The total fertility rate in Israel is currently estimated at 2.77 children born per woman, one of the highest rates in the world. Ronit Haimov-Kochman, a gynaecologist at Hadassah Mount Scopus Medical Center in Jerusalem, recently led a team of doctors that successfully performed in vitro fertilization (IVF) on a 16-year-old girl. The patient, AH, had had extensive medical and surgical fertility treatment since the age of 14. Haimov-Kochman tells Ewen Callaway why she helped a teenager get pregnant – and why other Arab teens are likely to follow.

What was your team’s initial reaction when AH asked for treatment for her infertility?

Usually at this age we are approached by teenagers searching for effective contraception.

We had many reservations over infertility treatments of this very young patient. We were fully aware of the obvious cultural gaps between the patient’s world and ours. However there were several moral, social, legal as well as medical aspects to these reservations.


Women who marry and conceive early tend not to complete primary education. We were concerned over the patient’s right to grow up and achieve basic formal education.

Adolescents generally are not authorised to sign informed consent to medical therapies. Infertility therapies may be dangerous to the adolescent’s recent and future health, Moreover, the impact of infertility drugs in adolescence is completely unknown, whereas teenage pregnancies have evidently more risks.

Was there pressure from the patient’s family?

In the conservative Arab society, the fertility of a woman plays a major social role. The bigger the household, the more honoured the woman and the more respected and esteemed the husband and his family. A recently-married adolescent couple is totally dependent on the husband’s family in terms of income and residence, and thus particularly vulnerable to family pressure. Adolescent brides usually quit high school and live with the husband’s family.

So what contributed to your team’s eventual decision to treat AH?

Treatment of AH was based on the couple’s decision to start therapy. Respecting the patient’s mentality and cultural norms, the patient’s right for therapy, and its wide availability in Israel all contributed to our decision to treat the patient.

It is understandable that in a society with an exceedingly high fertility rate, where the major role of the female spouse is to bear and rear children, strong peer and family pressure is imposed on infertile patients – especially the young and less educated ones.

Teenagers are considered as minors by Israeli law, who are legally incapable of making independent decisions. Still, on special occasions, such as in cases of termination of an unwanted pregnancy, adolescent consent is fully respected.

The dilemma of teenage autonomy has grown further when a teenage mother, as a parent and a guardian of her child, is authorised to give informed consent regarding an operation for her child, while she is not allowed to consent to fertility treatments or an appendectomy that she may need.

Legally speaking, laws are set for the rights of patients rather than the physicians. Physicians may not abstain from delivering fertility treatment, whereas a patient’s right to fertility treatment is well established.

Do you expect adolescent IVF to become more common?

We hope that IVF and other fertility treatments will not be prevalent among adolescents, in order to give them their natural right to achieve proper education and maturity before parenthood. But we are aware that in communities where girls tend to marry young and with the development of easily-reached IVF technologies, this phenomenon may expand.

Should there be legal or professional restrictions on treating adolescents for infertility?

The European Society of Human Reproduction and Embryology task force on ethics and law recently issued professional guidelines for physicians focusing on the welfare of the future-child in medically assisted reproduction. The welfare of the mother-child was ignored.

Apart from health reasons that may carry a potential risk for the welfare of the future child, psychosocial factors may be significant as well. However, the immaturity of the teenage mother has not been mentioned.

From our experience, it is obvious that as long as there is no law restricting treatment prior to the age of 18, the majority of teenage patients will elect to go further and receive assisted reproduction technologies, mostly because of the socio-cultural reasons.

What are your personal thoughts?

In the atmosphere of the Israeli multiculturalism, my position as a female physician touches the lives of many women in places where women are still suppressed and unprivileged under norms of religion and tradition. I cannot help but cry out for their inequality and suffering.

Journal reference: Fertility and Sterility, DOI: 10.1016/j.fertnstert.2008.02.172