis reported that the cost of an IVF cycle in Israel is approximately $2,560, and the cost of a “take home baby” was estimated at $19,267. This sum included direct costs – which are divided into fixed costs (laboratory tests, chemicals, supplies, medication, loss of working days) – and indirect costs, which include the costs of premature IVF babies, hospitalization of the pregnant women in high risk units, and the costs of complications.