The Ontario government announced Thursday it will become only the second province in Canada to fund in-vitro fertilization [IVF] for people unable to have children otherwise, a move specialists have long urged to help curb the country’s epidemic of risky multiple births. The province will pay for the cost of one “cycle” of IVF treatment per patient suffering from “all forms of infertility,” said Deb Matthews, the Ontario Health Minister. The government will also set up an advisory body to ensure high-quality practices are followed, including ensuring that only one embryo is used per treatment. So-called single-embryo transfer has been shown elsewhere to cut the number of twins, triplets and other multiples that result. Patients paying for the service out of pocket now usually have two or more embryos transferred to increase their chances of pregnancy.
“Supporting the safe use of modern IVF treatment will result in fewer high risk pregnancies – while at the same time helping thousands of Ontarians realize their dream of having their own family,” Ms. Matthews said in a statement. Critics, though, say taxpayers will essentially be tackling a problem created by the for-profit fertility field, which is now holding governments “to ransom” — and call IVF funding a generally questionable allocation of scarce health dollars. The government said the new policy would cover the cost of IVF for 4,000 more people a year – facing both “medical and non-medical” impediments to having children – at an estimated annual cost of about $50 million. Word that Ontario would join Quebec in more widely financing the procedure — which costs in the range of $10,000 — was welcomed heartily by patients and fertility doctors.
“Patients … are absolutely thrilled,” said Gloria Poirier, acting head of the Infertility Awareness Association of Canada. “[To afford IVF] some people are remortgaging their house, some people are not buying their house, some people are getting their inheritance from their parents early. It’s a huge financial burden.” Art Leader, an Ottawa fertility doctor who co-authored an advisory report that urged the Liberals in 2009 to pay for IVF, said he was “delighted” the government is going ahead with the idea. “It’s the smart thing to do, in terms of cost savings and avoiding twins and higher-order multiples,” said Dr. Leader. “And it’s also the right thing to do because these people suffer from an illness.… Infertility is recognized as a disease.” But Amir Attaran, a professor of law and population health at the University of Ottawa who filed a human rights complaint over the lack of IVF funding, said he is skeptical about the announcement, saying the Liberals made a similar promise in 2007 and didn’t deliver on it. The province also received expert advice in 2009 that the most cost-effective approach is to fund three in-vitro cycles per patient, not just one, said Prof. Attaran. The number of multiples born in Canada has soared in the last few decades as IVF and other fertility treatments have become increasingly popular, though the rate dipped slightly in 2012. Multiples have a greater risk of complications at birth and long-term health problems, their treatment assumed by the public health-care system.
When Quebec began funding IVF in 2010 — with the proviso that only one embryo could be transferred per “cycle” — the rate of multiple births from the treatments dropped to 7.9% from 30%, which experts say has saved hundreds of millions of dollars. The program has proven more popular than expected, though, with Quebec spending $60-million a year for about 8,000 treatments. The province began a review of the policy last year, as some doctors questioned whether single mothers, same-sex couples and others with no medical infertility problems should be eligible. Perhaps more fundamentally, fertility specialists ought not hold the medicare system “to ransom” by agreeing to restrict the number of embryos only if the procedure was covered by medicare, said Francoise Baylis, a bioethicist at Dalhousie University and long-time expert on the field.“Doctors should practice good medicine,” said Prof. Baylis. “You should not be creating multiple births, and you can’t turn around and say to the government ‘the only way for me to practice good medicine is for you to fund it.’ ”
It is not the industry or physicians who are resisting single-embryo transfer, however, it is financially stretched patients who want the best chance at pregnancy with each treatment, said Dr. Leader.
