Assisted reproduction policies in Israel: a retrospective analysis of in vitro fertilization–embryo transfer

Simonstein, Frida; Mashiach–Eizenberg, Michal; Revel, Ariel; Younis, Johnny S.

doi:10.1016/j.fertnstert.2014.07.740

Cited by 23 publications

(17 citation statements)

References 18 publications

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“…IVF health-related policy is a subject of public and professional debate, in which the question of resource allocation should be thoroughly and openly discussed. As pointed out previously [ 15 ], the existing policy of assisted reproduction in Israel, that is, of unlimited rounds with IVF, should be further questioned and assessed. Possible conclusions of such an assessment may be that IVF treatments should cease before 45 years of age, and/or limiting treatment number for an individual patient.…”

Section: Discussionmentioning

confidence: 99%

In Vitro fertilization (IVF) treatments in Maccabi Healthcare Services 2007-2014

Kol¹,

Yellin

Segal³

et al. 2016

Isr J Health Policy Res

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BackgroundIsrael reports the world’s highest IVF cycles per capita. However, clinical outcome data of these treatments are scarce. In a previous publication, we summarized IVF results among Maccabi Healthcare Services members for the years 2007-2010. The main findings included an increase in mean patients’ age over the period studied, a 50 % increase in cycle numbers during this time, and a decrease in success rate (live birth) from 18.8 % in 2007 to 14.8 % in 2010. The purpose of the current publication is to summarize IVF outcome for the years 2011-2014, and to explore possible changes in the trends we reported previously.MethodsIVF and live births data were collected from Maccabi Healthcare Services’ fertility treatments registry. Analyses were conducted by treatment year and patients’ age at the initiation of treatment cycles. Autologous cycles, were included (ovum donation cycles and frozen-thaw cycles were excluded). A successful cycle was defined if a live birth was recorded within 10 months of its initiation.ResultsIn accordance with previous data for the years 2007-2010, mean patients’ age continued to rise (from 36.2 in 2011 to 37.1 in 2014). In contrast to previous years, during which a continued increase in treatment cycles was recorded, we found that treatment number decreased from a peak of 9,751 in 2011 to 8,623 in 2014. Contrary to that trend, the number of patients over 40 years of age increased from 3,204 in 2011 to 3,648 in 2014. Success rate fluctuated between 14.4 % in 2014 to 16.4 % in 2013. The majority (78 %) of treatment cycles were conducted in four private medical centers.ConclusionsThe decrease in treatment cycles in recent years notwithstanding, Israel is still leading the world with IVF treatments relative to population. Success rate is relatively low compared to international data. Given the steady increase in patients’ mean age, and particularly, the increase in patients over 40 years of age, we maintain that the low success rate reflects a growing number of treatments that a priori have a low chance of success.

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Section: Discussionmentioning

confidence: 99%

In Vitro fertilization (IVF) treatments in Maccabi Healthcare Services 2007-2014

Kol¹,

Yellin

Segal³

et al. 2016

Isr J Health Policy Res

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“…Obviously, patient selection is crucial when studying POR occurrence during ART treatment. Liberal policy of ART employment in POR women, such as in Israel may diverge from its strict use [ 32 ]. These factors should be well evaluated in prospective targeted future studies with appropriate external validation in order to reach clearly defined and reproducible threshold criteria for these biomarkers.…”

Section: Reviewmentioning

confidence: 99%

The Bologna criteria for poor ovarian response: a contemporary critical appraisal

2015

Self Cite

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Postponement of child bearing and maternal age at first pregnancy are on the rise, contributing considerably to an increase in age-related infertility and the demand for assisted reproductive technologies (ART) treatment. This brings to the infertility clinics many women with low ovarian reserve and poor ovarian response (POR) to conventional stimulation. The Bologna criteria were released to standardize the definition of POR and pave the way for the formulation of evidence-based, efficient modalities of treatment for women undergoing IVF-ET. More than four years have passed since the introduction of these criteria and the debate is still ongoing whether a revision is due. Women with POR comprise several sub-groups with diverse baseline distinctiveness, a major issue that has fueled the discussion. Although antral follicle count (AFC) and anti-Müllerian hormone (AMH), are considered good predictors of ovarian reserve, their threshold values are still not universally standardized. Different definitions for sonographic AFC and diverse assays for AMH are held responsible for this delay in standardization. Adding established risk factors to the criteria will lead to more reliable and reproducible definition of a POR, especially in young women. The original criteria did not address the issue of oocyte quality, and the addition of risk factors may yield specific associations with quality vs. quantity. Patient’s age is the best available criterion, although limited, to predict live-birth and presumably oocyte quality. High scale studies to validate these criteria are still missing while recent evidence raises concern regarding over diagnosis.

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“…Statistics from European countries are from the European Society of Human Reproduction and Embryology's (2014) ART Fact Sheet. Israel's IVF birth share is reported by Simonstein et al (2014). 3 Relatively young US patients (under 35 years old) in 2012 achieved a birth after 40 percent of cycles, while patients just under 40 years old had success rates approximately one-half as large.…”

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confidence: 99%

Health Care Access, Costs, and Treatment Dynamics: Evidence from In Vitro Fertilization

Hamilton

Jungheim

McManus

et al. 2018

American Economic Review

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We study public policies designed to improve access and reduce costs for in vitro fertilization (IVF). High out-of-pocket prices can deter potential patients from IVF, while active patients have an incentive to risk costly high-order pregnancies to improve their odds of treatment success. We analyze IVF’s rich choice structure by estimating a dynamic model of patients’ choices within and across treatments. Policy simulations show that insurance mandates for treatment or hard limits on treatment aggressiveness can improve access or costs, but not both. Insurance plus price-based incentives against risky treatment, however, can together improve patient welfare and reduce medical costs. (JEL G22, I11, I13, I18, J13, J16)

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Assisted reproduction policies in Israel: a retrospective analysis of in vitro fertilization–embryo transfer

Cited by 23 publications

References 18 publications

In Vitro fertilization (IVF) treatments in Maccabi Healthcare Services 2007-2014

In Vitro fertilization (IVF) treatments in Maccabi Healthcare Services 2007-2014

The Bologna criteria for poor ovarian response: a contemporary critical appraisal

Health Care Access, Costs, and Treatment Dynamics: Evidence from In Vitro Fertilization

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