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Quebec’s IVF restrictions: Economics or ethics?

Dec. 05 2014

Last week, Quebec Health Minister Gaétan Barrette tabled a bill that, if passed, will prohibit women over the age of 42 from having access to in vitro fertilization (IVF). While the purpose of the bill, on the surface at least, is to lessen financial strain on the health care system, this particular section of the bill will achieve a different outcome; it will reduce the number of births to Quebec women who rely on the use of donated eggs to conceive.

Quebec started providing medicare for assistive reproductive technologies (ART) in 2010 in the hope of achieving three objectives: reduce health care costs resulting from multiple births; enable infertile couples to have children; and increase the number of births in the province by between 1,000 and 1,500 per year.

Despite claims that the program has been widely abused, the number of births to Quebec woman has only fallen since IVF funding has been made available. This is in part because the increase in artificially conceived births has been well short of that predicted by the government: fewer than 700 more babies were conceived this way last year compared to the year the program was insured, and in part because the decrease in naturally conceived births has far outweighed the increase in births through assistive technology; there were 906 fewer babies born last year as a result of natural conception compared to four years ago.

It is possible that by reducing the cost of assistive reproductive technologies the program has encouraged some women to postpone having their children to a later age, but if this is why the province of Quebec wants to scrap the ART program they seem to keeping that quiet.

An advisory report issued by the province’s Health and Welfare Commissioner last June found that the province has achieved the first goal of reducing the health care costs resulting from multiple births. While this reduction in costs was not sufficient to offset the cost of the program, the report recommended the province find alternative ways to fund the program rather than eliminate it all together; a recommendation the provincial government appears have ignored.

The report also recommends a moratorium on IVF for women over the age of 42 who wish to use their own eggs. This recommendation is made based on the health risks to children born to women over this age who do not use donor eggs. At no point, however, does the report suggest that women over the age of 42 who have IVF with donor eggs impose any additional costs on the system or that there are any additional risks to those children.

The bill tabled by the Quebec government last week goes much further than banning women over the age of 42 from using their own eggs – it bans women from having IVF even when donor eggs are used and even when the women are willing pay for the procedure themselves. In addition to that, if passed the new bill will impose heavy fines on doctors who refer these women to clinics out of the province for the procedure.

According to data made available by the Centers for Disease Control in the United States, the only real difference between a 43 year old woman and a younger woman is the need by the slightly older woman to use donor eggs; women in this age group are not less likely to give birth following an IVF cycle using donor eggs than are women in their late thirties.

If Quebec imposed the age specific moratorium recommended in the report, then 100 per cent of births to women over the age of 42 would be using donor eggs and, I suspect, this is the real reason for including a complete prohibition on the use of IVF for women in this age group.

There has been considerable debate over the ethical implications to using donated genetic materials in the IVF procedures and those implications appear to cause the most discomfort when the donor is a woman. There are many who wish to argue that a child born of donated egg is deprived of the right to know his or her biological mother, even when we readily accept that child born from a donation of sperm will never know his or her father.

It is worth nothing that if the new bill is put into law, couples undergoing ART that require using “genetic material” donated by the third party will have to bear the additional expense of undergoing a psychosocial assessment that appears not to be required by couples using the their own gametes.

Governments should be able to restrict medical practices that are widely considered unethical, however, hiding this restriction in a law that is being promoted as a cost saving exercise eliminates the possibility of creating a forum for debate over ethical practices in reproductive technology which, in my opinion, is exactly what we have been missing.

This post originally appeared at the Globe and Mail.

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