My jaw dropped open in surprised delight when I heard yesterday that the province of Ontario is considering funding up to three attempts of in vitro fertilization (IVF) through OHIP. Hello (Ontario Premier) Dalton McGuinty? Between this and the all-day kindergarten thing, I think I love you.
I haven’t had time to read through the entire report yet, but I will and I’ll write an informed summary and analysis when I do. (Um, I still owe you that second post on the Senate Child Care report too, don’t I? It’s on my list, I swear!)
Anyway, here’s what I think of the recommendation at first glance: yippee!!!, with a healthy side of “It’s about farking time!” As most of you know, my first son Tristan was conceived through IVF in 2001, so I admit to a strong bias on this. But you know what? Given the horrible amount of misinformation and misconceptions (snicker) that swirl around the issues of reproductive technologies, people who have been there and done that truly are in a better position to evaluate the proposals.
I find it rather ironic, in fact, that (assuming the recommendations are implemented) our reproductive years will have fallen smack dab in the middle of the decade and a half during which IVF was not funded through medicare. Up until 1994, IVF was funded in Ontario, and continued to be funded for women with two blocked fallopian tubes. I’m quite happy with how things turned out for us, though, and wouldn’t change a thing — but I sure would love to know that other families don’t have to abandon their dreams of having a family simply because they can’t afford to spend tens of thousands of dollars on fertility treatments.
Here’s why I think IVF should be funded not just in Ontario, but in all provinces and territories.
As the media has noted, one of the driving forces behind the recommendation to fund IVF is the idea of reducing multiple births. Multiple births are expensive on the health care system — there are higher incidences of premature births, c-sections, and intensive neo-natal care. One of the conditions of public funding would be that Ontario’s 14 fertility clinics would have to agree to stricter controls on the number of multiple births, which they would do by making more stringent the rules about the number of embryos that are transfered during an IVF cycle.
(I’m a bit removed from the latest clinic culture these days, but in 2001 when I was 32 years old, they would not allow me to transfer all three of our surviving embryos. We were allowed to transfer two and elected to have the third one frozen. So the clinics haven’t exactly been irresponsible to this point in time anyway. I’ve always been a little bit shocked to hear stories of clinics – largely in the US – that would allow the transfer of up to five or more embryos for a woman undergoing her first cycle, who is young and otherwise healthy.)
The idea, then, is that the amount that would be spent to fund up to three attempts of IVF would be offset by the reducing the costs to the system that result from currently high percentages of multiple births. What’s not mentioned, IMHO, is the value to the system of us creating all these little future taxpayers. Aren’t we all wringing our hands about declining fertility rates?
One other argument that I don’t see in the current media coverage is this: currently, Ontario does provide funding for other fertility treatments like Clomid and intrauterine insemination (IUI). I’ve never used Clomid (a drug that essentially causes you to ovulate more than one egg, thus increasing both your chances of conception and your chances of multiple births) but we did try two cycles of IUIs with superovulation, meaning they used drugs to torque my reproductive system into producing multiple eggs, took a sample of Beloved’s junk and ran it through a gyroscope-thingee (really!) to filter out all the poor swimmers, and had the surviving sperm squirted into my uterus.
The difference between IUI and IVF, then, is a much higher rate of control of the number of conceptions that occur. With (currently funded) IUI, multiple rates are much higher and completely out of the clinic’s control — millions of frisky sperm seek out up to half a dozen fertile eggs. With IVF, the conception occurs in the labratory instead of the uterus, and the doctors place one or two embryos into the uterus, hoping they will implant and grow. It’s the difference between using a calligraphy pen or a bucket of paint to dot your i, if I can make up an analogy.
As an aside, as many of you know, though Tristan was conceived through IVF, Simon and Lucas (and the babies we lost in 2000 and 2006) were conceived naturally. Beloved had an OHIP-funded surgery on his bits in 2001, while I was pregnant with Tristan, because he was in considerable discomfort. (You have to be in a lot of discomfort, I think, to have elective surgery down there — spoken as someone who will never know!) As a consequence, his fertility improved dramatically and obviously. So we might have been able to avoid the whole cost of the infertility treatments had the fertility doctors recommended this OHIP-funded surgery before the IVF.
You know what I would even consider as a reasonable compromise, for those of you who feel that taxpayer dollars should not be funding fertility treatments? Fund unsuccessful treatment cycles. Including two IUIs, a cycle of IVF with ICSI, four years of frozen embryo storage, and the costs to thaw and transfer Frostie, we easily spent $10,000 or $12,000 to overcome our infertility. I think you’ll agree that my darling Tristan is worth every penny times a thousand. We’re lucky that we never had to face the unimaginable agony of an unsuccessful round of IVF treatments compounded by the idea of spending all that money for naught — just try to imagine spending everything you have, financially and emotionally, and coming away empty-handed.
At the very least, this proposal levels the playing field just a little bit for people facing infertility. This editorial, written by a couple who have filed a discrimination complaint at the Human Rights Tribunal of Ontario, outlines some of the ways in which the current system of funding for reproductive technologies in Ontario are discriminatory. Two blocked fallopian tubes? You get three funded IVF attempts. Testicles fried from the radiation to treat Hodgkins disease? You’re out of luck. PCOS? So sorry. Low ovarian reserve? Too bad. Poor sperm motility or mobility or count? Yer on yer own, buddy.
Anyway, I’m all over the place here. As you can see, even after all this time I still react passionately to stories about infertility and reproductive technologies. (Hal, if you’re reading, now you know why infertility is one of the metatags on my blog!) I am beyond delighted to see that Ontario is considering funding up to three cycles of IVF for eligible families, and applaud the province of Quebec for its forward-thinking policies in this area. Once I read the report, I’ll come back with another post and try for a more detached tone. (Anybody want to take bets on how long I’m able to maintain that illusion of detachment?)
What do you think? (And yes, I’m open to dissenting opinions, so long as they are expressed with respect. And you realize that there’s nothing you can say that might change my opinion on this one!)
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