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A doctor at afertility clinic in Italy prepares eggs and sperm for an attempt at artificial insemination. (�� Reuters Photographer / Reuter/REUTERS)
A doctor at afertility clinic in Italy prepares eggs and sperm for an attempt at artificial insemination. (�� Reuters Photographer / Reuter/REUTERS)

Globe editorial

Quebec's foresight on in-vitro fertilization Add to ...

The Quebec government will make medical history on Aug. 5, when it becomes the first jurisdiction in North America to fund fertility treatments for women.

The decision to pay for up to three cycles of in-vitro fertilization brings Quebec into line with countries such as Australia, Israel and Britain, which already fund the procedure.

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It is a welcome move, justified by the savings in costs to the health-care system, and one that other provinces should consider.

More than 350,000 couples in Canada struggle with infertility, a disorder of the reproductive system. Yet assisted procreation has to be paid for out-of-pocket. In the past, governments have argued that IVF is not medically necessary - nobody has the right to have a child.

While this is true, it makes better ethical and financial sense to pay for treatment, and in this way to reduce the risk of premature babies, and of multiple births.

Of course, fertility programs must be carefully managed, lest the costs balloon, and care taken to ensure procreation "tourists" don't migrate to Quebec for free treatment.

IVF, the process in which a woman's eggs are fertilized by sperm outside the womb, costs about $10,000 per cycle. Currently,

infertile women often choose to transfer several embryos at once, increasing the likelihood of multiples.

This results in more miscarriages for the mother, and a greater risk of long-term disability for the baby. Multiples are 17 times more likely to be born pre-term, require a Caesarian section or need expensive care at birth.

Under Quebec's new legislation, doctors will restrict the number of embryos that are implanted, and give priority to women near the end of their childbearing years. The program will cost $32-million in its first year, but save the province up to $30-million on money spent to treat premature babies born as a result of fertility treatments.

Last year, an expert panel in Ontario recommended that the province fund up to three IVF cycles for women under 42 (based on the very low likelihood of women over this age getting pregnant through IVF). The report estimated the province could save $550-million in long-term health care and social services by reducing the multiple birth rate.

Yet the Ontario government has not acted. Experts point out that, while society has changed in the last two generations, biology has not. That means that educated women are delaying having children until they are in their 30s or 40s, to pursue education and establish a career. The proportion of children over 35 giving birth in Canada has more than tripled from 5 per cent in 1982 to about 18 per cent in recent years.

Doctors should counsel women about fertility, which declines after the age of 35, so that IVF is only a last resort.

Funding IVF allows provincial governments to better control the process, to reduce the strain on the health-care system in the long-term, and to offer a medical service to women in a more egalitarian way. Quebec should be applauded for its foresight.

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