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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 ...

The number of women in Canada having children in their 40s has tripled in the past 30 years, The Globe's Jennifer MacMillan writes in Tuesday's paper. Many have turned to in-vitro fertilization to facilitate the process using their own eggs, but the practice has a low success rate since the quality of women's ova deteriorates quickly after the age of 35.

More Related to this Story

Through donor eggs, rare cases of women giving birth well into their 50s and even 60s have made headlines, sparking debate over just how old is too old to be a mother. Last month an expert panel recommended that Ontario's health-care plan cover the cost of IVF for anyone unable to conceive on their own, including same-sex couples and people who want to be single parents. But not for women over 42.

The panel members say it's a cost-benefit decision based on the very low chances of a woman over 42 getting pregnant through IVF, not a judgment on the ideal age for parenting. Indeed, if the recommendations are implemented by the Ontario government - they're currently under review - women over 42 will still be able to get fertility treatments provided they pay for them.

Still, the controversy remains: Should there be a cut-off age for such procedures? Sylvia and Mike Braithwaite, an Ontario couple who went into debt to attempt in-vitro fertilization outside Canada, took your questions about the challenges of conceiving over 40. Fertility specialists Dr. Arthur Leader and Dr. Marjorie Dixon joined the coversation to talk about their roles on Ontario's expert panel on infertility and adoption.

What follows is a transcript of the discussion. Use the Cover It Live player below to replay the event as it happened.

Dr. Art Leader: Thanks for joining our online discussion on in-vitro fertilization. We'll get underway with some reader questions answered by Art Leader, a fertility specialist based in Ottawa and a member of Ontario's expert panel on infertility and adoption.

Dr. Art Leader: A question from Susan: I'd like to know about the long-range health implications for multiple trials of IVF? How do the drugs and hormones that are used impact a woman's health?

Dr. Art Leader: Egg retrieval has no long-term adverse effects on a woman's health. In countries like France and Israel where multiple cycles of IVF are funded menopause does not come earlier in women who have IVF multiple times (compared to those who have never had IVF. The fertility drugs used for IVF have been associated with long-term health risks: clomiphene citrate tablets used more than 12 times in a lifetime is associated with an increased ovarian cancer risk; injectable gonadotropin use is associated with a slightly increased risk of breast cancer, but no increased risk of uterine or ovarian cancer.

If too much of the drug is used to hyperstimulate a woman's ovaries during an IVF treatment, there is a risk of ovarian hyperstimulation syndrome, cyst formation or ovarian twisting or torsion.

Dr. Art Leader: Question from reader: How much of your practice involves treating men with fertility issues vs. women with fertility issues? Do you think there is less awareness among men about their declining fertility as they age?

Dr. Art Leader: Probably 50% of the time, the cause of infertility can be traced to a male factor. About 60% of all IVF done in Ontario is for male factor infertility. The general public is less aware that not only does men fertility decline with age >40 but also that paternal age >40 increases the risk of miscarriage, still birth rates and fetal abnormalities. Myths are continued by older men who father children with younger women.

Dr. Art Leader: When the panel was drafting these recommendations, did they consider how age caps are applied to other publicly funded medical procedures? What sort of precedence exists for age caps?

Comment From Guest: Were Sylvia and Mike successful?

Globe and Mail: From Sylvia: Although we were not able to have a child biologically together, we are close to finishing the adoption process and hope to have our child soon.

Globe and Mail: A question from John-David: My question is in regards to male infertility. In my case I have a blocked vas deferens on the right side and no vas on the right. It is my understanding that women in Ontario with blocked fallopian tubes are currently covered for IVF. Why the difference between male and female? Is it not the same condition? Also, do you think that this is a discriminatory practice and should be taken up with the Ontario Human Rights Commission?

Globe and Mail: Answer from Dr. Marjorie Dixon, fertility specialist and member of the expert panel on infertility and adoption:

This is an excellent question for which I have no logical answer. A blocked vas deferens is not exactly the same as blocked fallopian tubes, but in principle, it is similar. Often, the blockage occurs as a result of infection with STI's such as gonorrhea or chlamydia. Alternately, the blockage or absence is due to prior surgeries, trauma or simply a congenital issue (noted from birth). Nevertheless, it is currently not covered by OHIP. In our research for the recommendations of the panel regarding male infertility, it became clear that there is room for improvement in all aspects of this coverage. It should also be noted that though IVF was previously delisted (in 1994) for a host of female infertility indications, it was never their practice to cover male fertility. Whether this sets the stage for the Human Rights Commission is not for me to answer.

Comment From Michel: Hello, this is probably off-topic a bit...I am a quadriplegic, and my wife and I had a child who is now a terrific 12 year old girl. We have not yet told her that she was conceived with donor sperm, partly because we felt she should be mature enough to work out some of these implications with us, and partly out of fear of her reaction to this important issue in her life...any thoughts?

Comment From Chris: To Michel re: donor sperm... The information about her conception belongs to her, you and your wife are merely the guardians of it until she knows. We told our son when he was 3 so he will always know. Our friends told their boys at age 13, with sensitivity and openness. They are fine. Most important is that you DO tell her, and that you remain open to communicating about it on her terms.

Globe and Mail: A question from a reader: Dr. Leader, could you explain a bit more about the panel's stance on legalizing the sale of donor eggs in Canada?

Globe and Mail: Dr. Art Leader: The panel is not asking that the sale of eggs be legalized. It is recommending that compensation be broadened from just receipt able expenses to such reasonable costs as time lost from work, travel time and child care expenses.

Globe and Mail: One of our commenters noted: "If the province is going to pay for in vitro, then I think that it should also pay for birth control. Fair is fair." Dr. Leader, what's your take on that?

Globe and Mail: Dr. Art Leader: The panel recommended that procedures, not drugs be paid for by OHIP. For anyone who cannot afford medications, there is a drug benefit program in operation and we recommended its expansion or a tax credit to cover IVF-related drugs.

Comment From Lynn: In response to Michel's comment: When we went through the process of possibly needing donor sperm the counselor suggested to us that it would be best for them to grow up knowing, it would be normal to them that way, instead of a big shock when they are older

Comment From sandi: how long before we find out if they will pass the ivf bill and when will we know if it will be covered or not?

Globe and Mail: From Jennifer MacMillan: Hi Sandi, thanks for your question. Both Premier Dalton McGuinty and Minister of Child and Youth Services Deb Matthews have confirmed the report is currently under review by the Ontario government. The recommendations are just that at this point, and no timeline has yet been attached for approving/implementing them.

Comment From Tess B.: Isn't this recommendation only for the province of Ontario? In Calgary, where my husband an I went to have our IVF/ICSI done, the fertility clinic has created a not for profit organization aimed to help less fortunate couples to have their own. As far as I know, application are screened and there are criteria before they get accepted. And as far as whether my twin sons' awareness how they come to life, we will deal with it later when they are big enough to understand. Right now, their focus is the joy being in a kindergarten class.

Globe and Mail: From Jennifer MacMillan: Yes, you're right Tess. This report applies only to the province of Ontario. Quebec is the only other province that has taken big steps forward in funding IVF. Their National Assembly passed Bill 26, which provides funding for up to three rounds of IVF, in late June.

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).

Globe and Mail: Here's an update from Sylvia and Mike Braithwaite on their continuing efforts to build a family:

Our experience has been a good one although the wait is a long one, we can appreciate how hard working everyone at Children's Aid Society has been. We started the process on Sept 11, 2008 by attending an orientation where they gave us details on the process and a package to fill out and return if we wanted to continue. The package contained information on health, financial and personal details on what we were looking for in terms of a child (age, gender, race, background). One of the toughest parts is outlining what you can and cannot commit to. Once the package was in, November 2008, we waited to hear back and did in Feb 2009. Early March 2009 a CAS Worker visited our home and met with my husband and I to go over the information we handed in, we then were put into a 9-week adoption course in April 2009. The course was excellent in opening our eyes on how best help and understand children who would be adopted.

Now since the course ended in late May 2009, we have been waiting for what we understand is a home study where they will visit our home twice and get to know us as people and parents. Once that takes place, they start a matching process in which they try to match the needs of the child and the adoptive parents.

Globe and Mail: Mike and Sylvia, do you have any advice for other couples that might be considering adoption?

Question yourselves as adoptive parents/parent as to what type of child you are looking for and what you can and cannot commit to.

Although adopting a baby through CAS is not impossible, babies come up for adoption infrequently. Adoptive parents need to be patient with the process and understand that Children's Aid Society workers are looking out for the children first and foremost as it should be. We have nothing but positive things to say about the staff at CAS.

Couples need to realize that here in Canada we have a lot of children who need homes and you don't have to pay as you would with adopting children internationally.

Globe and Mail: We'll be ending our liveblog discussion soon, but we've had a huge response and a lot of great questions. Unfortunately we won't be able to answer all of them today - apologies to those we didn't get to.

Comment From snorman: Without using IVF our family would never have experienced the joys we have

Comment From Tess B.: Just out of curiosity, is there any other country/countries that cover the cost of IVF?

Globe and Mail: From Jennifer MacMillan: Hi Tess, thanks for your question. Many other countries, including several Scandinavian and Western European countries, publicly fund IVF to a certain degree. Israel and Australia do too, but each country has their own take. For instance, in Australia, the government funds only half the cost but imposes no age limit or restriction on how many cycles of IVF a person can try. Australia has been funding IVF since 1990.

Comment From Guest: I am happy to have a health 2 month old daughter, thanks to IVF!

Comment From snorman: unfortunately, this joy cost a lot financially. Though I understand public funding restrictions, when you think of the benefits to society (economy) of having children in solid and loving homes, isn't it all ultimately worth it?

Comment From Joan: Do you think there's any future for anonymous egg donation in Canada? At present it is not allowed under the Reproductive Technologies legislation, but donor eggs through a clinic in the US worked for us. We are very grateful to be expecting twins in January.

Globe and Mail: Answer from Dr. Marjorie Dixon:

Congratulations! I am hopeful that Quebec's Supreme Court challenge will bring these issues to the forefront and help to educate the public on the restrictive nature of the prohibited actions.

In the report, we made a clear statement explaining the definitive deficiences of the act, and that this restrictive legislation will only serve to further push Ontarians to the brink in their efforts to start a family (both emotionally and financially).

Only time will tell what the outcome will be---but I'm an eternal optimist! In the meantime, we will manage the best that we can with altruistic known donors ...

Globe and Mail: From Jennifer MacMillan: Unfortunately we've run out of time for today. Apologies again we weren't able to get to all of the questions. The interest has been overwhelming. Thanks very much to everyone who participated today and shared their stories.



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