Israel’s Health Ministry last week suspended all new in vitro fertilization (IVF) treatments, as well as some already in process, in light of the ongoing coronavirus pandemic, throwing thousands of hopeful couples into uncertainty, as their dreams of having a child were put on hold indefinitely.
“It was not an easy decision,” the chairman of the Israel Fertility Association, Dr. Adrian Shulman, told The Times of Israel on Sunday.
In vitro fertilization — literally, “in glass” fertilization — typically involves a round of hormone treatments to stimulate a woman’s ovaries’ follicles, in order to produce several mature eggs; a procedure to retrieve those eggs; incubating the eggs with sperm in order to fertilize them (this is the “in glass” part); selecting the embryo, or embryos, with the best chance of a successful pregnancy; and implanting it or them in a woman’s uterus, where the embryo will hopefully implant, and develop into a fetus.
IVF is a difficult process — technically and emotionally — that requires close, regular monitoring and, even when done properly, statistically fails more often than it succeeds. Yet in Israel, which has the highest rate of IVF in the world, roughly five percent of all births come from the procedure, according to Health Ministry data from 2017.
In calling off IVF treatments, Israel was following the path of similar decisions made by the European Society of Human Reproduction and Embryology and the American Society for Reproductive Medicine in recent weeks, Shulman said.
Shayna Kovler, whose IVF cycle was called off just as it was about to begin, said she was driven to begin a cycle of treatment precisely because of the ongoing coronavirus crisis, in which so much is uncertain.
“It was an act of hope, of something to look forward to,” Kovler told The Times of Israel.
A Health Ministry spokesperson said that it had ordered all new cycles of IVF called off, along with any treatment where the size of the ovary follicle was smaller than 15 millimeters. (A woman whose ovary follicle has reached 15 millimeters would be toward the end of the hormone treatment, likely two to three days away from egg retrieval.)
In addition, the implantation of embryos was halted.
The move came amid a series of directives from the Health Ministry to curb non-essential medical procedures and a general effort in Israel to prevent the spread of the virus, which has thus far killed one person and infected roughly another 1,000.
According to Shulman, the ministry wanted to halt all procedures across the board, but he and his colleagues fought to let those already in the midst of treatment to continue.
“We said it wouldn’t be right to stop in the middle,” he said.
However, Kovler said she was aware of a woman undergoing IVF who had been asked to stop her treatment much further along in the process, at the point where an embryo would be implanted in her uterus.
She lauded her doctor, who had told her in advance that her treatment might be called off, but said that other women she knew were surprised by the decision.
“Other were told on Sunday that everything’s fine and then on Wednesday that everything was not,” Kovler said.
Shulman said he and his colleagues at the IFA, along with the Health Ministry, determined that there was a twofold risk in allowing IVF treatments to continue: for patients and staff, there was an increased risk of contracting COVID-19, as the close monitoring often results in cramped waiting rooms where the disease could easily spread; and for the potential babies, there is an unknown danger from the coronavirus, as it is not yet clear what effect, if any, the virus has on fetuses.
Though some steps could be taken to mitigate the risk to the doctors, nurses, and the women undergoing IVF, the careful timing needed to track the women’s ovulation limits the clinics’ ability to fully prevent the gathering of “sometimes 40 to 50 women” in the waiting rooms, Shulman said.
“It would be difficult to spread this out throughout the day,” he said.
Shulman said that the issue of the effects of the coronavirus on fetuses should be cleared up by researchers within the coming weeks and months, aided — he anticipated — by a quarantine-assisted “baby boom.”
“I expect there will be more pregnancies, a baby boom, with everyone at home,” he said.
Shulman said it was decided that the risks were too great and that the procedures must be called off, though he acknowledged that the decision was based on uncertainties and concerns, rather than hard empirical data.
“In a few months, we might say we made a mistake, that it was all nonsense,” he said.
It is not immediately clear when IVF treatments will again be allowed. Shulman said he expected them to resume in late April or early May, but much will depend “on the virus’s behavior.”
Kovler said that she’d heard the estimates that treatments may start up sometime late next month, after the Passover festival. But she was concerned by the ongoing uncertainty surrounding the coronavirus.
“We don’t know how long this will last. Am I supposed to wait 18 months until there’s a vaccine?” she said.
Kovler, 31, who has already been through 10 rounds of fertility treatments, including one of IVF, and underwent open-heart surgery in order to fix an underlying problem that would have prevented her from safely getting pregnant, argued that she and the other women looking to go through IVF treatments were already aware of the multiple risks involved in the process, both to themselves and to their babies, and were willing to go through with it anyway.
“The desire to have a child is a very deep desire,” she said.
Kovler, 31, also noted that for most women, IVF is a last-resort measure, when other fertility treatments have failed and the window of time when they can safely have children is closing.
“[My husband and I] would like to have two kids,” she said. “But I do feel my biological clock ticking.”