Gila (not her real name) is 43, with a 3-year-old daughter. A single mother, she is desperately trying to have a second child the way she had her first, with state-subsidized in vitro fertilization. It took her 10 years of fertility treatments, from the age of 29, to have a successful pregnancy ending in the birth of her daughter.

“It’s only the two of us, and I want a sibling for her so it will feel like a real family,” says Gila.

Until recently Israel provided unlimited, nearly-free IVF treatments until a woman was 45 or had two children with the procedure; the cost was low even for families with several children that want to expand the brood.

But last month the Health Ministry introduced a number of restrictions to Israel’s world-famous generous IVF policy. Women are now limited to eight state-funded IVF treatment cycles. Only if her medical team and a social worker determine that it’s worth trying again would her health insurer be asked to cover additional cycles. “In the past, the treatments would just continue automatically,” says ministry spokeswoman Einav Shimron Greenbaum.

In addition, women over 42 are now limited to three unsuccessful treatment cycles.

For Gila, that means the window to another baby is probably closing much more quickly than she had expected. And if the eight-cycle limitation were introduced years ago, she might not be a mother today.

“I’ve paid my taxes my whole life,” she says. “Other than my fertility treatments, I don’t think I ever went to the doctor or missed a day of work. And now, when I need the state, the state is pulling the rug out from under me.”

Many Israeli women, single and otherwise, express similar sentiments as they try to understand what the new guidelines mean for them and their desire for motherhood. The uncertainty in the weeks since the new policy was announced has led to stress, anger and confusion for women trying to conceive with IVF and other forms of Assisted Reproductive Technology.

“It adds a lot of stress right now, and we know that increasing stress decreases fertility,” says Dr. Karen Friedman, who knows Gila through Rimon – the Mind Body Fertility Center at Hadassah University Hospital, Mount Scopus, which she heads. Friedman, a psychologist, cofounded the center to help support women undergoing fertility treatments, which usually include heavy doses of hormones that can put patients on an emotional roller coaster. Rimon offers free therapy, support groups and a range of complementary techniques such as yoga.

“The women are very nervous, upset and frustrated,” says Friedman. “Some are feeling rushed into making decisions right now. It’s giving them the impression they don’t have more time whereas they thought they did. And it’s such a child-centered society. People find it very hard to find their place here if they don’t have children.”

Some of the women in IVF waiting rooms around the country seek to become single mothers by choice. Kayama, formed two years ago as a support community for the growing numbers of Jewish Israeli women heading into motherhood on their own, says many members are upset by the changes.

“We’re not compensated fairly for our work, but our one small benefit in Israel that if we have problems conceiving, we’ll get help – and now they’re taking even that away,” says Kayama cofounder Dina Pinner. “It’s especially disappointing for our members. They’ve been waiting for their prince. Everyone said, ‘Wait, he’ll arrive, he’ll arrive.’ And then they reach an age where they say, ‘Forget it, I’m running out of time and I want to be a mum.’ But now the health care system says, ‘Oh, sorry about that.’”

Women who are denied further subsidized treatment can go private, but that’s a pricey option. One treatment cycle costs about 14,000 shekels ($4,000). Part of the push to limit IVF cycles is meant to encourage women over 40 with numerous failed attempts to turn to donor eggs. But that’s even more expensive, paid out of pocket and generally using a foreign donor: Few Israeli women are willing to donate their eggs.

“If Israel would really open up egg donation, that would be encouraging,” Pinner says. “It’s very well to say after age 42, you only get three chances, but they have to replace what did exist by offering viable, affordable alternatives.”

The Israeli Fertility Association notes that for women in their mid-40s, IVF is less effective than many people think it is. The Health Ministry, in explaining why it is limiting treatments for women over 42, said that according to the medical literature worldwide, the chances of a successful pregnancy after three consecutive failed IVF treatments are near zero at that age.

Straight to IVF

One promising policy change is that starting from age 39, women trying to conceive can jump directly to IVF. In the past, they had to try a variety of other treatments with much lower success rates, such as intrauterine insemination and months of ovary-stimulating drugs such as Clomid.

“We found data that it’s a waste of time to run the women though this protocol,” says Dr. Arye Hurwitz, the head of the IVF unit at Hadassah Mt. Scopus. “Our research group actually suggested that if these women elect to go straight to IVF, we be allowed to do that. On the other side, many professionals saw a need for some kind of restrictions.”

Thus, the decision to limit women to three subsidized IVF treatments after age 42, after which her insurer decides whether to continue funding additional cycles. Hadassah Medical Center and other public hospitals won’t treat anyone over age 45, because, “between 44 and 45, the take-home baby rate is 0.5 percent,” Hurwitz says.

Health risks

“Sometimes women continue and continue even when there’s a very negligible chance to get pregnant. Sometimes the option should be egg donation or I don’t know what,” Hurwitz says. “You have to put the mirror in front of the couple and say, ‘Look, we did the best we can.’”

Ayellet Weider-Cohen, a clinical psychologist specializing in women’s fertility and a board member of the religious women’s forum Kolech, says some women plunge into fertility treatments without being warned about their emotional toll and potential health risks.

In an interview, she says the Health Ministry should have considered additional measures, such as offering subsidized psychological counseling for women going through the treatments. Most of the women she sees, for example, say their doctors never warned them that the hormones would put them at greater risk for depression.

“We’ve built the world empire of fertility treatments, with almost no concern for cost. For the women, it’s been good for those who want to do everything to get a baby, but sometimes it’s the doctor’s job to be the bad guy and say we’ve tried everything and more, and it’s ridiculous to continue,” Weider-Cohen says.

But she believes the policy changes should have been introduced slowly, with a more comprehensive take on all issues. “To talk about limiting treatments to three times or eight times, is very dramatic for our patients,” says Weider-Cohen, who also counsels at the Rimon Center. “The situation had to be changed, but it should be done much more gradually.”

Open gallery view Babies born in Israel. Credit: Ancho Gosh