Researchers: Yael Benyamini ¹, Ronit Leichtentritt¹, Maayan Abramov ², Einat Shalom-Paz²

Background: Israel's unprecedented extent of fertility treatments and funding for them reflects the high value of parenthood in the Israeli society and leads women to undergo multiple treatment cycles, even when odds of success are poor.

Objectives: To investigate the psychological mechanisms that contribute to Israeli women’s continued use of fertility treatments even after repeated failures.

Method: One hundred women (ages 31-45) undergoing in-vitro-fertilization (IVF) treatment (1-22 previous cycles) were recruited at a medical center and filled in questionnaires assessing their treatment history, estimates of treatment success, information received from physicians, plans for continued treatment, psychological adjustment. Follow-up was conducted on average 17(±4) months later, by phone and medical records. In-depth interviews were conducted with 14 women.

Findings: Most women (57%) stated they will continue treatment as long as needed till they have a child or do not know till when (18%); 25% mentioned a specific plan Women’s estimates of success showed vast unrealistic optimism, which was unrelated to age, previous cycles, or plans for continued treatment. Unrealistic optimism was related to better psychological adjustment. The adjustment was higher among those who planned to continue treatment “as long as needed”. Follow-up data showed that almost all women who did not conceive continued treatments. The qualitative study also confirmed the lack of decision-making regarding continuing treatment and the mechanisms underlying women’s optimism.

Conclusions: Unrealistic optimism helps women maintain hope and psychological well-being along the demanding journey to (biological) parenthood in a country where childlessness is highly stigmatized and contributes to a culture of perseverance in treatment.

Recommendations: 1. Encouraging discourse regarding social parenthood and fully funding oocyte donation;
2. Providing psycho-social support, anchored in mandated positions and protocols;
3. Raising awareness of fertility decrease with age and considering funding for fertility preservation;
4. Use of aggregate country-wide information on treatments.

Research end date: 02/2019