IVF in Israel: Populations, Politics and Options for Women?

This story was in the NYT a couple of days ago.   It’s not exactly news—there’s no specific event that is being reported.  But it does give me something to think about:  As the article puts it, Israel is the world capital of in vitro fertilization (IVF).

It’s not so much that Israel is a destination for reproductive tourism.   It’s that Israel provides unlimited free access to IVF for any woman under the age of 45, until she has two children to take home.   Given that in many places IVF isn’t even covered by private insurance, that’s pretty remarkable.   And the policy applies across the board–single or married, lesbian or straight, Jewish or Arab.  (It is hard to say which of these is the most surprising given the politics of the region, but in general the across the board access is consistent with a commitment to fairness and non-discrimination.)

Here’s a quote that helps but things in a global perspective:

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.

This means IVF is nearly 15 times more common in Israel than in the US.   That’s rather startling.

It’s also rather expensive, although the precise costs seem to be a bit vague.  So you have to ask what explains the willingness to devote so many resources to IVF?

The article offers several possible answers–the felt need to replenish the Jewish population after the Holocaust, the demographic realities of holding on to control in a democracy, an acceptance of technology, recognition of the human desire for children and (as perhaps is always the case) the financial interests of the fertility industry.  (Just because it is free to the women using it doesn’t mean the centers aren’t getting paid.)   Surely it is a combination of these factors as well as others.

There are some interesting collateral benefits from this policy.   The doctors doing IVF have a much wider range of experience and therefore arguably greater expertise.   This could make Israel a profitable fertility tourism destination.   And because there are unlimited IVF attempts there’s less to transfer many embryos at once in the hope that at least one will take.   In other words, patience is easier (though never easy, I’m sure) and that means fewer multiple pregnancies.

But it isn’t all perfect and wonderful.  Most obviously, it is expensive and there are limited resources, so who can say what isn’t being funded.   And then there is this observation:

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.

IVF has costs for women.  And easy access to IVF makes choosing not to have children–or choosing not to use IVF to have children–a more difficult option to choose.

This is quite striking.   It’s fine to recognize that there are many women who very much want children.   But there are also women who do not want to have children and, from my point of view, this too should be a respectable option.    It’s bound to be a bit harder to make choice given the circumstances described here.  It isn’t just that IVF is free, really, though. It’s that the same forces that drive the state to make IVF available as it does will also pressure women into having children by making the choice not to have children that much harder.

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