Anna, a 42-year-old doctor, has been trying to get pregnant for two and a half years now. In January, she and her partner began fertility treatments.
“We did one IVF treatment that wasn’t successful, and in March we were just about to start a second one,” Anna explains. “The day I was supposed to begin, I got a call from the clinic saying that they were going to have to put my treatment on hold because of the COVID-19 epidemic. I was so disappointed to hear this. We’d already purchased all the syringes full of the medicine with which I was going to inject myself. I was already feeling a bit emotional about the whole ordeal, but this news just threw me over the edge – I felt like I was about to lose my only chance at becoming a mother. I pray every day that this pandemic ends soon. This is my last chance to have kids.”
What has it been like for you these last few months?
“It’s been awful. I really wanted to start this treatment and see positive results. Emotionally, I’m a bit all over the place. My partner is also really disappointed, but it’s not as big of a deal for him, since he has kids from his previous relationship. But I don’t have any kids. He has been super supportive of me, though. Going through IVF is not a simple process. When they told us that the first time wasn’t successful, I felt so hopeless. I was so upset upon hearing this news that I had to leave work right away and I cried the whole way home.”
Although the COVID-19 outbreak has affected every aspect of our lives, not much has been said about IVF treatments, which were halted for the time being by a directive from the Health Ministry for a number of reasons, including overcrowding in hospitals, as well as concern that patients would be exposed to contagion. Although this directive seems reasonable, for women trying to conceive, accepting the news has been fraught with emotion.
“On one hand, we understand the situation and how dangerous this virus is, and that hospitals and medical staff are overwhelmed with the COVID-19 outbreak, while trying to treat all the other sick people, too. That doesn’t make it any easier, however, for women who had prepped themselves physically and psychologically to undergo IVF treatments,” explains Daria Sharvit, 43, a clinical psychologist from Beersheba.
Sharvit is a single mother of an 18-month-old child. A year after her son was born, Sharvit began treatments to have another child. Unfortunately, she experienced three miscarriages, one after another. She’d been planning to start a fourth cycle when the clinic received instructions to shut down.
“I’d already started the first week of daily injections leading up to egg retrieval when I was told to stop,” Sharvit recalls. “I was so disappointed. And I’d shelled out a lot of money for this, too. Even after the discount, it still cost me NIS 900 for each set of injections. It doesn’t help knowing that my biological clock is ticking, and that soon I won’t be eligible for IVF treatments. I can’t just say to myself, it’s no big deal – I’ll just try again next year, since it’s not clear at all when this craziness will end. I can’t just tell my body to freeze my eggs until the corona epidemic ends.”
How have you been coping with the situation?
“I’ve been working really hard on myself to accept the situation as it is, since no one can change the reality. I know I need to accept the fact that I’ll probably only have one child, but it’s not easy. IVF treatments are not an extravagance – it’s not an aesthetic treatment. It’s about bringing another child into this world. I don’t want my son to be an only child, and every day that I need to wait is critical.”
“The Israel Fertility Association (AYALA), chaired by Prof. Adrian Shulman, published a position paper on fertility treatments during the COVID-19 epidemic,” says Dr. Einat Shalom-Paz, the director of the IVF Unit at Hillel Yaffe Medical Center in Hadera. “We sent our recommendation to the health ministry, and on March 22 the Israel Health Ministry published its guidelines that no new fertility treatments should be started. These guidelines were based on recommendations from the European and American associations in light of the spread of the COVID-19 virus.”
What are the dangers of carrying out IVF treatments during the epidemic?
“IVF is not a life-saving treatment. These treatments can lead to complications if the patient contracts COVID-19, such as premature births, deformities and miscarriages. In addition, at the moment we’re doing our utmost to prevent hospitals from overcrowding. On an average day, there are dozens of women who are undergoing IVF sitting and waiting for ultrasounds and blood tests in hospitals. We’re trying to avoid any situations where people need to be concentrated in one area together so as to reduce contagion. For that reason, only women who were already in the late stages of IVF treatments were permitted to continue. The doctor, together with the patient, will decide whether to implant the fertilized eggs into their uterus. I’ve recommended to all my patients that the best way to proceed now is to freeze the eggs and wait until after the virus outbreak ends to move on to implantation.”
What’s it like having to hold these conversations with your patients?
“It’s heartrending. Each and every time that I’ve explained to a patient that the best mode of action is to stop for the time being is excruciatingly difficult. Of course, there are lots of tears, but I must do what’s right and be realistic. Everyone’s life has been disrupted by COVID-19 in one way or another.
“I’ve instructed some of my patients to carry out necessary tests in the meantime, and to take nutritional supplements. We’re all kind of stuck together experiencing this period of helplessness. We all want to help our patients to bring children into the world, but the situation is too risky right now. We are holding online conversations with women who are in the middle or who have not yet started treatments. We are still carrying out all the bureaucratic tasks to help the women along and be ready so that the moment we’re allowed to resume treatments, we can get right to work.”
A similar directive to put IVF treatments on hold came from Israel’s National Council for Women’s Health, Genetics and Neonatology.
“The Council, under the leadership of Prof. Eliezer Shalev, has held two recent Zoom meetings, during which it made the decision to accept the recommendation of the American and European Fertility Associations, to halt all fertility treatments,” proclaims Prof. Shlomo Mashiach, an expert in cutting-edge IVF treatments in Israel. “We advised the Health Ministry of our recommendation, which they then accepted as their policy.
“The developments of the COVID-19 outbreak have hit us like a tsunami. Everywhere we turn, the restrictions in every field are getting stricter and stricter,” continues Mashiach. “IVF treatments require doctors and patients to be in extremely close proximity with each other. Yes, we could wear protective gear as medical professionals do in the COVID-19 sections of the hospital. And yet, medical practitioners will claim that this is not lifesaving work, and therefore they are not willing to take the chance in spreading disease. That’s why we decided to stop IVF treatments for the time being.”
What other factors affected your decision?
“If, for example, a woman who had COVID-19, but hadn’t been diagnosed yet, was given general anesthesia so that her eggs could be harvested, and there were complications, then the entire team – the gynecologist and all the nurses – could become infected. And another important question is, what happens to a pregnant woman’s fetus if she has the virus?
It’s very nice to try to be optimistic and rely on information we have coming out of China, which shows that women who had COVID-19 gave birth to healthy babies, and that the amniotic fluid showed no signs of COVID-19. But this was not a scientific study, just anecdotal evidence of a few individual cases. In the SARS outbreak, for example, there were cases that the disease had indeed affected the pregnancy. So, it makes sense that this might be the case with COVID-19 too.”
How have the patients reacted?
“Currently, the Israeli health system covers the costs for IVF treatments until the age 45 (if you’re using your own eggs) until you’ve had two children. Some additional insurance programs cover costs for a third child, too. For a woman who is 30 now, waiting until the COVID-19 epidemic is over is not a big deal, since she’ll still have a high chance of succeeding. But for women who are over 40, statistically every year their chances are reduced by another 50%.
“If our committee meets again before the epidemic is over, I’ll suggest making an exception for a few cases. For example, we could have one private or public clinic offer treatments to women, so long as everyone is wearing proper protective gear. Another thing we could do is to offer women who are 44-and-a-half the option of extending their rights to IVF past the age of 45 so that we’ll still have time to help them after the epidemic ends.”
Prof Mashiach estimates that about 5,000 women are currently undergoing IVF fertility treatments in Israel. He has found a creative way to help these women through these difficult days. “Last month, I posted a message on Facebook that I’m willing to offer consulting services over the phone for free,” Mashiach explains with a big smile on his face. “I’m doing my best to support all these women and offer them practical suggestions about what they can be doing now while we wait. They really appreciate speaking with a person who’s considered a leading pioneer of IVF treatments in Israel.”
L, a 44-year-old single woman with no kids, started a series of artificial insemination treatments in Israel four years ago. After six failed tries, she began trying IVF. So far, she’s done four IVF treatments.
“I got pregnant the first time around, but unfortunately I miscarried during week eight,” L recalls “and I never got pregnant in the other three. After that, I decided to take a break for a year, partly because the treatments were a significant burden economically. Although the government subsidizes the treatments heavily, there are still so many costs involved, including expensive medication, and if you go to a private gynecologist on top of all this, the bills add up quickly. Just as the COVID-19 epidemic hit, I’d been thinking of trying again. I’m truly devastated, since this was probably my last chance because of my age. Every day I wait is critical. This virus is preventing me from achieving my dream. Not knowing when it will end is so difficult.”
“The feeling of frustration is indescribable,” adds Sagit Salach, 44. a single mother of a toddler. She conceived her son through IVF at Hillel Yaffe Medical Center, and recently returned there so her son could have a brother or sister.
“I had a C-section with my son, so they told me I had to wait a year before trying for a second child,” Salach explains. “I began this round of treatments about six months ago, and had two failed cycles. Each cycle involves injecting yourself with hormones, going for follow-up appointments, egg retrieval, embryo implantation, and then waiting two weeks to see if it worked. I was just about to start my third cycle when everything was shut down because of the COVID-19. I still have three frozen eggs from my second round, so I’d already begun injecting myself with hormones and preparing for the implantation.”
But then you found out that everything was being put on hold?
“Yes. I was so sad when I got the news, but the staff members at the clinic have been so amazing and caring. It’s like reaching the gates of the Promised Land and then being told that you’re not allowed to come in. I totally understand why they had to stop everything, but that doesn’t mean I’m any less disappointed. But because no one knows how long everything will remain shut down, I’m afraid I might lose out on my last chance at having another child.”
Translated by Hannah Hochner.