Quebec is moving to dramatically curtail one of the most generous public-funding plans for fertility treatments in the world after the costs of the program ballooned since its inception four years ago.
Quebec Health Minister Gaétan Barrette tabled a bill on Friday that would end medicare coverage of in vitro fertilization, a treatment that had been free and virtually unlimited in the province since 2010.
Mr. Barrette had previously called the program an "open bar," and made no secret of his desire to scale it back.
Still, his plan drew harsh criticism from the association that represents Canada's fertility doctors, which called the changes a "huge step backward" for the province, which had led the way in treating infertility as a medical issue.
"Quebec was really seen as one of the leaders in North America in terms of recognizing infertility as a medical condition and wanting to offer coverage for that condition," said Neal Mahutte, the president of the Canadian Fertility and Andrology Society. "Quebec really went from being the leader in North America in terms of having the most comprehensive coverage to being really at the back of the line."
If the bill passes as expected, the only fertility treatment that would still be covered for all Quebeckers would be artificial insemination.
The province would also begin to pay for fertility preservation services – including egg freezing – for women about to undergo cancer treatments, and would offer tax rebates based on a family's income for one cycle of IVF for women under the age of 37 and two cycles for women between the ages of 37 and 42, provided neither would-be parent had already had a child.
Women who had their tubes tied and men who had vasectomies would be ineligible for the rebates.
Art Leader, an Ottawa fertility doctor who sat on Ontario's Expert Panel on Infertility and Adoption in 2009, called it good news that Quebec promised to preserve some funding for IVF through the tax rebates, especially since Premier Philippe Couillard and Dr. Barrette, both medical doctors, had previously expressed their opposition to the program.
"You have a province which is in a huge deficit situation," Dr. Leader said. "[The proposal] speaks to the fact that there is still value in funding these treatments."
One aspect of the bill that is expected to be particularly controversial is a ban on in vitro fertilization for all women under the age of 18 and over the age of 42, even if they want to pay for it themselves. The bill would also bar Quebec health-care providers from directing patients to other provinces that do not have such stringent rules.
"If you're 43 years old and you want to pay for treatment or you want to use egg donation which is very successful at age 43, you don't have access to it," Dr. Mahutte said. "Let's say you have embryos that are already frozen or eggs that are already frozen but you happen to now be 43. You have to abandon your own embryos because it's forbidden for you to do treatment after the age of 42? It's preposterous."
When Quebec launched universal coverage for IVF in 2010, the goal was to help couples struggling with infertility and to reduce the number of multiple births by mandating that doctors implant one embryo at a time in most cases.
The hope was that the decrease in multiples – who tend to have more health problems than their singleton counterparts – would save the public health system enough money to largely offset the cost of more IVF cycles.
Multiple births did drop among mothers who conceived through assisted reproduction, from 38.5 per cent in 2009-2010 to 17.2 per cent in 2012-2013, according to a June advisory report from Robert Salois, the province's Health and Welfare Commissioner. But his report found the hoped-for savings did not materialize.
Meanwhile, the cost of funding IVF in the province grew from $16.4-million in 2010-2011 to $80.8-million in 2012-2013, the report found.
Mr. Salois recommended keeping the program, but advised the provincial government to seek ways to reduce costs and increase oversight.
With a report from The Canadian Press