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Mike and Sylvia Braithwaite were told to give up trying to get pregnant when Sylvia was 46 years old. (Ryan Enn Hughes)
Mike and Sylvia Braithwaite were told to give up trying to get pregnant when Sylvia was 46 years old. (Ryan Enn Hughes)

Q&A

Your in-vitro fertilization questions answered Add to ...

Globe and Mail: A question from Angela: Is it true that Ontario still only pays for IVF for those with fallopian tube issues, and what is the thinking of that? Are tubal issues seen as "plumbing problems" and therefore "not anyone's fault"?

Globe and Mail: Answer from Dr. Marjorie Dixon:

Yes, the only scenario in which IVF is currently funded by OHIP is for bilaterally blocked fallopian tubes. And in fact, tubal infertility- or blocked tubes are often linked to previous infections (chlamydia, gonorrhea) or other pelvic conditions which can alter the anatomy (endometriosis, appendicitis, previous gastrointestinal surgery...) within the pelvis. In 1994, IVF was delisted mainly based on, "insufficient evidence existing to establish whether or not IVF was effective for non tubal causes of infertility." Now that it's 2009, there is a plethora of evidence which exists identifying other instances in which IVF should be the current standard of care. We need to move assisted reproduction in this province into the 21st century!

Globe and Mail: A question from a reader: What sort of health risks do women who conceive over 40 commonly face during pregnancy?

Globe and Mail: Answer from Dr. Marjorie Dixon:

The most common complications among older expectant mothers include the following:

- hypertension

- diabetes

- pre-eclampsia (hypertension, protein in the urine, generalized swelling and risk of seizure)

- placenta previa (where a portion of the placenta lies over/ adjacent to the cervical opening)

- babies with aneuploidy (chromosomal abnormalities such as Down's syndrome)

- Caesarean delivery

- stillbirth

Most of these complications can be well managed/minimized with appropriate antenatal care by a qualified healthcare provider.

Globe and Mail: A question from a reader: Is there anything women can do to prolong their fertile years?

Globe and Mail: Answer from Dr. Marjorie Dixon:

Unfortunately, there isn't much that can be done to change a woman's fertility potential. Of course, eating heathfully, adjunctive therapies (accupuncture), not smoking, cutting out alcohol and increasing one's intake of folic acid will set the stage for the best possible pregnancy experience for both mom and baby. But, believe it or not, the optimal time for planning a pregnancy is in the less than 35 year range. And the actual ideal time is written in a woman's genes (blame your parents!)

Women are born with the maximum number of eggs that they will ever possess. This number is continually depleted throughout her lifetime by a process called apoptosis- or programmed cell death. Furthermore, this process accelerates after age 35 (and even further after age 40)! Women cannot and do not regenerate eggs - end of story.

Comment From sandi:

so whats it gonna take us having to go to another province to get the funding taken careof. its sad that couples have to put up with so much stress "BS" behind the scenes, what if its a medical issue why not have it covered right away no questions asked.

Comment From Michele:

With respect to age caps, did the Panel consider having eligibility criteria (FSH level, # failed attempts, AMH) as opposed to have a flat cutoff at age 42 ? I expected a cutoff of 45 or 46 since that is when the odds get pretty close to 0.

Globe and Mail: Answer from Dr. Marjorie Dixon:

Yes, all was considered with regards to age caps, and this was one of the details which we AGONIZED over (among others). We looked to evidence in the literature comparing success rates with IUI vs. IVF, which were found to have similar outcomes after that age, REGARDLESS OF FSH AND AMH. AMH was a good predictor of how well women would stimulate in their 40s, but the outcomes were not improved with IVF. When considering where IVF would be the most beneficial within a publicly funded model, all roads pointed toward this cutoff.

Comment From Erin: In what situations is IVF most likely to be successful? At 27, my husband and I have been given an "unexplained" diagnosis. Doctors seem to think that IVF will work since I'm young but is age really that important of a factor??

Globe and Mail: Answer from Dr. Marjorie Dixon:

Yes, age really does matter with regards to fertility. The good news is that where unexplained infertility is concerned, you are in a "good prognosis group" and 80% of couples will conceive within one year of trying. IVF is indicated in a scenario of unexplained infertility after a failure of the more conservative therapies including cycle monitoring and timed intercourse, ovulation induction, and sperm wash (after 4-5 cycles of the aforementioned--literature shows that it's time to move on).

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