You might not know this but in the U.S. this week marks National Infertility Awareness Week. It is a week to talk about infertility and assisted reproduction, among other topics. I have blogged a number of times about infertility and assisted reproduction and my last piece was a contribution to the Macleans ‘charts to watch‘ in the run up to Budget 2016.
One of my main messages on this topic is that Canada can’t continue to ignore assisted reproduction.
In Canada, the prevalence of infertility has risen from 5% in 1984 to upwards of 16% in 2010 (Bushnik et al 2012, p. 1). Increasingly, these infertile couples are seeking medical help, including turning to assisted reproduction technology (ART). The Canadian Fertility and Andrology Society (CFAS) reports that the number of assisted reproduction technology clinics in Canada increased by 50% between 2001 and 2012 (the latest year for which figures are available), and the number of ART cycles reported by these clinics increased by nearly 250% over the same time frame (Gunby and Daya 2005, and Gunby n.d.). Notably, in 2012 a total of 27,356 ART cycles were reported in Canada (Gunby n.d.).
Many people seem to associate infertility as solely being an issue of older women trying to conceive, but that is seriously uninformed view. The Canadian Fertility and Andrology Society produces regular statistics on assisted reproduction and according to their data only about 12.8% of ART cycles are due to ‘advanced maternal age.’ In contrast, 30% are due to male factor infertility, 13.2% due to a tubal factor, 9.3% due to Endometriosis, and 7.8% due to PCOS, among other exogenous factors. That is, there is an underlying health issue that necessitates the need for ART. Backing that up is that the majority of women accessing ART are under the age of 35.
The Canada Health Act does not require the provinces to cover ART as part of their medical plans as the federal government has deemed that these procedures are not medically necessary (Hughes, 2010, para. 2). As a result, most provinces cover the cost of infertility testing, but few cover the costs associated with ART.
One of the biggest side effects of ART is the incidence on multiple births. The natural rate of multiple births is about 1 in 89 birth (~1.1%), whereas in the multiple birth rate in Canada has grown to about 1 in 30 (3.3%). Further, data from the Canadian Fertility and Andrology society shows that the multiple birth rate from in vitro fertilization treatments in Canada without regulated embryo limits was around 30%. Multiple births are both risky and costly, not only to the parents but also to the health care system and to the babies themselves. ART increases the multiple birth rate through either the transfer of multiple embryos through invitro fertilization or due to super ovulation during inter uterine insemination (IUI). Despite these concerns, only Quebec and most recently Ontario regulate embryo transfers (and no province regulates IUI).
34 years have passed since the birth of the first babies conceived through IVF in Canada and in that time the federal and provincial governments in Canada have collectively and individually shown little leadership with respect to infertility, assisted reproduction treatments, and the growing multiple birth rate in Canada.
The federal government particularly needs to reexamine the asinine and difficult to enforce limits on surrogacy and embryo and sperm donation. While some Canadians have moral difficulties with medical interventions in conception, the reality is that for many couples these interventions are both medically and mentally needed. These limits force Canadians to seek treatments in other countries, like the US, that do not have such limits or lead them to breaking the law. The limits also impede access to viable treatment alternatives, including for women unable to face the possibility of yet another miscarriage.
The issue of infertility, assisted reproduction treatments, and the growing incidence of multiple births needs a fulsome, mature, and national discussion in this country and the longer the federal and provincial governments ignore this significant reproductive issue, the costlier it will become.