The Quebec government is backing away from draconian proposals that would have forbidden women from seeking in-vitro fertilization beyond age 42 and would have forced couples to have intercourse for up to three years before qualifying for IVF.
But Quebec Health Minister Gaétan Barrette said Tuesday the province will push ahead with plans to drop IVF coverage from the provincial health plan and instead offer a tax credit to eligible families, a move that discriminates against lower-income individuals, according to the head of the Canadian Fertility and Andrology Society.
Mr. Barrette said the changes are based on feedback the government received from experts and members of the public.
"We heard them and we decided to modify the bill," he told a news conference. "They made sound suggestions."
But Neal Mahutte, president of the CFAS, said he believes the government only floated the controversial age cap in November to direct public attention away from the true intent of the new legislation – to dramatically scale back IVF coverage to save money.
"All along we felt, fertility groups really felt the over-42 clause was a lightning rod, maybe a bit of a red herring," Dr. Mahutte said.
In November, Mr. Barrette said that the province would make it illegal for any woman to pursue IVF beyond age 42, and that doctors who referred them to out-of-province clinics would be sanctioned. He also said couples would need to have intercourse for up to three years to qualify for treatment, even if the couple had a condition, such as blocked tubes or a low sperm count, that makes natural conception very difficult.
Now, the province says women over 42 are free to pursue IVF but will have to pay out-of-pocket because the high costs and low success rate don't make it feasible for public coverage. In addition, individuals or couples will be able to qualify for IVF based on standards created by the provincial college of physicians. Those standards have not yet been published.
Under the new legislation, women between ages 18 and 42 who qualify for IVF will be able to receive an income-based tax credit. Those with a family income under $50,000 could receive an 80-per-cent tax credit, while those in higher income brackets could receive as low as 20 per cent.
The problem is families would have to pay thousands in up-front costs – a round of IVF costs around $10,000 – and for many lower-income individuals, finding that kind of money won't be possible. As a result, many families will be priced out of IVF and the system will increasingly favour wealthier individuals, Dr. Mahutte said.
"I think for a lot of Quebec couples with infertility… it's going to mean the difference between them having a good chance of having a child versus not having a great chance of having a child," he said. "I really see it as a big difference maker for a lot of patients."
Arthur Leader, professor of obstetrics and gynecology at the University of Ottawa, said the change will unfairly benefit those who have the means to pay. "The right thing would have been to introduce oversight to the system," said Dr. Leader, who is also co-director of the Ottawa Fertility Centre.
For instance, the province could have reduced the number of cycles that were covered, which would have saved significant sums, or it could have refused funding to clinics with low success rates. A system for licensing and inspecting clinics should also have been created to ensure funds were being spent appropriately, Dr. Leader said.
"What they did is they let basically the system go unchecked," he said.
Toronto fertility lawyer Sara Cohen said she is relieved the government is scrapping plans to "almost criminalize" people seeking IVF beyond a certain age, but that the tax credit system could present some serious problems. "I'm really concerned about some of the equality issues and access issues," she said.
Ms. Cohen and others will now be watching to see what other provinces, such as Ontario, which is preparing to release its plans for IVF coverage, do in light of Quebec's new legislation. One of the biggest challenges is that provinces are writing laws in an area that is constantly changing as a result of medical advancements that are improving the success rates of some forms of assisted reproductive technology for women well into their 40s.
"Things aren't simple," she said. "They're not black and white anymore."