By Dina Kraft
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| Vered Letai-Sever, an Israeli from the small town of Tsoran, with her son Eitan, whom she had through in vitro fertilization. |
TEL AVIV, Israel — Jewish and Arab, straight and gay, secular and religious, the patients who come to Assuta Hospital in Tel Aviv every day are united by a single hope: that medical science will bring them a baby.
Israel is the world capital of in-vitro fertilization and the hospital, which performs about 7,000 of the procedures each year, is one of the busiest fertilization clinics in the world.
Unlike countries where couples can go broke trying to conceive with the assistance of costly medical technology, Israel provides free, unlimited IVF procedures for up to two “take-home babies” until a woman is 45. The policy has made Israelis the highest per capita users of the procedure in the world.
“It’s amazing when you think about it,” marveled Keren, 35, who asked to be identified only by her first name. She was seated in a waiting room at Assuta’s in vitro fertilization clinic, a beige canister of her husband’s frozen sperm at her feet. The sperm had been delivered from another hospital where she had her first IVF attempt three years ago, resulting in the birth of her daughter.
“I want at least three kids, and if we had to pay so much money I’m not sure we would be able to do this,” she said.
Although the procedures account for one of the country’s largest public health expenditures, the policy has drawn little debate or criticism, one of the few issues nearly all sectors of the typically fractious Israeli society seem to agree upon. There is even a growing pool of single religious women using in vitro fertilization, their efforts sanctioned by rabbis.
“The unique thing about Israel is that it’s a high-tech culture on the one hand and a very traditional one on the other,” said Sigal Gooldin, a Hebrew University medical sociologist who has studied IVF regulation in Israel. “It’s not just because of the fear of losing children in high-risk military activity, it’s because family is an extremely important social institution in Israel and what makes a family is the children.
“Anyone who lives here is expected to have children,” she added. “In casual conversation you will be asked how many children you have and if you say one, people will ask why only one, and if you say two, why only two?”
Israelis already have a high fertility rate: an average of 2.9 children per family. Beyond the biblical imperative to be fruitful, some Israeli Jews remain concerned with replenishing their numbers in the wake of the Holocaust.
Demographics here are also political. Israel has historically focused on promoting Jewish birthrates to retain a Jewish majority and more recently as a counterweight to higher fertility rates of Palestinians in the occupied territories. Arab citizens of Israel, however, have the same rights to state-paid fertility treatments as their Jewish counterparts.
A survey published by the journal Human Reproduction Update in 2002 showed that 1,657 in vitro fertilization procedures per million people per year were performed in Israel, compared with 899 in Iceland, the country with the second highest rate, and 126 in the United States, which trailed far behind European countries.
Experts say Israel’s rate still far outstrips the rest of the world. Four percent of Israeli children today are the products of in vitro fertilization, compared with about 1 percent estimated in the United States.
A major center of the baby-making industry is Assuta, which performs about a quarter of Israel’s approximately 28,000 IVF procedures a year. At the fertility center there, a lab housing 25 incubators and 60,000 frozen embryos stored in liquid nitrogen sits between an operating room where women have their eggs aspirated and a so-called transfer room where the embryos are implanted in the patient.
Citing the countless prayers that have been sent up from within its sterile white walls, Shai Elizur, the in vitro fertilization director at Assuta, calls the transfer room “a holy room.”
While the procedure is entirely state-paid at public hospitals, at private hospitals like Assuta patients using supplementary insurance may be charged a modest co-payment of $150 or so. Patients must also pay for their hormone shots, which are also heavily subsidized by the state.
The Health Ministry says it spends about $3,450 per treatment, although some critics say the real cost may be higher.
In the United States an average treatment or cycle, from egg retrieval to embryo implantation, costs $12,400. Insurance companies that do cover treatment, even partially, usually cap the amount of cycles they pay for.
Dr. Elizur said the success rate tended to drop off after the sixth try but, he added, “It’s very hard to tell a couple that the only reason they cannot have kids is the money.”
Mira Huebner-Harel, the Health Ministry’s legal adviser, said that Israel was the only country to cover not only unlimited IVF treatment until age 45, but to make treatment available for all women regardless of their marital status or sexual orientation. She said a state committee was considering whether to open coverage of fertility treatments to gay men using a surrogate.
“We are very sensitive here to the desire of people to have a family,” she said. “I think our country can be proud that a woman who wants to be a mother can try do so.”
Still, the policy is not entirely without its critics.
Hedva Eyal, who works for Isha L’Isha, an Israeli feminist organization, says there should be more discussion of the potential emotional and physical toll of the treatment, which includes a battery of hormone shots. She says that discussion is muted largely because of the confluence of public pressure and the medical establishment’s financial interest in the lucrative fertility business.
The booming industry has also provided other advantages to Israeli physicians. The large pool of patients with diverse fertility problems has helped them tailor treatments that end with a successful pregnancy, they say. And because cost is not an issue, there is less pressure to implant multiple embryos, which can lead to larger than desired multiple births — triplets, quintuplets or even the occasional octuplets.
Vered Letai-Sever, 32, a patient of Dr. Elizur’s from Tsoran, a small town in central Israel, has had eight in vitro fertilization treatments. The last led to the birth of her son Eitan four and a half months ago.
“If we lived anywhere else we probably would never have gotten here,” she said as she gently bounced the boy to sleep in her arms, his head snuggled on her chest. She counts 11 friends who have undergone the procedure.
“There is something deeply humane about this policy, this idea that people have the right to be parents,” she said. “It’s something that characterizes life here: the value placed on life.”
