Thirty-five years of assisted reproductive technologies in Israel

AbstractIsrael is known as a pronatalist country. Whether due to the Biblical commandment to ‘be fruitful and multiply’ or the traumas of the Holocaust and perennial wars, reproduction is a central life goal for most Israelis. Israeli women bear substantially more children than their counterparts in industrialized countries and view child-rearing as a key life accomplishment. These personal world-view and real-life individual quests take place in a context of equally pronatalist state policies and religious openness to assisted reproductive technologies. In this paper, I outline 35 years of assisted reproductive technologies in Israel by tracing a principal axis in the development of three major technologies of assisted reproduction: the proliferation of IVF-ICSI; the globalization of gamete donation; and the privatization of surrogacy. The paper is based on a policy analysis as well as various studies of assisted reproductive technologies, conducted in Israel over this period

The politics of 'The Natural Family' in Israel: State policy and kinship ideologies

Israel is the only country in the world that provides nearly unlimited, universal state funding for fertility treatments. This exceptional policy has been widely understood as symbolising the state's pronatalism. In this paper I probe the policy and assess medical experts' practice to show how a specific modality of pronatalism--enhancing 'the natural family' concept--is being construed through legislation and practice. Policy analysis discloses how the relatively efficient and safe technology of donor insemination has been devalued as a last resort solution to male infertility, to be applied only after all 'natural' alternatives have failed. At the same time, in vitro fertilisation (IVF), despite its health risks and lower efficacy, is proactively encouraged through various policy measures including unrestricted public funding. Interviews with practitioners reveal that similar preferences are enhanced through the infusion of secrecy and shame into donor insemination, coupled with active support of IVF. To complete the picture, Israel's adoption law is outlined, showing tight restrictions on domestic adoption and complete lack of state support or subsidy for inter-country adoption. I suggest that both the marginalisation of non-genetic forms of kinning and the emphasis on IVF indicate a state interest in upgrading the 'natural family' so as to nurture a geneticised notion of the local Jewish collectivity.Israel Policy Family Kinship Genetics Reproductive technologies Adoption In vitro fertilisation (IVF) Donor insemination (DI)

Physiognomy, familism and consumerism: preferences among Jewish-Israeli recipients of donor insemination

This paper examines the physiological preferences of Jewish-Israeli donor insemination (DI) recipients regarding the desirable donor.1 By comparing recipients' own physiognomy with that of a hypothetical donor, we explore some of the social potentials of DI in its emerging democratized form. We examine prevailing notions regarding the 'natural family' and 'family resemblance' and query the relative weight of the natural vs. the consumer model as applied to one's own family through considerations regarding physical appearance. While examining the 'natural family' concept as a limit in the making of actual Israeli families, we consider the meanings of choice in the context of procreative technologies. The study may also provide practitioners with relevant information for donor matching. The paper is based on questionnaires delivered in four sperm banks during the years 1995-1998. It is important to note that the preferences we study are hypothetical, as in Israel no choice is offered and donor matching is performed exclusively by doctors.2 Three comparisons serve as vehicles for characterizing the gaps between the natural and the consumer model: women's preferences regarding the donor's appearance vs. their male partners' appearance; men's preferences vs. their own features; single women's preferences vs. those of married ones. The paper ends with a discussion of the social implications of democratized DI on family, gender power relations and social hegemony.Donor insemination Israel Choice Physiognomy

Incidence of surrogacy in the USA and Israel and implications on women’s health: a quantitative comparison

Purpose. Gestational surrogacy (GS) has been researched in multiple qualitative studies. In sharp contrast, quantitative aspects of the practice are conspicuously understudied. The present article aims to assess and compare the incidence of GS in the USA and Israel, two industrialized countries that have maintained active, formally regulated surrogacy practice, for over two decades. Method. The article is a secondary analysis of official GS figures published by the USA and Israel. Each dataset is analyzed vis-à-vis the respective country's population, adult population and number of deliveries and infants born, so as to devise local Incidence Scores. These scores are the basis for an inter-country comparison. Results. The incidence of GS is rising in both countries. Though USA surrogates are contracted by both local and international, heterosexual and gay, partnered and single intended parents, the relative incidence of GS is lower in the USA than in Israel, at a ratio of 2:3, even though in Israel only local heterosexual couples and single women may contract a gestational surrogate. Conclusion. GS emerges as reflective of its social surrounding, with the ratios between the countries' GS incidence resembling the ratios between their respective fertility rates. The paper ends with considering two risks facing gestational surrogates: the risk of not conceiving and not being paid, which is the outcome of most GS cycles, and the risk of carrying a multiple pregnancy, which is extremely prevalent in GS pregnancies, and sustaining the short- and long-term health consequences that are likely to accompany it

Incidence of surrogacy in the USA and Israel and implications on women's health: a quantitative comparison.

PURPOSE: Gestational surrogacy (GS) has been researched in multiple qualitative studies. In contrast, quantitative aspects of the practice are conspicuously understudied. The present article assesses and compares the incidence of GS in the USA and Israel, two industrialized countries that have maintained active commercial surrogacy practice, for over two decades. METHOD: The article is a secondary analysis of GS figures published by the Israeli Parliament's Centre for Research and Information (2018) and by the USA's Centers for Disease Control (2016) and related professional publications. Each dataset is analyzed in reference to the respective country, so as to devise local incidence scores that are then juxtaposed in inter-country comparison. RESULTS: The incidence of GS rises steeply in both countries. Though US surrogates are contracted by local and international, heterosexual and gay, and partnered and single intended parents, the relative incidence of GS is lower in the USA than in Israel, where only local heterosexual couples could contract a gestational surrogate. An exceptionally high rate of multiple births was observed in both settings, suggesting some overlooking of professional recommendations for elective single-embryo transfer. CONCLUSION: GS incidence appears to resemble the ratio between the countries' respective fertility rates. The paper underscores two main risks facing gestational surrogates: the risk of not conceiving and not being paid and the risk of carrying a multiple pregnancy, which is extremely prevalent in GS pregnancies, and sustaining the short- and long-term health complications that are more prevalent in such pregnancies

Incidence of surrogacy in the USA and Israel and implications on women's health: a quantitative comparison.

PURPOSE: Gestational surrogacy (GS) has been researched in multiple qualitative studies. In contrast, quantitative aspects of the practice are conspicuously understudied. The present article assesses and compares the incidence of GS in the USA and Israel, two industrialized countries that have maintained active commercial surrogacy practice, for over two decades. METHOD: The article is a secondary analysis of GS figures published by the Israeli Parliament's Centre for Research and Information (2018) and by the USA's Centers for Disease Control (2016) and related professional publications. Each dataset is analyzed in reference to the respective country, so as to devise local incidence scores that are then juxtaposed in inter-country comparison. RESULTS: The incidence of GS rises steeply in both countries. Though US surrogates are contracted by local and international, heterosexual and gay, and partnered and single intended parents, the relative incidence of GS is lower in the USA than in Israel, where only local heterosexual couples could contract a gestational surrogate. An exceptionally high rate of multiple births was observed in both settings, suggesting some overlooking of professional recommendations for elective single-embryo transfer. CONCLUSION: GS incidence appears to resemble the ratio between the countries' respective fertility rates. The paper underscores two main risks facing gestational surrogates: the risk of not conceiving and not being paid and the risk of carrying a multiple pregnancy, which is extremely prevalent in GS pregnancies, and sustaining the short- and long-term health complications that are more prevalent in such pregnancies

The Egg Freezing Trifecta

In 1978, Louise Brown, the world's first “test‐tube baby,” was born in England, allowing her infertile parents to overcome nine years of involuntary childlessness. Forty years later, more than 8 million in vitro fertilization babies had been born, representing at least 4% of all children in Western societies. The most recently conceived assisted reproductive technology is oocyte cryopreservation, more commonly known as egg freezing. From its inception, egg freezing has been hotly contested. Through in‐depth ethnographic interviews carried out with nearly 200 individuals who froze their eggs in either the United States or Israel, the authors demonstrate the existence of an egg freezing trifecta involving three major forms: medical egg freezing for cancer patients facing fertility emergencies; elective egg freezing for single women without stable reproductive partnerships; and transgender egg freezing for transmen wishing to preserve their biogenetic parenthood potential prior to transitioning

Medical egg freezing and cancer patients’ hopes: Fertility preservation at the intersection of life and death

Egg freezing (i.e., oocyte cryopreservation) is a new reproductive technology that allows women's eggs to be frozen and stored for future use. Over the past five years, so-called “medical egg freezing” (MEF) has begun to play a major role as a form of fertility preservation for young women with cancer and other fertility-threatening medical conditions. Indeed, women who are candidates for MEF are often facing the “double jeopardy” of fertility loss and potential death. In this article, we examine the experiences of the first generation of women to use MEF in the United States and Israel, two countries where experimental use of MEF began early, and where MEF is now offered clinically in many in vitro fertilization (IVF) clinics. Through an ethnographic, interview-based study carried out between June 2014 and August 2016 with 45 women (33 American, 12 Israeli) who had completed at least one cycle of MEF, we highlight women's reflections on their egg freezing experiences, and their considerable hopes for future recovery and motherhood. However, MEF is a Janus-faced new “hope technology.” On the one hand, it holds out the promise of life in terms of recovery and future childbearing. As such, women's reflections on MEF reveal hope and gratitude for the technology's existence. However, as with IVF itself, future motherhood can never be guaranteed. This is especially true for women facing death from advanced or aggressive forms of cancers. Three ethnographic case studies of cancer patients, two from the US and one from Israel, highlight how MEF offers hope for life among women confronted with a deadly disease. •First ethnographic study of women who have undertaken medical egg freezing (MEF).•Reveals women's hopes for survival and future childbearing through MEF.•Points to the “double jeopardy” of fertility loss and death facing cancer patients.•Examines the experiences of women with advanced and aggressive cancers.•Provides ethnographic cases from two countries (United States and Israel)