The Israeli population of approximately eight million citizens consists of about 75 % Jews, 20 % Muslims, and the rest mostly Christians and Druze. The social importance of fertility is of the highest possible level, since many Jewish religious Orthodox families aspire many children, similarly in the case of many Muslim families. Furthermore, many families are interested in male children, in addition to female (in the case of Orthodox Jewish families) and mainly male heirs in the case of Arab families. Furthermore, many young couples apply for medical consultation and assistance long before 1 year of unprotected intercourse without conception, sometimes due to the social impact and “pressure” from family and neighbors. The social impact of “infertility” in the Israeli population is probably much more intense compared to the other developed countries and Western society. Due to these and other reasons, the Israeli health system subsidizes infertility treatment to every Israeli couple up to the first two children, almost at no cost. Even unemployed citizens are eligible for free infertility treatment, up to the successful birth of two children. For citizens who are insured by additional insurance (paid by themselves), they can get subsidized treatment (by 50 % of cost) even for the third and fourth child. Moreover, every infertile woman is eligible until the age of 45, according to the decision and regulations of the Ministry of Health. A couple may have several children from previous marriage(s) and still be eligible for almost free treatment up to the delivery of two children from their current marriage/connection. The indications for IVF/ART/ICSI are compatible with the concurrent accepted indications of ASRM and ESHRE, and the financial cover by the health insurance companies and suppliers depends on the female age. In the young age, failure to achieve a successful pregnancy by at least six cycles of COH using FSH/hMG/hCG with or without intrauterine insemination (IUI), is an indication for IVF. However, in the older age (> 40), it may be after two to three cycles, or even less than that, in cases of severe oligo-terato-asthenozoospermia (OTA), or concurrent incomplete mechanical factor, and/or endometriosis.

In case pregnancy was not achieved despite six successful ET cycles of viable embryos, a committee is to decide whether it is recommended to continue IVF attempts or not. In case no eggs are retrieved, or no available embryos for transfer were generated, the committee is to decide whether it is recommended to continue IVF attempts or not.

Embryo transfer of multiple embryos in IVF program may increase the multifetal pregnancy rate associated with premature delivery and maternal and perinatal morbidity [1].

Most Israeli fertility specialists consider single embryo transfer as a means of minimizing the risk of multiple pregnancy. On the other hand, patients and many physicians are considering the possible risk of significantly decreasing the overall live birth rate.