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Yoav Dudkevitch/TPS on 2 August, 2023
Israeli Fertility Clinics Plagued by Lack of Oversight and Staffing Shortages
Jerusalem, 19 November, 2024 (TPS-IL) -- Patient safety, inadequate oversight, and staffing shortages were among the issues raised in a scathing study of Israel’s in vitro fertilization system in a report released by State Comptroller Matanyahu Englman on Tuesday.
The comptroller, also known as the state ombudsman, periodically releases reports auditing Israeli preparedness and the effectiveness of government policies.
Israel offers some of the most generous public funding for IVF in the world. The government subsidizes unlimited IVF treatments for women up to the age of 45, as long as they are trying to have their first two children.
“The public funding policy in Israel is relatively unusual compared to that of the countries examined – both in terms of the maximum age of the woman eligible for funding – her 45th birthday, which is one of the main parameters that affect the chances of success of the treatments, and in terms of the number of treatment cycles to which she is entitled – which in Israel is almost unlimited,” the report said.
Israel, which leads the world in fertility treatments per capita, has seen a 60% increase in IVF cycles over the past decade, reaching 61,000 treatments in 2021. However, the Ministry of Health failed to adequately prepare for this surge, according to Englman’s report.
The report identified a severe shortage of embryologists in Israel. Embryologists collect and assess the quality of the sperm and eggs, fertilize them in a laboratory, then prepare the embryos to be implanted or cryogenically stored. Englman reported that IVF units were operating at 45% below required staffing levels. In 10 of 25 examined units, the staffing shortage exceeded 50%, potentially compromising treatment quality and safety.
A particularly concerning finding was the apparent underreporting of adverse events. In the six years prior to September 2022, only four special events were reported. However, in the following 20 months, 17 incidents were reported – suggesting many previous incidents may have gone unreported.
The investigation also revealed a significant shift in service provision from public to private facilities. As of 2021, 60% of IVF procedures were concentrated in just four private units, while the remaining 40% were distributed across 21 public units. This imbalance has led to overwhelming workloads in private facilities, which the report identifies as a factor in recent errors.
Other critical issues include the lack of updated operational standards, with units still following decade-old guidelines, and problems with data reporting. Approximately 60% of treatment cycles are not properly reported to the national database, hampering the ability to monitor outcomes and develop evidence-based policies.
The report also highlighted the ongoing challenge of stored embryos, with some units maintaining specimens from the 1980s due to the lack of clear protocols for handling unclaimed embryos. “From detailed data provided by seven in vitro fertilization units to the State Comptroller’s office, it appears that the percentage of embryos kept by them for over 20 years was 10% to 25%,” the report noted.
In 2022, Israel was rocked by the news that an embryo was mistakenly implanted in the wrong woman at Rishon Lezion’s Assuta Medical Center.
The mix up was only discovered when doctors detected a heart defect in the fetus during the third trimester. Subsequent testing revealed that neither the woman who was carrying the fetus nor her partner were the biological parents. The biological parents were eventually identified and are seeking custody of Baby Sophie.
Englman called on the Health Ministry to strengthen its supervision and control mechanisms.
