Should the state pay for in vitro fertilization?
By Julia Belluz - Wednesday, February 27, 2013 - 0 Comments
Josemanuelerre / Flickr
If you’ve been watching the health headlines lately, you may have noticed a number of reports calling on provincial governments to fund in vitro fertilization treatments for would-be parents.
This week, a Calgary charity asked the Alberta government to swoop in and cover the cost of IVF since “people in the province are selling their homes, working several jobs and going heavily into debt just to conceive a child.”
Another report this month, by the Infertility Awareness Association of Canada, claimed that the province of British Columbia “could save $78 million healthcare dollars in the first five years alone if it funded single embryo transfer IVF treatments.”
Right now, Quebec is the only province in North America to publicly fund IVF treatments, and these groups suggest others should follow suit in order to save health-care dollars and help would-be parents.
These messages, along with images of cute babies and wrenching stories from expectant moms, have been delivered uncritically by the media. But what about the evidence behind them? Science-ish scratched the surface of these reports and found conflicted interest groups, patchy science, and celebrity advocacy, all peppered by high emotion and moving anecdotes. In other words, a perfect recipe for wild health claims and evidence-free policy.
Let’s start with the conflicts of interest behind the recent headlines. The Calgary outfit calling for IVF coverage in Alberta is called Generations of Hope. The well-meaning charity helps to cover the cost of parents who can’t afford IVF. Among its sponsors are a drug company that makes fertility therapies (EMD Serono Canada) and a fertility website that was created by the drug-maker. Similarly, the group behind the B.C. claim is the Infertility Awareness Association of Canada, which is funded by a range of fertility clinics and pharmaceutical companies.
So the folks who sponsor the groups advocating for state-sponsored IVF are the same ones who would gain financially from such policies. Any realist will not be surprised by this fact. But if these groups are going to push for pan-Canadian policy changes, they’d better have good data to back their arguments—and right now they don’t.
Take the suggestion that other provinces should follow Quebec’s lead in order to save money. This claim is based on the fact that Quebec’s funding is linked to a single embryo transfer policy, which means that when the state pays for an IVF treatment, doctors should only implant a woman with one embryo instead of many. Single embryo transfers reduce the number of multiple births, which are linked to pre-term deliveries, cesarean sections, and higher usage of the neonatal treatments.
The assumption is that when cash-strapped families pay for treatments themselves, they may demand multiple embryos be implanted in fewer cycles to improve their chances of getting pregnant while containing the costs. With government assistance, this pressure would be alleviated—and so would the health-systems costs associated with delivery complications.
Some, like Quebec pediatrician Dr. Annie Janvier, argue that the province’s program reduced the rate of multiple births, and so they extrapolate that that must mean overall savings. In an email, she explained multiple births in Quebec dropped from 30 per cent to five per cent following the IVF coverage. Science-ish traced that figure to unpublished data from a PowerPoint presentation at a fertility conference.
When asked about money part of the equation, she sent back a quick calculation. “About 60 per cent of twins are admitted to the neonatal intensive care unit, often for weeks or months. The NICU costs $5,000 per day, and this is without examining the costs to disabled children, or higher maternal costs for twin pregnancies. One IVF cycle costs $5,000 or less in the public system.” All that sounds great, but again, when pressed for citations or formal analyses, Dr. Janvier could not produce them.
That’s because—despite the big claims about cost savings—there is no such study of the net benefits to the system yet, said Dr. Hananel Holzer, Medical Director of the McGill University Reproductive Centre. “The cost effectiveness studies are not done yet,” he told Science-ish. “We are trying to perform some here now.”
There was actually a report in Le Devoir this week that the program is costing more than anyone anticipated based on government data.
Still, Dr. Holzer said, the Quebec program has done one thing well: increased the rate of single embryo transfers, which are the standard of care, according to professional practice guidelines, and better for women’s bodies, baby’s health, and the health system. “(Funding) was a tool to enforce single embryo transfers,” he said. “You could see the reduction within a few months of the program being introduced.”
But not everyone agrees that such a carrot should be used to get doctors to practice the best medicine. Francoise Baylis, a professor and Canada Research Chair in bioethics and philosophy at Dalhousie University, made the point that doctors should only be performing single embryo transfers regardless of funding mechanisms. “No physician under any circumstances should be practicing bad medicine,” she said, adding that this is an issue the profession should address, independent of whether provinces are attaching dollars to the practice.
Meanwhile, there’s another science-ish lesson here: Quebec’s decision to fund IVF was pushed along by celebrity advocacy. Media darling Julie Snyder had trouble conceiving, but IVF ended those struggles, and she has said, “When I got pregnant, I swore to God that I would help other women.” Her help came in the form of vigorous campaigning—involving other celebrities like Celine Dion, and even a documentary on the subject— for the provincial government to pony up and cover couples in need.
Celebrity advocacy in the absence of evidence does not make strong public policy. If provinces decide, on compassionate grounds, to fund IVF, that’s one thing. But interest groups making claims about cost savings that aren’t true is quite another. Quebec is actually the perfect Petri dish in which to examine the impact of state-funded IVF. We just need some independent study and good data to make a case either way.
Science-ish is a joint project of Maclean’s, the Medical Post and the McMaster Health Forum. Julia Belluz is the senior editor at the Medical Post. Got a tip? Message her at julia.belluz@medicalpost.rogers.com or @juliaoftoronto on Twitter.
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Ottawa doctor suspended for inseminating three women with wrong sperm
By Allison Jones - Thursday, January 31, 2013 at 5:22 PM - 0 Comments
TORONTO – A renowned Ottawa doctor who admitted to professional misconduct after three women…
TORONTO – A renowned Ottawa doctor who admitted to professional misconduct after three women were artificially inseminated with the wrong sperm has been suspended for errors that a disciplinary panel said left the women’s children grappling with a lifetime of “social and psychological pain.”
The College of Physicians and Surgeons of Ontario panel stripped Dr. Bernard Norman Barwin of the ability to practice medicine for two months.
“It’s hard to imagine a more fundamental error in your former speciality than to impregnate the right women with the wrong sperm,” disciplinary panel chair Dr. William King told Barwin at the Thursday hearing in Toronto.
Barwin agreed last year to stop the practice of artificial insemination after the college filed notice it would conduct a hearing after three of his patients alleged they were not impregnated with the sperm of their chosen donors. Two had intended to be inseminated with sperm from their husbands.
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Is India really a superpower?
By Erica Alini - Friday, March 9, 2012 at 6:22 PM - 0 Comments
Sukanto Debnath/Flickr
For all the hype around the unstoppable ascent of the world’s most populous democracy, “India is not a superpower (and may never be),” according to a group of researchers at the London School of Economics, who just penned an interesting new study on the topic.
The paper, of course, isn’t denying India’s rise. After all, the country’s economy expanded fourfold in the last 10 years, lifting millions out of poverty along the way. And if its domestic market weren’t so tied up with rules meant to keep foreigners at bay, Western companies would probably be stepping over each other to win Indian contracts, as they’re doing right now in China.
But an economic miracle isn’t enough to qualify for superpower status, the authors of the report argue. India is still grappling with a number of serious domestic challenges. These include a disruptive Maoist guerrilla faction; the terrible waste of human resources that is the Hindu caste system; and a corrupt and divided political leadership that can’t ever come up with a coherent, grand strategy for anything from developing the economy to rebooting the military.
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You can’t mandate marriage, even if it’s good for society
By the editors - Tuesday, October 11, 2011 at 11:20 AM - 1 Comment
Marriage may not matter as much as it once did to young couples. But it matters a lot to society at large.
Chris Wattie/CP
Marriage may not matter as much as it once did to young couples. But it matters a lot to society at large.
Married couples are a foundation of the economy. They earn, save and spend more than their unmarried counterparts. They are happier. And a mountain of evidence shows stable two-parent families are good for kids. Children who grow up in a married family are far more likely to succeed in school, find employment and avoid problems later in life than those raised in other situations, however loving.
But despite all this, the future of marriage as a continuing social institution often looks quite grim. This week saw the release of a sobering international report detailing the decline in significance and prevalence of marriage, and the impact this is having on fertility rates, social cohesion and economic growth worldwide.
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IVF babies may be at increased risk of Down’s syndrome
By macleans.ca - Monday, July 4, 2011 at 11:21 AM - 1 Comment
Drugs used in IVF treatments may up the risk, experts say
A team of UK researchers who looked at 34 couples have concluded that the drugs used to kickstart a woman’s ovaries during IVF treatments may disturb the genetic material of their eggs, upping the risk of Down’s syndrome in their babies, the BBC reports. The magnitude of the risk isn’t yet known, but it could also cause other conditions beyond Down’s, they say. In the study, researchers looked at 34 couples undergoing fertility treatment; all the women were older than 31 years, and were given drugs to make their ovaries release eggs for the IVF treatment. Researchers studied these eggs and found some had genetic errors, which could either cause the pregnancy to fail or a genetic disease in the child. The error often resulted in an extra copy of chromosome 21, they reported, which causes Down’s syndrome. The chance of a baby being born with a genetic condition rises with the age of the mother, especially for mothers over 35.
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Mitchel Raphael on the Tory who helped Helena Guergis
By Mitchel Raphael - Thursday, December 16, 2010 at 10:00 AM - 1 Comment
Ignatieff on his eyebrows, Jann Arden’s ‘apology’, and Foote in mouth
Ignatieff on his eyebrows
A fire alarm during question period had MPs rushing out of the Commons. Conservative MP James Lunney helped a very pregnant former Conservative-now-Independent MP Helena Guergis (due date: Dec. 15) down the stairs and out of the building as they talked about contractions. Lunney is a chiropractor trained to deliver babies. Once outside, MPs kept dry from the rain under the wood shelters attached to the building (thank goodness for smokers, one MP joked). Liberal MP Martha
Hall Findlay took the opportunity to thank her leader, Michael Ignatieff, for not growing a moustache as part of the Movember prostate cancer awareness campaign. “I thought you were growing your eyebrows,” Scott Brison piped in. Ignatieff laughed and joked, “No. I shave those every day.” -
Evolution favours shorter and heavier women—like it or not
By Katie Engelhart - Thursday, March 18, 2010 at 12:00 PM - 72 Comments
Natural selection is still at work
Photograph by Hans Neleman/ Getty
What might our granddaughter’s granddaughter’s granddaughter’s granddaughter’s granddaughter look like? Shorter and stouter, says a report in the Proceedings of the National Academy of Sciences. If current trends continue, its authors predict, then by 2409 descendants of the women in the study will have evolved to be one kilogram heavier and two centimetres shorter than their 2010 foremothers.
For years, some scientists heralded the end of human evolution. The post-industrial homo sapiens, they argued, was free of the kinds of “survival-of-the-fittest” pressures that could drive large-scale genetic change. In 2008, Steve Jones, professor of genetics at University College London, gave a much-hyped lecture entitled “Human Evolution is Over.” “Not so,” says Stephen Stearns, co-author of this latest study, professor of evolutionary biology at Yale University, and founding editor of the Journal of Evolutionary Biology. “The basic take-home is that humans continue to evolve,” Stearns told Maclean’s.
“One [could express] the result as: women are going to get shorter and fatter,” he explains. But he prefers a different bent: “There is natural selection against women being slender.” Stearns’s work shows that plumper, shorter women tend to bear more children—who carry on those same traits. His analysis drew on data from the Framingham Heart Study: a survey, begun in 1948, that collected medical information from 5,209 subjects, and monitored them and their offspring for 60 years.
