Public Funding of Assisted Reproduction in Quebec - Interview - (Fall 2010)

Public funding of assisted reproduction in Québec: A specialist’s opinion

Véronique Robert interviews Dr. Louise Lapensée
Fall 2010

Questions have arisen regarding the innovative Québec program which came into force on August 5 and which will fund three IVF cycles. Is it affordable? Will the program's single embryo transfer policy lower pregnancy rates? Will the higher demand translate into lower-quality services? Dr. Louise Lapensée, an obstetrician-gynecologist and fertility specialist at both the Hôpital Saint-Luc and OVO fertility clinic in Montreal, answers CREATING FAMILIES’ questions.

What do you tell people who claim the program is premature?

I would say it is overdue. It was to be implemented a year ago. My colleagues and myself have been advocating this type of program for years. At last, infertile couples will no longer fall into two categories: those who can afford treatment, and those who cannot.

Can Québec society afford to finance up to 7,500 IVF cycles per year?

Yes, thanks to the new single embryo transfer policy which will bring about a clear reduction of multiple births, down from the current 32% to a rate below 10%. With considerably fewer babies in intensive care or with long-term handicaps, the government can expect to save substantial sums. These are not fanciful projections. This is what has happened in those countries where they have been funding IVF treatments. Moreoever, funding fertility treatments is a societal choice. Our present birth rate is extremely low and we will not be able to compensate for its decline through immigration. What’s more, we can never hope to please everyone.

Multiple births also result from ovarian stimulation, which is also covered by the program.

True, but we will perform fewer ovarian stimulation treatments now that IVF will be government-funded, since IVF is safer, thanks to the single embryo transfer. However, the number of multiples will never go down to zero.

Will neonatalogy units be able to handle the extra volume of patients? Doubts have been expressed about this issue.

Having substantially fewer premature births and fewer babies in intensive care will, on the contrary, actually lower the stress on neonatalogy units.

What about the long waiting lists? Will the quality of services suffer?

We will not be able to accommodate the higher demand immediately. At OVO, we have doubled our capacity, but no one can be totally ready for such a major change. This is why the government has set a limit of 3,500 cycles this year – there will be 7,500 when the program operates at full capacity. Regarding diminished quality of services, the risk is always there when the public system takes over from the private sector. We will have less time with patients, especially at the outset, but the demand will stabilize after a while. We do have the capacity to adapt. After all, we will be delivering the same type of care, only we will be implanting one embryo at a time, a welcome development.

There is concern that the single embryo transfer policy will result in lower pregnancy rates.

The rates will probably fall somewhat at first, but I expect a median 75% success rate a few years down the road for women with frozen embryos. Here is why: rather than freezing the extra embryos, in the past many couples had several embryos implanted to maximize their chance of a pregnancy and hopefully avoid paying for further IVF cycles. IVF is now publically financed, including embryo freezing and storage, and a woman must have all of her frozen embryos transferred before she is allowed to undergo a second IVF cycle – the government’s intention was to prevent an accumulation over time of hundreds of frozen embryos only to find itself facing serious problems later on. It is the cumulative effect of increasing the number of transfers which will improve pregnancy rates.

You do not seem to find much wrong with the new Québec program.

It’s the eighth wonder of the world! You can’t begin to imagine the suffering of infertile people who cannot afford IVF treatments. This is the best news we have seen in the health sector in a long time.