Frida Simonstein1. 1. Department of Health Systems Management, Yezreel Valley College, D.N. Emek Yezreel, Israel. j.j.vanhoof@utwente.nl
Abstract
BACKGROUND: The social acceptance of IVF has had the effect of shifting the focus of discussion from the earlier disapproval of IVF to its [un]availability. It has also been suggested that affordable ARTs may stop the falling rates of population turnover in Europe. As many couples cannot afford it, let alone in developing countries, there are ongoing efforts to make IVF 'cheaper' and 'affordable'. OBJECTIVES: This paper reviews IVF policies in several countries before focusing particularly on the exceptional policy of the ARTs in Israel. It analyses the effectiveness of IVF cycles over time as reflected in the literature; examines women's health and welfare after long-term IVF use; and asks whether in a scheme of unlimited free-access to IVF, women would necessarily be better off. METHODS: Review of the literature dealing with IVF outcomes, policies and practices. RESULTS: Long-term effectiveness with IVF is unclear. Age and the number of unsuccessful IVF cycles are predictive of a negative outcome, which is at odds with the Israeli policy of open-ended rounds. Women's health and welfare after long-term IVF remains unclear. In a scheme of unlimited free-access to IVF--in a pro-natalist country--women may end up worse-off. CONCLUSIONS: A systematic long-term assessment of the health and welfare of the women after IVF--especially after prolonged treatment with IVF--is necessary to develop a reliable, effective and evidence-based policy on assisted reproduction not only in Israel, but also in other countries. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.
BACKGROUND: The social acceptance of IVF has had the effect of shifting the focus of discussion from the earlier disapproval of IVF to its [un]availability. It has also been suggested that affordable ARTs may stop the falling rates of population turnover in Europe. As many couples cannot afford it, let alone in developing countries, there are ongoing efforts to make IVF 'cheaper' and 'affordable'. OBJECTIVES: This paper reviews IVF policies in several countries before focusing particularly on the exceptional policy of the ARTs in Israel. It analyses the effectiveness of IVF cycles over time as reflected in the literature; examines women's health and welfare after long-term IVF use; and asks whether in a scheme of unlimited free-access to IVF, women would necessarily be better off. METHODS: Review of the literature dealing with IVF outcomes, policies and practices. RESULTS: Long-term effectiveness with IVF is unclear. Age and the number of unsuccessful IVF cycles are predictive of a negative outcome, which is at odds with the Israeli policy of open-ended rounds. Women's health and welfare after long-term IVF remains unclear. In a scheme of unlimited free-access to IVF--in a pro-natalist country--women may end up worse-off. CONCLUSIONS: A systematic long-term assessment of the health and welfare of the women after IVF--especially after prolonged treatment with IVF--is necessary to develop a reliable, effective and evidence-based policy on assisted reproduction not only in Israel, but also in other countries. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.