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A year and a half ago, the Ontario government promised to finance one cycle of in-vitro fertilization for those who qualified. Since the spring of 2014, hopeful would-be parents have been waiting for more details. Some of them have added their names to year-long waiting lists, hoping to be first in line at fertility clinics when the public money comes in. Others have found the cash elsewhere, or watched their chance for a biological baby disappear.

Now comes news of a leaked Ontario Health Ministry document that recommends there be almost no restrictions on who is eligible for government-financed IVF. No age restrictions, even though a woman's chances of carrying a healthy baby to term drop drastically at the age of 35. No weight restrictions, even though obesity can cause both infertility and serious perinatal problems.

If this is how the Ontario IVF program proceeds, it will be totally nonsensical and a cowardly ducking of responsibility. Deciding who does, and does not, get government financial help to fulfill this basic human desire is an unenviable job. But it is one that must be done.

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Assisted reproduction is expensive. For those who, for whatever reason, can't get pregnant through heterosexual intercourse (how quaint), the price list at the fertility clinic at Toronto's Mount Sinai Hospital starts with a non-refundable $350 administrative fee. The numbers only get bigger from there. Each cycle of IVF, in which an embryo is implanted in a uterus, costs at least $7,000. There are 7,000 places that every public health dollar could go; they must be spent where they have the greatest chance of improving lives. It's unfortunate, but a fact, that only 13 per cent to 18 per cent of IVF cycles in women 40 and older result in conception – and conception doesn't mean a successful birth.

Unlimited access to government-financed IVF is a waste of money. It's a heartbreak for the women (and their families) whose uteruses cannot be coerced into pregnancy. It's unfair to those who could be helped by reproductive treatment but are languishing on waiting lists. This doesn't mean we can't help people form families, but a focus on producing biological babies for infertile male-female couples concentrates energy and limited finances on individuals while obscuring the larger picture.

One place to save some money would be to stop treating same-sex conception like a heterosexual infertility problem. In Canada, doctors are not allowed to oversee intrauterine insemination – direct deposit of fresh sperm into the uterus – if the donor and mother are not sexual partners. Lesbians must choose between inviting their donor over for a doctor-free turkey-baster party, or pointlessly freezing the sperm and storing it for six months (at Mount Sinai, that costs $500) before unwanted medical tests and then having an overmedicalized conception in a clinic. (One of my friends was told she had to have a full physical before insemination – even though the one getting pregnant was her wife.) Aside from being silly, this is a needlessly expensive process that is often financed by taxpayers.

Sometimes, waiting to address fertility issues until people are in their late-30s or older is an attempt to find a medical solution to a societal issue. Everyone's fecundity declines with age, yet we don't try very hard to help people start families sooner. Rather than writing hormone prescriptions for 38-year-olds, we could try unburdening 29-year-olds from student-loan debts and housing costs. This is partly why child care should be a bigger election issue: The lack of daycare spaces that are both safe and affordable is another reason to delay child-bearing, until a higher salary helps offset the cost.

The concept of technologically assisted reproduction is often met with skepticism, and many would-be parents are advised to "just adopt." But many who would like to do so complain of a disjointed, ineffective system that often forces them to try fertility treatments, while they still have a slim biological chance. Across Canada, 30,000 children are waiting for permanent homes but far too often, their files move from desk to desk until they finally "age out" of the foster care system and, according to the Adoption Council of Canada, into a high chance of homelessness, poverty or mental illness.

While Ontario dithers about its IVF promise, Quebec has decided to drastically dial back its own coverage. Beginning in 2010, Quebec financed up to three IVF cycles for almost any woman who wanted it. The number of procedures more than quadrupled, and costs to the government rose to $67-million in 2014 from $27-million in the first eight months it was offered. Last spring, the province announced new rules: Women between 18 and 42 would get an income-based tax credit after paying the costs of IVF up-front instead. This, too, is imperfect, but the other option was totally unaffordable for the province.

Saying yes to people who want to love and care for a child isn't just about pursuing a pregnancy at any cost. When it comes to unlimited funds for IVF, provinces must find the guts to occasionally say no.

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