Nablus (Palestinian Territories) (AFP) – Yasmine is the proud mother of two daughters. But since she couldn’t imagine life without children, this Arab-Israeli travels for hours to circumvent Israel’s IVF rules and choose the sex of her baby in the West Bank.
That day, she was a stressed patient in the waiting room of a private clinic in Nablus, in the northern Israeli-occupied West Bank.
After drug treatment and egg extraction, she must undergo an embryo transfer, a strictly regulated but more lax practice in this Palestinian territory, doctors warn.
Around the young man of 27 years, the walls of the Dima clinic are covered with portraits of babies, offered by grateful patients to the medical team for having made them parents thanks to In Vitro Fertilization (IVF).
The director of the clinic, Amani Marmash, a gynecologist who studied in the United Kingdom, estimates that she averages about 20 consultations a day, half of them with Palestinians from the West Bank.
The other half are, like Yasmine, Israeli Arabs – descendants of Palestinians who remained in Israel with the creation of the Jewish state in 1948 – who go to the West Bank for so-called “selective” IVF.
The overwhelming majority want a son who will be able to perpetuate the family name and provide financial support, in a society where female labor exists but is not yet the norm.
“We came to find a brother for our two daughters”, explains Jacki, Yasmine’s husband.
The couple, who drive hours each time from the suburbs of Jerusalem, demanded the use of fictitious names to testify because the subject of in vitro fertilization remains taboo.
In Israel, IVF is free for women up to 45 years old. But to implant only male embryos, the woman must have already had four daughters.
In the occupied West Bank, “they hardly ask for anything”, says Yasmine, who met the Dima center via social networks.
From 3 to 5 embryos
On its Facebook page, the clinic praises the benefits of selective IVF, highlighting the 99.9% chance of success in sex selection, without specifying that the percentage of positive results from fertilization itself is much higher. weak.
The possibility of getting pregnant is 60 to 65% in the best cases, explains Dr Marmash to AFP.
To “increase the chances of success”, two or three embryos are transferred into the uterus, admits Dr. Salam Atabeh, who works in this clinic, despite international recommendations which establish their number at one or two, at most three, at the women over 40. years.
According to a 2019 United Nations Population Fund (UNFPA) report on private clinics in the West Bank, three to five embryos are transferred in 70% of cases, posing health risks.
Yasmine chose a transfer of three embryos to give herself more chances, after the failure of a first operation.
And if that one also fails, she will do a third one without hesitation, despite the cost that fluctuates between 10,000 and 15,000 shekels (between 2,950 and 4,400 dollars), a fortune for many Palestinians, which encourages them to want maximize the chances of pregnancy.
– “It’s a job” –
Dr. Atabeh leaves it up to the patient to choose the number of embryos but takes care to inform her of all the risks: hyperstimulation of the ovaries, premature delivery and multiple pregnancies, as well as potential risks for the baby.
A gynecologist who did not want to reveal her identity affirms that she receives a dozen patients each month in an Israeli hospital for complications linked to these in vitro fertilizations practiced in the West Bank.
Although rare, the most serious cases of ovarian hyperstimulation can result in hospitalization for breathing difficulties, nausea, or kidney failure.
And after a multiple fetus pregnancy, common when more than two embryos are transferred, some babies can “end up with a lifelong disability”, underlines this doctor, who cites risks of blindness, deafness or brain development problems.
“When women arrive with complications, it is Israel that pays, not the clinics in the West Bank,” he rages, criticizing the lack of transparency of these medical centers in Palestinian territory.
These clinics implant up to five embryos because “they need better results to have more money. It’s a business”, explains Basem Abu Hamad, professor of public health and co-author of the UNFPA report.
In Ramallah, the Palestinian Ministry of Health says it is working to regulate the sector.
Head of the department of gynecology at the ministry, Hadeel Masri evokes a lack of means to guarantee in vitro fertilization in the public sector, which leaves these treatments in private hands.
Currently “we do nothing but expose women to risks just because of a gender issue”, she laments.
© 2022 AFP