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Any government that is planning to introduce public funding for in-vitro fertilization should consider the age eligibility criteria to maximize return on their investment, said Neal Mahutte, medical director of the Montreal Fertility Centre.

Ben Birchall/The Associated Press

The cost to Quebec taxpayers for a single baby born to a woman 40 and older ranges from almost $45,000 to more than $100,000 under the province's publicly funded IVF program, a study has found.

And while no live births were recorded for women at the age of 44, the mean cost of failed in-vitro fertilization among this age group hit almost $600,000.

Those findings, say researchers, represent a cautionary tale for any other jurisdiction considering whether to fund a similar program.

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In 2010, Quebec became the first jurisdiction in North America to cover the costs of IVF for couples unable to conceive on their own. The program funds three cycles of the procedure – stimulating ovulation, egg retrieval and embryo transfer – that results in a live birth.

The actual cost is higher: The program does not reimburse patients for medications needed for IVF, which typically run between $3,000 and $5,000 a cycle and are often paid for by private insurance.

In all, 246 babies were born to women 40 and older during the 2010-12 study period, said lead researcher Neal Mahutte, medical director of the Montreal Fertility Centre.

Researchers found that each live birth achieved through IVF for 40-year-old women, and using their own eggs, cost the government $43,153, a figure that increased exponentially with age, reaching almost $104,000 for 43-year-olds.

In contrast, IVF treatment that resulted in a live newborn for women younger than 35 averaged $17,919, say the researchers, whose study will be presented Monday at the American Society for Reproductive Medicine (ASRM) annual meeting in Baltimore.

Because the Quebec government didn't put an upper age limit on its program, older women whose prognosis for conception even with IVF continues to diminish with each birthday are also eligible for funding.

"So you had an awful lot of patients in Quebec who actually underwent more than three egg retrievals, and particularly in your 42-year-old and older patients, where they have high cycle-cancellation rates, they can have high rates of having a retrieval but no egg, or an egg that doesn't fertilize or nothing to transfer," Dr. Mahutte said.

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"You had patients who would repetitively cycle because they had basically everything to gain and nothing to lose by trying again."

Dr. Mahutte said there's a clear relationship between the live birth rate per IVF cycle start and a woman's age.

"And because the live birth rate per cycle start goes down quite substantially at age 40 and above, funding those cycles comes at a very substantial financial cost to the public," he told a media telebriefing.

"So our conclusion was that any government that's planning to introduce public funding should be aware of this relationship and should at least consider age eligibility criteria in order to maximize return on their investment."

Ontario recently announced it will begin funding one cycle of IVF to achieve egg retrieval and one-at-a-time transfer of all viable embryos to allow for the possibility of multiple chances for pregnancy. Women age 42 and younger are eligible for coverage, which begins in December.

Meanwhile, the Quebec government is poised to overhaul its program under Bill 20, which would remove most IVF coverage from the province's health coverage.

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Bill 20 would cap the eligibility for IVF at age 42. Women older than that would have to pay for the assisted reproduction procedure out of their own pockets.

Under the proposed legislation, women who qualify for IVF would be offered tax credits based on family income. Those with an annual family income of less than $50,000 would receive an 80-per-cent tax credit to cover the cost of treatment, while those with higher earnings could receive a credit as low as 20 per cent.

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