Quebec should be applauded for its decision to fund fertility treatments for women who cannot conceive naturally. Clinical studies show that public funding of in-vitro fertilization can reduce the number of multiple births, saving both lives and money. However, a strict regulatory regime is needed to ensure costs don't balloon and the province can manage the inundation of new patients.
In the last month, fertility clinics in Montreal have received as many as 200 calls a day in anticipation of the new funding regime, which begins today. The wait list for treatment is as long as six months, and Ontario clinics may be called on to treat the overflow of patients.
Quebec is the first jurisdiction in North America to cover IVF, joining Germany, Britain and Australia in funding the procedure. Last year, an expert panel recommended the Ontario government pay for up to three IVF cycles for women under 42, but that province has not implemented the recommendation.
The new Quebec program will cost $32-million in the first year, but also save $30-million on money spent to treat premature babies born as a result of fertility treatments. Currently, many women choose to transfer several embryos at once, increasing the likelihood of multiples. Multiples are 17 times more likely to be born pre-term, to require a Caesarian section or to need expensive care at birth. Under the government's new program, the number of embryos implanted will be restricted, and it will only fund three cycles of IVF.
The Quebec government, however, has introduced no age restriction or other criteria for patients, leaving it up to fertility clinics to screen for eligibility. Age limits for IVF are needed because of the very low likelihood of women getting pregnant past a certain age.
Federal regulations already exist to safeguard the reproductive health of Canadians. However, the Assisted Human Reproduction Act has never been enforced. Health Canada has said that this is because of a 2008 legal appeal by Quebec, which is challenging the constitutionality of the legislation on the grounds that it intrudes upon provincial jurisdiction over health care.
Fertility clinics, therefore, operate on an honour system. They do not offer procedures that violate the Canadian law, such as paying for eggs or sperm, says Dr. Marjorie Dixon, a reproductive endocrinologist. "However, it leaves open the possibility of abuse," she adds.
While publicly-funded IVF is a sound model, the Quebec government risks being overwhelmed by demand. It should establish more detailed guidelines, including age limits, to regulate the myriad ethical and health issues that arise from this form of treatment.