Should the state pay for in vitro fertilization?

Fertility politics: An evidence-free zone?

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If you’ve been watching the health headlines lately, you may have noticed a number of reports calling on provincial governments to fund in vitro fertilization treatments for would-be parents.

This week, a Calgary charity asked the Alberta government to swoop in and cover the cost of IVF since “people in the province are selling their homes, working several jobs and going heavily into debt just to conceive a child.”

Another report this month, by the Infertility Awareness Association of Canada, claimed that the province of British Columbia “could save $78 million healthcare dollars in the first five years alone if it funded single embryo transfer IVF treatments.”

Right now, Quebec is the only province in North America to publicly fund IVF treatments, and these groups suggest others should follow suit in order to save health-care dollars and help would-be parents.

These messages, along with images of cute babies and wrenching stories from expectant moms, have been delivered uncritically by the media. But what about the evidence behind them? Science-ish scratched the surface of these reports and found conflicted interest groups, patchy science, and celebrity advocacy, all peppered by high emotion and moving anecdotes. In other words, a perfect recipe for wild health claims and evidence-free policy.

Let’s start with the conflicts of interest behind the recent headlines. The Calgary outfit calling for IVF coverage in Alberta is called Generations of Hope. The well-meaning charity helps to cover the cost of parents who can’t afford IVF. Among its sponsors are a drug company that makes fertility therapies (EMD Serono Canada) and a fertility website that was created by the drug-maker. Similarly, the group behind the B.C. claim is the Infertility Awareness Association of Canada, which is funded by a range of fertility clinics and pharmaceutical companies.

So the folks who sponsor the groups advocating for state-sponsored IVF are the same ones who would gain financially from such policies. Any realist will not be surprised by this fact. But if these groups are going to push for pan-Canadian policy changes, they’d better have good data to back their arguments—and right now they don’t.

Take the suggestion that other provinces should follow Quebec’s lead in order to save money. This claim is based on the fact that Quebec’s funding is linked to a single embryo transfer policy, which means that when the state pays for an IVF treatment, doctors should only implant a woman with one embryo instead of many. Single embryo transfers reduce the number of multiple births, which are linked to pre-term deliveries, cesarean sections, and higher usage of the neonatal treatments.

The assumption is that when cash-strapped families pay for treatments themselves, they may demand multiple embryos be implanted in fewer cycles to improve their chances of getting pregnant while containing the costs. With government assistance, this pressure would be alleviated—and so would the health-systems costs associated with delivery complications.

Some, like Quebec pediatrician Dr. Annie Janvier, argue that the province’s program reduced the rate of multiple births, and so they extrapolate that that must mean overall savings. In an email, she explained multiple births in Quebec dropped from 30 per cent to five per cent following the IVF coverage. Science-ish traced that figure to unpublished data from a PowerPoint presentation at a fertility conference.

When asked about money part of the equation, she sent back a quick calculation. “About 60 per cent of twins are admitted to the neonatal intensive care unit, often for weeks or months. The NICU costs $5,000 per day, and this is without examining the costs to disabled children, or higher maternal costs for twin pregnancies. One IVF cycle costs $5,000 or less in the public system.” All that sounds great, but again, when pressed for citations or formal analyses, Dr. Janvier could not produce them.

That’s because—despite the big claims about cost savings—there is no such study of the net benefits to the system yet, said Dr. Hananel Holzer, Medical Director of the McGill University Reproductive Centre. “The cost effectiveness studies are not done yet,” he told Science-ish. “We are trying to perform some here now.”

There was actually a report in Le Devoir this week that the program is costing more than anyone anticipated based on government data.

Still, Dr. Holzer said, the Quebec program has done one thing well: increased the rate of single embryo transfers, which are the standard of care, according to professional practice guidelines, and better for women’s bodies, baby’s health, and the health system. “(Funding) was a tool to enforce single embryo transfers,” he said. “You could see the reduction within a few months of the program being introduced.”

But not everyone agrees that such a carrot should be used to get doctors to practice the best medicine. Francoise Baylis, a professor and Canada Research Chair in bioethics and philosophy at Dalhousie University, made the point that doctors should only be performing single embryo transfers regardless of funding mechanisms. “No physician under any circumstances should be practicing bad medicine,” she said, adding that this is an issue the profession should address, independent of whether provinces are attaching dollars to the practice.

Meanwhile, there’s another science-ish lesson here: Quebec’s decision to fund IVF was pushed along by celebrity advocacy. Media darling Julie Snyder had trouble conceiving, but IVF ended those struggles, and she has said, “When I got pregnant, I swore to God that I would help other women.” Her help came in the form of vigorous campaigning—involving other celebrities like Celine Dion, and even a documentary on the subject— for the provincial government to pony up and cover couples in need.

Celebrity advocacy in the absence of evidence does not make strong public policy. If provinces decide, on compassionate grounds, to fund IVF, that’s one thing. But interest groups making claims about cost savings that aren’t true is quite another. Quebec is actually the perfect Petri dish in which to examine the impact of state-funded IVF. We just need some independent study and good data to make a case either way.

Science-ish is a joint project of Maclean’s, the Medical Post and the McMaster Health ForumJulia Belluz is the senior editor at the Medical Post. Got a tip? Message her at julia.belluz@medicalpost.rogers.com or @juliaoftoronto on Twitter.




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Should the state pay for in vitro fertilization?

  1. The problem I have with state-funded IVF treatment is that advocates don’t adequately consider how much this will change the demand for the treatment. The cost of IVF currently limits usage of the treatment, which itself doesn’t have a particularly high success rate (typically <50% clinical pregnancy per cycle.) Making the treatment free is going to cause a spike in demand. This would be a boon for treatment providers, but could easily annihilate any cost savings for government. If governments are going to pursue this policy, it should be a deliberate attempt to address falling birth rates rather than some specious cost savings argument. (My wife has gone through this treatment, and we have had one successful pregnancy as a result. I sympathize with people looking for this treatment, but I'm not convinced it's something we have to subsidize.)

    • Interested to know….how many fertilized embryos were implanted each time you attempted IVF and what was your wife’s age.

      • 2 per on 3 implantations, 1 per on 2 implantations. Successful pregnancy was attempt #2 with 2 embryos. Age was mid-20s, which statistically skews the success rate upwards significantly.

    • You make a good point about the failing birth rates, even if it cost more it can still justified. We have an aging population and not enough people to take care of/replace them. Immegration can only help so much, especially with the higher standards of many Canadian proffesions. Of course this assumes IVF would lead to an increase in birth rate.

      • But government mentality likes this. Tax people more, and the responsible people have less kids as they can’t afford it. Canada’s domestic baby production is indeed negative population growth as it is now under 1.5 per family. And why we have loose as a goose immigration, be married and fertile gets you in quick, even faster if you already have kids.

        But tax us more, we have less. People need to stop looking at the government as a solution for everything. Often the government is the problem.

    • Not enough women are infertile (or have problems conceiving) for IVF to make much of a difference in the birth rates. Low birth rates have more to do with females choosing to postpone, not have kids or drastically reduce the amount of kids that they decide to have.

  2. Having a child is not a right!

    You want something, you pay.

    • Having an abortion is not a right!

      You want something, you pay…Oh wait.

      • Let me explain!

        Abortion is not a right! In fact, the government should not be involved in either abortionn or IVF. I do agree about paying, NGO’s should be funded through donations.

        Furthermore, the vast majority of the rabid anti-abortionists belong to religious organizations who also get a free ride on property taxes. They should pay as well!

        BTW: Governments are broke, they don’t have $15000 to give away so people can copy themselves!

        • I guess you missed the sarcasm John.

        • 1 local municpalities like Edmonton do tax on properties owned by churches and religious group
          2 Any funding should strictly be raised by donation no matching grant from government
          3 people to should be encouraged and educated by fertility peaks about early twenties and drops at increasing rate after 28

    • There has been interesting research revealing that the increase in infertility is perhaps related to people putting off reproducing until they are past the prime age when their bodies are ready to produce kids. In short, we are meant to reproduce in our twenties. Our decision to hold off until we are financial more stable or better educated might be making us unable to have children when we want them. Therefore, if we get the process underway earlier as our parents and grandparents did, we can have them without paying.

      • Maybe if we didn’t let in 450,000 people a year with a 7.5% unemployment rate, private sector employee’s might have more money and security. But alas, high price housing, low wages/cheap lattes and no job secuity are what the boomers want: for others.

    • Agreed. But we live in a society that increasing thinks everyone else should be responsible by not themselves. If you go over to CBC on a other peoples money story you can get censored for asking self pity types to take responsibility for their own lives.

      Far too easy today to force other people to pay for it mentality.

  3. The state pays to mutilate women who want to be men, and men who want to be women, on the grounds that these confused folk are trapped in a physical body opposite to their psychological make up. If that’s a good enough reason to pay for mutilating surgical procedures, why not pay for fertility therapy to satisfy the urge to be parents?

    • My husband and I went through five years of non-IVF treatment due to unexplained infertility (sometimes, medical science simply has no clue). When the last resort was IVF, we gave up because the price of the drugs and treatments was far, far beyond our means. I was never able to conceive, and today, we have no children. (No big deal, right?)

      Our government spends billions on jets we don’t need and assorted other flotsam–one need only read Maclean’s annual “99 stupid things the government spent your money on” feature.

      Immigration is, no doubt, much less expensive than helping Canadians build their families, so that’s a plus. Good thing we have our priorities straight.

    • If the state and religion had their way, they would treat women like breeding cows. Anti-abortion, what to eat….only thing missing so far is having government choose your mate, that is if you get one.

      Me, I am 100% behind womans own choice for herself. As I respect women. But if you want vitro, you pay.

  4. I remember a colleague of mine saying that a very premature child often easily costs the healthcare system 1 million dollars. A woman I know had IVF. 3 infants were born 2 months premature. 2 had serious health problems. One was seriously developmentally delayed. The other required heart surgery at birth. Her IVF procedure cost twenty thousand dollars. You do the math.

  5. Youth Idle No More… Ahhhahhahhhhh. We are the boomer’s children. We are the slaves who are supposed to pay for the benefits that accrue to you to through magical economics. We are the ones who are forced to pay for the imaginary beliefs in fantastical imaginary genders, occupiers of taxpayer spaces, indian reserves full of idleness, ponzi scheme health care… cleverness ran out after typing that little tiny bit of truth. What will not die is reality. We cannot possibly pay for your greed. Your sellout of our country to third world “diverse” immigrants has fail to pay your share as well. We have no jobs, no future, no loyalties, no cares, no desire to save you. economics will fail you. We hope that you lose your life savings in the grossly inflated housing market. enjoy dying alone boomers, selfish pieces of crap that you are. We do not want to indenture ourselves paying for your heart surgery…. neither do those you seek to replace us with. NOBODY in the third world cares about your pathetic sense of entitlement. You will die amongst the third world masses you pretended would care about you on your death beds, your children unemployed and unsympathatic to all the distant unsolvable causes you cared more about than your own legacies.

    Enjoy the decline.

    Have fun ripping apart the 2:30am grammar rather than the true feeling in the post… its easier. Yes, im educated, and Yes, I have a trade, and Yes, I make more than you.

    • John, you really should seek counselling for all of this pent-up resentfulness toward your parents and those who came before you for things that neither you nor they can change at this point. The stress of your hatred could lead to physical illness like the cardiac problems you are predicting for all the boomers, “crap that they are”. Lucky for you, myself and nurses like me will be there to care for you when you do. Take care John.

    • No John, you don’t have an education.

      In fact I’ve rarely seen that much ignorance in one post.

      • Hate to point it out Emily but ignorance and education are not mutually exclusive. I believe Tom Flanagan taught us that last week. Cheers.

  6. Fascinating. Cons want people to have more children so we need fewer immigrants…..but they don’t want to do the very things that will produce results.

    IVF, day care and overseas adoptions.

    Easier to throw a hundred bucks a month at them, and then wonder why that doesn’t do the job of building our population.

    • Emily, it isn’t just “cons”. As the article pointed out….only Quebec pays for IVF. Many of the provinces have had “non-con” governments and yet none have paid for IVF.

      • Keeping costs down is not the same thing as opposing a certain procedure.

  7. This is a tough one. My wife and I are about to have our second child through IVF (this would be our fifth procedure). We live in Ottawa, our first child was conceived in Montreal before the free IVF was implemented. Although free IVF certainly increased the demand on the clinics in Montreal, it is hard to say if it affected the % of positive outcomes. We decided not to risk it, and went to Toronto for our second.

    If you can afford the procedure, it is far better to have a user pay system. It’s hard to say which stresses the health system more, paying for IVF, or increased natal care. In all cases, we insisted on three embryo transfer. Since we were paying, we could insist on a higher number. Luckily, we ended up with singletons, but it could have been a much different outcome.

    I wouldn’t recommend user pay for critical services though. Could you imagine trying to pay for oncology, cardiology or something similar?

  8. There are a few things I really don’t like about this article.

    1. She assumes that funding IVF is not saving money because a formal report is not in from Quebec yet. That is not only very premature, but also ignores the original studies and actual savings found in other countries when they implemented. It is actually very well documented and researched. A pediatrician that she quotes makes sense about the math or neo-natal care. The author says that unless citations are provided you can’t believe this statement. Yet, she provides no citation or research to support her conclusion that it is costing the system money (just quoting some spurious article that also has no research behind it)

    2. Don’t talk to “bioethics” people about issues like this. They are almost exclusively faith-based folks with a moral bias against many forms of medicine. Looking at the literature from the one quoted here, she seems to have a pretty clear bias against any forms of reproductive medicine. I prefer to be guided by science and medicine… and not by philosophy majors. Oh, and she runs her own “bioethics” company so according to the logic of the author cannot be trusted to give neutral information since she benefits financially from opposing this sort of thing.

    3. She is absolutely wrong in suggesting that fertility clinics are funding these efforts in an attempt to line their pockets. In Quebec for example, the fertility doctors are getting paid much less per treatment now that it is funded by government than they were when it was funded by the patients. They are doing more treatments overall, but they have always been very busy and didn’t have the extra capacity to make up that difference in payment… so in effect they end up working more for the same or less money than they did before.

    4. The suggestion that the “bioethics” person suggested that the government simply mandate single embryo transfer in a procedure that they do not fund is nonsense. Firstly, if government attempted to put restrictions on a private, self-funded procedure like that… patients would simply wander across the border to the U.S. where fertility clinics often transfer far more embryos than the 1-2 that are done in a self-regulated Canadian industry. Even worse, people could end up going to places like India where the regulation is almost non-existent and people are truly being exploited. We would end up with GREATER neo-natal costs than we do now. Secondly, I have never heard of one expert in reproductive medicine call transferring two embryos as “bad medicine”. That is someone with a philosophy degree saying that.

    The author certainly uses innuendo and casts aspersions based on zero actual information and verified facts…. yet she demands facts in the article who hold an opposing viewpoint than she does (without apparently talking to anyone really involved… I don’t see quotes from anyone directly in the field)

  9. “Good data to back up their arguments”?
    Who gets to define what constitutes “good data”?
    Data is not actually the issue.
    If parents can’t afford the procedure can they actually afford to be having children in the first place?
    Enough of us are fed up with the exploitation of the term “child poverty” — impoverished children have impoverished parents who have obviously exercised very little foresight.
    Another drain on the healthcare system for something that really doesn’t fall under the heading of healthcare can’t be justified in the eyes of the majority.

  10. I would have to say no. Any non-health medicine like implants, liposuction, fertilization, sex change, hair removal, all procedures for minor appearance sake should not be covered.

    As it is, we have people dying waiting for life critical stuff. Until the huge costs and people suffering and dying form basic cancer or heart issues are solved, this is optional stuff. Our taxpayers wallets are limited resources.

    Sorry whiners, I personally know of a case where a person had to wait to get cacer treated, was sent to a underskilled doctor, a year later properly diagnosted and again had to wait while the cancer grew. Then had to have radical surgery and kemo where if treated earlier would have been a minor surgery.

    That is more important than vitro fertilization and a lot of other stuff being put on the taxpayers wallet.

    And these people have options. Pay for it or adopt a child in need.

    • hey dave

      So how do you like paying for people who have sex changes, cause that is exactly whats happening. Governments are paying for these operations and yet they cant fund for people who have medical issues that are causing them to not be able to have children, if you walked a mile in my shoes and know what it feels like you wouldnt be thinking like that.

  11. If the science is there, the service should be available and free, to at least preserve womans eggs (freeze them) while they are healthy and available. I am 22 years old and no I don’t want a baby until I finish my degree , get married and have a stable income; however I just went one year without my period and I am scared to death that I will stop getting my period and I will completely miss an opportunity that I can’t afford now, but desire so desperately in my future. The gov’t should at least provide free services to preserve eggs; so that people who are trying to earn money for their future and family can save healthy eggs while the opportunity is available.

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