Quebec's experience with publicly funded in-vitro fertilization will be held up as a "cautionary tale" this week at a meeting of the American Society for Reproductive Medicine in Baltimore, Md.
Having no age limit on women seeking IVF treatment ended up being both costly and ineffective, Quebec researchers found. The average cost per child born more than doubled from women under age 35 to age 40, from almost $18,000 to more than $43,000. And up it went, precipitously, as women aged.
Starting in August, 2010, the Quebec health-care system began funding IVF for women of any age in the province. It was left to individual clinics to establish cutoffs; some stopped offering the treatment at age 42, while others drew the line at 43 or 44. Last year, citing costs, the province moved to dramatically reduce its coverage.
Dr. Neal Mahutte of the Montreal Fertility Centre, along with colleagues at McGill University, the University of Montreal and other private clinics, used data provided through the Canadian Assisted Reproductive Technologies Registry to determine how much it actually cost to achieve a live birth in women over 40.
The researchers tallied up the costs of stimulating the ovaries, retrieving the eggs, fertilizing them and transferring them into the uterus, and then divided that by how many children actually resulted.
In women under age 35, the average cost per child born was $17,919.
In 40-year-olds, however, that figure leapt to $43,153. And it continued to rise: $62,290 at age 41, $79,100 at age 42 and $103,994 at age 43. The province spent almost $600,000 on IVF in women aged 44, but not a single child was born to a woman in that age group.
Their figures don't include the costs of IVF drugs, pregnancy care or birth.
All of the women in the study used their own eggs.
"If you're looking at this as an investment of public funds, you have to say at a certain point that we can't afford to do this," Mahutte said in advance of the presentation. "Do you stop at 40 or 42 or 43? You do need to stop somewhere."
It is a lesson that the Ontario government seems to be heeding: In its IVF funding announcement earlier this month, Health Minister Eric Hoskins made it clear that Ontario women would become ineligible for funding as of their 43rd birthday.
Ontario has also avoided another of Quebec's pitfalls by changing the way a cycle of IVF is defined. In Ontario, one cycle will mean one harvest of eggs from the ovaries and whatever pregnancies a woman can achieve from that. In Quebec, one cycle meant one transfer – a procedure where embryos are placed into the uterus.
The difference is important, because many older women have trouble producing viable eggs that develop into healthy embryos, so it could take many harvests before there are any embryos to transfer. But because no embryos were transferred, under the Quebec program, those cycles didn't count. Women could, and did, go back again and again, Mahutte said.
Ontario has also only promised to pay for a single round in total, compared to Quebec's offer of three, and has limited total expenditure to $50-million a year, which the government anticipates will help some 4,000 would-be parents.
Unlike Quebec, which funded IVF through its provincial health insurer, Ontario will make direct payments to fertility clinics, according to the office of the health minister.