Israel | State Comptroller’s report: lack of specialists, lack of quality control and safety in the field of IVF

State Comptroller Matanyahu Engelman released a special report indicating serious problems in the in vitro fertilization (IVF) system in Israel. With a sharp increase in the number of IVF procedures, the country is faced with insufficient regulation in this area and other problems, which jeopardize the health of patients and the quality of medical services provided.

State Comptroller Engelman: “The State of Israel ranks first in the world in infertility treatment. However, the system is not ready for a significant increase in the volume of in vitro fertilization procedures. During inspections of the Ministry of Health, shortcomings and gaps in the work of IVF departments were identified three years before the famous incident in September 2022 years, as well as the lack of control over the elimination of identified violations. These shortcomings are fundamental failures of the Ministry of Health to ensure that critical errors are not repeated.”

Israel as the world leader in the number of IVF procedures

Israel ranks first in the world in the number of IVF cycles performed annually, reflecting the high availability of these services for citizens. More than 61,000 cycles were performed in the country in 2021 alone, representing a 60% increase over 2011. Despite this achievement, there is a lack of national strategy and necessary measures to ensure the quality and safety of much-needed services. The majority of these procedures (60%) are performed in private clinics, while public institutions perform the remaining 40%.

Safety and quality control issues

The report highlights several incidents that indicate patient safety issues. In one case in 2022, a woman received an embryo that was not her biological child, which led to strong public outcry and raised questions about the reliability of identification and control systems in IVF laboratories. Another case revealed a genetic mismatch between father and child after IVF, also highlighting the dangers associated with a lack of strict standards.

According to the report, the Ministry of Health, responsible for control and quality assurance in the field of IVF, does not take sufficient measures to prevent such errors and does not monitor the correction of identified violations. The report notes that many identified deficiencies remain unresolved even years after they were discovered, and re-inspections are extremely rare.

Critical shortage of specialists and overload of clinics

One of the serious problems is the acute shortage of qualified embryologists involved in fertilization procedures in laboratories. In 2018-2019, the shortage of embryologists reached 45% of the required number, which, according to the state controller, significantly increases the risks for patients and reduces the quality of procedures. The report highlights that such overloads can lead to errors and incidents that threaten the physical and mental health of patients.

Gaps in reporting and oversight

The national database on IVF procedures, created to improve the safety and quality of medical services, turned out to be insufficiently complete and reliable. 14 out of 26 clinics, which account for about 60% of all IVF cycles in Israel, do not transmit data automatically, which leads to reporting irregularities and reduces transparency of what is happening in the system. In some cases, data are completely missing, especially in private institutions, which calls into question the effectiveness of nationwide monitoring and surveillance of IVF.

The State Comptroller also found that Israel does not have strict age and number of IVF procedures to qualify for government support. Unlike most countries, where the age limit for funding is set at 35-43 years, in Israel women have the right to IVF at the expense of the state budget until the age of 45, which creates the risk of undergoing procedures with minimal chances of success. Doctors and specialists emphasize that continuing treatment with a low probability of success can not only undermine the physical and emotional well-being of patients, but also waste significant public funds.

State Comptroller’s Recommendations

The report makes a number of recommendations for the Ministry of Health to improve the IVF system and ensure patient safety. The State Comptroller suggests:

– Complete the development and implementation of standards and norms for all stages of IVF, including laboratories, treatment rooms and operating rooms. These standards will help ensure uniform requirements for the quality and safety of services in both private and public institutions.

– Ensure regular monitoring and repeated inspections in clinics, especially those where violations have previously been identified. It is important to implement a monitoring and reporting system that will allow serious deficiencies to be identified and corrected in a timely manner.

– Introduce mandatory reporting requirements for all incidents in the field of IVF. The State Comptroller notes that between 2017 and 2022, the number of incident reports was critically low. Just after a major incident in 2022, the number of reports increased 10-fold, indicating possible hidden cases that were not previously reported.

– Consider changes to the rules of state support for IVF, taking into account age restrictions and the number of cycles of procedures. These measures could help avoid procedures with minimal chance of success, protect patients from unnecessary physical and emotional costs, and reduce wasteful government spending.

In addition, the Ministry of Health should provide sufficient funding and review existing policies in this area in order to bring the IVF system in line with international standards and create safer conditions for the country’s citizens.