Yasmine is the proud mother of two daughters. But unable to imagine life without boys, this Israeli Arab woman drove for hours to circumvent Israeli IVF rules and choose the sex of her baby in the West Bank.
On this day, she waits, stressed out, in the waiting room of a private clinic in Nablus, in the north of the occupied West Bank. After drug therapy and an egg retrieval, she will have to undergo an embryo transfer, a practice that is strictly regulated elsewhere but has been abused in this Palestinian territory, doctors warn.
Around the 27-year-old, the walls of the Dima Clinic are covered with portraits of babies donated by patients who are grateful to the medical team for making them parents through in vitro fertilization (IVF).
The clinic’s director, Amani Marmash, a gynecologist who studied in Britain, estimates that she averages about 20 consultations a day, half of them with West Bank Palestinians. The other half, like Yasmine, are Israeli Arabs – descendants of Palestinians who remained on their land when the Jewish state was established in 1948 – who go to the West Bank to perform so-called “selective” IVF.
The overwhelming majority want a boy who can carry on the family name and support them financially in a society where female labor is not yet the norm.
“We are looking for a brother for our two daughters,” explains Jacki, Yasmine’s husband. The couple, who drive hours from the Jerusalem suburbs each time, called for the use of false names to testify because the topic of IVF remains taboo.
In Israel, IVF is free for women up to the age of 45. But to have only male embryos implanted, they must have already had four daughters. In the occupied West Bank, “we hardly ask for anything,” says Yasmine, who knew the Dima center on social media.
Three to five embryos
On its Facebook page, the clinic praises the benefits of selective IVF, highlighting a 99.9% chance of success in sex selection, without stating that the fertilization success rate is much lower. The chance of getting pregnant is at best 60 to 65%, says Dr. Marmash.
To “increase the chances of success,” two to three embryos are transferred into the uterus, admits Dr. Salam Atabeh, who works in this clinic, despite international recommendations that have set their number at one or two or even three for women over 40 years of age.
This is according to a report by the United Nations Population Fund
(UNFPA) of 2019 on private clinics in the West Bank, three to five embryos were transferred in 70% of cases, posing health risks. Yasmine decided to have three embryos transferred to have more chances in her favor after the failure of her first IVF. And if it fails again, a third will do without hesitation, despite the cost varying between 10,000 and 15,000 shekels (from 2,700 to 4,100 euros), a fortune for many Palestinians, encouraging them to maximize the chances of conceiving to want.
dr Atabeh leaves the choice of the number of embryos to patients, but makes sure they are made aware of all the risks: ovarian overstimulation, premature labour, multiple pregnancies, but also possible dangers to the child.
Each month, a gynecologist, who asked for anonymity, claims to be treating a dozen patients at an Israeli hospital for complications related to these IVFs performed in the West Bank.
Although rare, the most severe cases of ovarian hyperstimulation can result in hospitalizations for difficulty breathing, nausea, or kidney failure.
And after a multiple pregnancy, which is common when more than two embryos are transferred, some babies “can face a lifelong disability,” this doctor points out, citing the risk of blindness, deafness or brain developmental disorders. “When women arrive with complications, Israel pays, not the West Bank clinics,” she said, criticizing the lack of transparency among West Bank practitioners.
These clinics implant up to five embryos because they “need better results to have more money, that’s business,” criticizes Bassem Abou Hamad, professor of public health and co-author of the UNFPA report.
In Ramallah, the Palestinian Ministry of Health claims it is working to regulate the sector.
Head of the department of gynecology at the ministry, Hadeel Masri, points to a lack of resources to offer IVF to the public, which is entirely in the hands of the private sector.
Right now, she laments, “we’re only putting women at risk because of a gender issue.”
Claire GOUNON and Delphine MATTHIEUSSENT/AFP
Yasmine is the proud mother of two daughters. But unable to imagine life without boys, this Israeli Arab woman drove for hours to circumvent Israel’s IVF rules and choose her baby’s sex in the West Bank. That day, she waited stressed out in the waiting room of a private clinic in Nablus, in the northern West Bank…