I've been meeting with women who weep for their bodies, via Zoom. Women who weep for the babies that haven't been born. Their doctors weep with them. But nothing can be done. Everyone understands that this is a justified decision.
This isn't a story about good people or bad people. No one is right or wrong. The corona crisis continues to circle over our heads. We are in the midst of a global tragedy that entails many mini-tragedies that are playing out as a butterfly's wings harm a second and third circle. One of these indirect tragedies is the decision to stop fertility treatments.
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More than 5% of babies born in Israel come into the world through medical intervention. Four percent of babies born in Israel are created in labs, through in-vitro fertilization (IVF). The process of bringing these children into the world has ceased.
In Israel and abroad healthcare systems have announced that fertility treatments are now on hold. No new cycles will begin. There are no injections, no implantations, no egg recoveries, and no laboratory fertilizations. The plagues the world has known have caused pregnancies and births to drop off, and then spike after the epidemics passed – but these were natural pregnancies.
The coronavirus crisis is too new for us to have data about how the virus will affect the new pregnancies created through intercourse. When it comes to pregnancies helped along by science, the line is clear: None of the 26 IVF units in Israel are operating.
"At my age, every month matters. Every treatment cycle is critical to my chances of becoming a mother," says Liat (her name has been changed), 43, who works in high-tech.
"The decision to stop the treatments is a death sentence for a woman my age. I've been waiting for a child all my life. It took me a long time to find a partner. I got married late. We've been trying to get pregnant for years. We've done treatments that didn't work. I was supposed to start a new IVF cycle right after Passover… As if it isn't enough that people are being hurt by corona, we have to cause new victims?"
Q: Who informed you that the treatments would be canceled?
"Rumors started in the Facebook groups for women undergoing fertility treatments, and then we saw the official announcement from the Health Ministry. I burst out crying. Anyone who was in the middle of a treatment and had already taken the [hormone] injections was allowed to complete it. But anyone who was between treatments wasn't allowed to come in. Our doctors, who understand the significance of every month that passes, should be fighting for us. This isn't a nose job. For us, it means to be or not to be."
Q: Can you understand the rationale for the decision?
"I understand that they stopped [treatment] out of concern that patients and medical staff might be infected. Or that private hospitals would need to take in corona patients and other patients in an emergency situation. Still, someone should have made a decision that took all the factors into account. This stops our lives. There are women who won't have another chance! For women my age, the road to having a child is painful in and of itself, and takes time. Now we also have the uncertainty about when treatment will resume."
Reut, 34, from Jerusalem, joins the Zoom chat.
"It's a burning issue for women of all ages. There are women who are a decade younger than me and have some early ovarian problems, or genetic issues. It's critical for them, too," she says.
"There is disagreement in the groups for women undergoing fertility treatments. Some understand the decision, and are afraid of getting pregnant right now because they're worried about what the disease could do to the fetus and the rest of their pregnancy. Others are women like me, who say, if women aren't being stopped from getting pregnant naturally, why are we being doomed like this?" Reut adds.
I speak to Shira, 41, who tells me, "I got married six months ago. I was supposed to start treatment a few weeks ago. In our area [the Galilee] there's only one doctor who is considered an expert. It's hard to get an appointment with him, but I managed to get there at the right time in terms of my ovulation, so as to not miss a month. We came to him to start injections and even he didn't believe what he had to tell us, that we couldn't begin treatment. I wasn't prepared for that."
Shira's voice breaks: "At age 41, with every month that passes, we don't know if it's our last chance. They aren't even scheduling appointments to determine a hormone profile so we could at least understand the situation, know if there are eggs that I could use later. It's a feeling of helplessness. We don't see an end. The epidemic might continue for months, and for us, it will be too late. Because of corona, everything else is being sidelined."
Q: What can be done? We can assume that the decision was made to protect you.
"They could make sure the environment is sterile. They keep a careful count of how many people die from corona, but they need to add those who won't be born! The ones hurt from the shockwave who have no way of coming into the world. They postponed elective procedures, but lifesaving procedures are still being done. What about procedures to create life? We need to count the dead around us, and my child who won't be born is another one. The immune system might be weaker during pregnancy, I don't know what they took into account, but I would jump at any pregnancy now," Shira tells me.
Reut, age 30 from Tel Aviv, says, "All we want is something to look forward to. My last implantation worked, but I had a miscarriage. I was so eager to start treatment again. A couple that doesn't need medical help can get pregnant now, and they'll need to be examined at a hospital. So why not us? I compare myself to others, who have it easier. The one thing we're asking is that they promise us that this is the first thing that will be allowed when it's possible."
'The body is cleansing itself'
Not all women are outraged. Hadas, 37, already has a two-and-a-half year-old son who was born after IUI (intrauterine injection). This past year, she tried IUI three more times without success, and received everything necessary to begin IVF – including a treatment plan and prescriptions.
"I was supposed to start treatment two weeks ago. I had an appointment with the nurses to show me how to do the injections but before I went they called me to tell me that no new patients were being accepted. It was the department head who spoke with me. He was empathetic and explained the danger that it entailed coming to the hospital every two days for ultrasounds and blood tests. I'm afraid of catching the coronavirus. I don't want to put myself or my son in danger," she says.
Q: Do you think about this as time you won't get back – that something has been stolen from you?
"No. The road to having a child is a long one anyway. If not this month, then next month. It doesn't matter all that much. I don't understand the women who think this is a terrible tragedy. Right now, medical staff needs to be free for other things. Who am I to waste their time right now, or bring viruses into the hospital? Yes, I want a child. I feel like my little guy at home needs a sibling."
"I wish that these months might bring me a natural pregnancy, that we [all] can make it through this epidemic with lots of new babies. I see the advantages. I was given hormones for six months – now my body is cleansing itself. This is an unusual opinion in the groups for women undergoing treatment, I admit. Most of the couples in the forums are really angry. They promised me at the fertility clinic that as soon as all this is over, the moment they're allowed, I'm on their list to start treatment. It calms you when someone tells you that, when they remember you."
The sense of loneliness grows stronger
I reached out to Dr. Nili Yanai, a senior gynecologist at Hadassah Ein Kerem Medical Center, to try and understand the reasoning behind the healthcare system's decision to stop fertility treatments because of coronavirus.
"As far as we know right now, pregnancy is safe during the corona epidemic. There haven't been reports about harm to fetuses or pregnant women, who are generally young and at low risk. Babies born with coronavirus because pregnant women were infected have gotten over it easily. But that isn't the problem. The problem is the public healthcare system, which doesn't know how burdened it will be. In Italy, they can't even address appendicitis. So all elective surgeries [in Israel] have been canceled. We are holding our resources for an emergency," Yanai explains.
Q: How could fertility treatments at a women's clinic come at the expense of saving lives in the battle against corona?
"The system needs to see the big picture, which is an immediate need to clear out the hospitals for emergency treatment. When an IVF cycle starts, it's a process that takes a few weeks. I have no idea what the availability of operating rooms will be these next few weeks. A woman could be under intensive hormonal treatment and on the day she is supposed to have eggs extracted, the hospital could be overloaded and the extraction might not proceed."
"So it's wrong for the system to start elective procedures that are not life-saving right now. We hope that in three months from now, the picture will be clearer. We had a woman give birth here who was positive for corona. She took a large group of staff workers who were with her out of service. We are protecting the staff and the system," Yanai adds.
Q: How did your patients respond when they heard that treatments were being stopped?
"One of the problems for women undergoing fertility treatment is that they suffer [through it] on their own. It's a very intimate process, they don't talk to friends about it. Every month, they have new anticipation and then [possibly] a failure, and a breakdown. It's very tough to meet with these women now. Most of them accept it with complete understanding."
"I have patients over age 40. These are women who are almost out of time, with the quality of their eggs declining and their chances of getting pregnant vanishing. They feel the urgency of each month. It's emotionally painful. The source of the outcry is understandable. But I have to say that statistically, three months either way won't make a difference. That isn't what will alter their chances of getting pregnant. There are a lot of needs, we're in the midst of a crisis of proportions we never imagined."
"We don't know how stress affects the ability to get pregnant. It's a riddle. If a couple has a definite problem and the woman doesn't have fallopian tubes, for example, they have no chance without laboratory [intervention]. However the couples we call 'unexplained infertility' – they might come out of it well. Look at how many children are born after wars. With all the stress and fear, pregnancies happen. I assume there is a natural need for continuity of life, and there will be a 'baby boom' here."
Professor Simcha Yagel, head of the Obstetrics and Gynecology Division at Hadassah, told me by phone that "Regrettably, we have no choice."
"I'm very sad. But the reasons for the decision are justified. We still aren't sure that corona isn't a danger to pregnancy. We know too little about the virus. We don't know whether it does something in the first trimester. We just don't know. There are diseases that involve fever that cause early-stage miscarriages. When we're talking about a precious pregnancy that occurs from treatment, it must be protected carefully."
"Secondly, these women spend a lot of time at hospitals, clinics, doing various tests, and have a lot of contact with a wide variety of the population. Aside from that, we're optimistic that everything will start again within three months. The decision to stop fertility treatment isn't restricted to Israel. There's a worldwide consensus about it," Yagel says.
Q: What about earmarking one medical facility to handle fertility treatment?
"That's not a bad idea. But during an epidemic and an existential war, I'm not sure that's where I'd put my money. It's not as if there won't be treatments for two years. I listen to my patients' pain. Two-thirds of them say that they think this is the right decision. Remember, for us [fertility] doctors, our life's work is to help couples have children. These patients aren't a nuisance. Pregnancies and births are my life. I feel their pain," he says.
