Advocates for infertility patients say Ontario should follow the lead of Britain, where a powerful health advisory agency recommended on Tuesday that the U.K. extend free fertility treatments to women up until the age of 42 and to same-sex couples.
In Ontario couples struggling with infertility continue to pay for costly treatments and there is no indication that the provincial government is moving toward funding in vitro fertilization (IVF).
“I think it’s fantastic what’s happening in Britain,” says Jan Silverman, a Women’s College Hospital infertility counselor who’s also a member of Conceivable Dreams, a grassroots organization representing infertile couples across Ontario.
“What makes me frustrated is that these models have come up in other areas, such as Quebec and now Britain, and yet we cannot budge the Ontario government right now.
“It is shameful that Ontario has let the needs of the infertile population go unrecognized and undealt with, causing unbelievable expense to people for wanting to have a child.”
The British health system usually pays for up to three cycles of IVF for couples who have been trying to get pregnant for at least three years. Previously, women had to be under the age of 40 to qualify. Many government-funded clinics already treat gay and lesbian couples, but the recommendations now make that explicit, though they are not binding. (The recommendations will likely be followed by many of the U.K.’s medical centres.)
The guidelines are likely to affect only a minority of patients, and it will be up to hospitals to decide whether to pay for IVF treatments. Britain’s health service is being forced to trim $31 billion USD from its budget by 2015 and many hospitals often ration who gets IVF and deny the treatment to eligible patients. One IVF cycle typically costs about $4,730 USD.
Adam Balen, chairman of the British Fertility Society, said the new draft guidelines recognized the importance of treating infertility, citing the psychological harm it can cause. “No one who stands a reasonable chance at conception should be denied the opportunity,” he said in a statement. “These (new) guidelines outline how that can be achieved.”
The draft guidelines issued Tuesday also say the government should pay for IVF in people with diseases such as HIV, or patients facing cancer treatment who want to preserve their fertility. About one in four IVF cycles results in a baby; that drops to about one in 10 for women over 40.
Elsewhere in Europe, many countries including France, Germany, Italy and Switzerland ban gay and lesbian couples from receiving IVF and often impose similar age limits for eligible women, cutting off treatment to women over 40.
In all Canadian provinces, except Quebec, IVF treatment is not covered. According to the Canadian Assisted Reproductive Technologies Registry, in 2008 – the last year for which statistics are available – 9,904 live births in Canada were the result of IVF.
The Royal Commission for New Reproductive Technology found that a quarter of a million couples in Canada are affected by infertility, which is defined an inability to conceive after 12 months.
In Ontario, because treatment is not covered by OHIP, most couples transfer multiple embryos rather than a single embryo. But multiples are 17 times more likely to be born pre-term, to require a caesarean delivery and to need expensive care at birth and throughout their lives, according to Conceivable Dreams.
In 2009, Ontario’s Expert Panel on Infertility and Adoption recommended that the province fund up to three cycles of IVF for women up to age 42, not discriminate against same-sex couples and adopt policies that reduce the number of multiple pregnancies through IVF.
The panel estimated that the savings to the healthcare system through a reduction in the number of multiple births through IVF would be between $400 million and $550 million.
“I understand that it’s a time of fiscal restraint,” says Silverman, who was part of the panel. “However, the arguments we have put forward are about cost-saving methodology not about further spending.”
During the last provincial election, advocates sought a commitment from all three political parties to provide OHIP coverage of IVF and encouraged Ontario to follow the lead of Quebec.
In August 2010, the Quebec government began funding up to three rounds of IVF treatment for couples, on the condition that only one embryo be transferred at a time. The aim is to reduce the number of multiple births, which are riskier than births of singletons.