25 replies to this topic

[Bud]

While it is well known that fertility treatments are the leading cause of increases in multiple gestations and that multiples are at elevated risk of premature birth, these results are not...

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[s00n]

This pressure for plans to fund IVF vs risking multiples is kind of akin to saying "we should fund gender reassignment so that people don't chop off their penises" - it's somewhat sound, but it's also trickier than that.

[JacMac]

Yes but it seems to be the only way to get the regular public and gov't on board. Convincing them it makes financial sense is easier to do than to fight the "why should my tax payer $'s help you have kids when there's so many other things we need to take care of, like dental and eye care."

[ilovemydogs]

From what I've seen, the commenters counter argue that the savings could be achieved by forcing SET and still using the savings for dental and vision.

[Merry33]

It shouldn't be about finances (from an ethical point of view), but when you're trying to convince governments/policy-makers to implement actions there is often no way around it than to go through the savings path.

Theoretically being able to reproduce should be a right, maybe similar to the right of having shelter, access to enough and adequate food, access to healthcare, access to education, etc. And there is a million of statements, huge agendas etc around this. But these rights rarely ever rmake it to reality because in the end it always boils down to money, sad as it is. Infertility is only one (and probably one of the "less important" examples). People love to say "let's end poverty, or homelessness, or child hunger", but when it comes to implementing initiatives that could help do that you can go looking far and beyond - because they often "cost too much".

 

It's only realistic to try to achieve IF funding by showing that it will incur cost savings for governments.

[JacMac]

I always counter the SET argument by saying if the government won't pay for my IVF then I should darn well be able to transfer two embryos if I want. Who knows if either of the two embryos we transferred on day 3 would have made it to day 5 for freezing. I don't think they would have and one of those embryos was our son. Even with my OHSS (which cost the gov't. Approx $90,000) I don't regret that we gave both those embryos a chance.

[Merry33]

I agree, but unfortunately the argument is not that simple. Because it can be countered by the fact that you won't be the one paying the bills for a high-risk pregnancy in the end. "Society" will (through our universal healthcare).

(added to the fact that in the end it's not up to us anyway, it's up to our physicians; at least to some extent)

It's just a very complex situation.

[JacMac]

I would has gone for an SET had our embryos made it to day 5 but only one did. So out of 15 eggs I only got three embryos. The two we transferred and the one we froze. That is my clinic's protocol for anyone under 35 with no history of pregnancy loss - two on day3 or one on day5.
If they brought in mandatory SET I think you would see more people go abroad for treatment.

[Merry33]

I'm not judging anybody's decisions around it (in fact, we transferred 2 embryos for both of our IVFs; and clinic policies are also flexible - the 2nd time it was 2 Day 5 embryos; typically only one would have been transferred, but their quality was not great, so we got the option to transfer two, which we did).

But it is what a person who has no idea around the issue would probably say - that he/she will pay for our multiple pregnancy with "my tax money". In the end I don't think that it really matters all that much what random people's opinions are to be honest. I think for governments it will purely be based on cost. And considering that the number of IVFs will only rise in the future I think that healthcare will cover it at some point. I don't think it would be all that easy to implement a "mandatory SET" since this would interfere in a physician's treatment decision. And I think that there is some pretty good protection around that. But who knows...I think it also depends on future progress made on IVF (eg, if success rate with SETs continue to rise).

 

If there ever was a mandatory SET (and if I would ever would want to do IVF again), I would also be among the first to go abroad for IVF. I think most people would....

[ilovemydogs]

Unfortunately its a bit more than cost. It's what will bring the votes in as well. I don't think they would bring in mandatory SET - it's not really on the radar despite being an argument used in the comments section. It would be a negative to the infertile voters without a covered cycle. If the other parties see too much backlash amongst the voters they won't support it even though it makes good economic sense.

[Merry33]

Yes, you're right ILMD. I'm just not really sure how much people truly care about infertility and IVF. Sure, they'll react to a news article, but I really don't think that a funding for IVF will be "big news" at all. There was a few articles around the new Ontario budget proposal, but in reality it was really not much at all (compared to let's say the new hot topic around immigration policies and foreign workers "stealing jobs"). I really don't think there will be a huge backlash around infertility funding. People still relate to some extent to the topic (at least much more than to some other topics, such as funding healthcare for refugees for example).

I might be wrong, but I'm guessing there is a reason that there is funding in Quebec, partial funding in Ontario, and a big new proposal in Ontario, where a huge proportion of all Canadians live.

[Red Wine]

I think that most people would try to use the system if it paid for IVF even if it's only SET's unless they have had multiple failures, are more mature and can't waste time, and/or have the money to go elsewhere for treatment.

 

I think the doctor's discretion would have to be relied upon heavily if a double embryo transfer were to occur. I think the gov't would basically say we want to see the pregnancy rates of twins at your clinic to be X% or less. I'm not sure what the twin rate is at my clinic, but I heard it has gone down in recent years and one reason for getting the twin rate down is to demonstrate to the gov't that caution is being used and they aren't transferring two or more embryos for every patient in the hopes to get the patient pregnant at any cost.

 

I think that the gov't will pay for IVF in the next couple of years, but it is a hard sell to the voters because voters see the money being "wasted". 

[CdnHockeyGal]

I believe I've seen comments from some of the QC girls that the provinces will accept a 10% multiple pregnancy rate from ivf clinics which allows the physician to potentially transfer more than 1 after repeated failures...but otherwise it's an SET.

Though it may not be a popular opinion a large part of our decision to cross the line for our cycles was the ability to have a DET if we're fortunate enough at some point to have that choice. I'm in the camp that believes if I'm the one paying for the cycle and have been properly educated as to the risks...I should have some say in the process with my physician's consent.

I know this May be an upsetting viewpoint for some and it isn't my intent to offend...just my two cents and how we feel about it. If I'm not the one footing the bill...then I have no problem with a SET.

I'm so far removed from being a raging extremist but I find it wildly sexist that an inability to have children isn't considered a basic medical condition. I know everyone here probably thinks that too...but in this day and age...it's just so sexist to me.

[JacMac]

It's not really sexist as much as it is elitist, but either way it is discrminatory. After all, men want to be parents as much as women and male factor infertility is just as common. Together they are a couple. It's not just women being affected by the inability to have children. In fact, I would say my husband us as affected as I am, if not more. He would often come home after the miscarriage and express feelings of being depressed and disappointed at being surrounded by all the young families in our community.

[CdnHockeyGal]

Elitist - yup...that makes sense. I probably should have termed it patriarchal instead...that heavy handed approach that presumes you can't actively participate in the conversation.

[Merry33]

Not sure I understand the sexist/patriarchal point. Men's infertility is equally not considered a medical condition. And an infertile man will in many cases also need IVF to have a child. I don't see the discrimination in this case (and I'm a big time feminist, lol).

[Merry33]

To be honest I actually think it's even worse for men - their right to have a child is almost entirely ignored by society.

[CdnHockeyGal]

Perhaps painting the entire industry with my experience was premature.    I haven't had an amazingly liberated experience...have had an MD ask me if I was having a baby to "hang on" to my husband...have had an MD refer to me as "you women" take taking preg way too seriously...and b/c my DH has been so busy with exams & school...his NID and I'm the one at all the appointments...I found with out previous clinic that I was being talked down too...I never felt like I could participate in the conversation because my questions/thoughts were irrelevant.  I find it can be a very heavy handed system...hence my use of the term patriarchal which admittedly still has gender based connotations.  Is that a better descriptor?  My experience though is probably not reflective of the vast majority...unless you girls are trying to have kids to hang onto your husbands as well...LOL

[Merry33]

I think I understand what you mean now, and I agree that there is a lot of  misperception around pregnancy & infertility in our society (which includes doctors and clinics too), and there definitely is a focus on the women. Which is why for example everybody automatically assumes that we don't have children because of my inability to conceive for example (which annoys the hell out of me, but that's a different topic).

The thing is though that, like JacMad said, it really affects both women AND men negatively. I have a bit of a different perspective on this since our primary Dx is severe male infertility. Which means that he's "the infertile", but it's me mostly dealing with the procedures, doctors and clinics. So in some way I get parts of both the fun. And what I can tell you is that there is no more sensitivity from doctors (or really anybody) when it comes to male IF. For example, I was told to "just have an affair" (in front of my husband), and we got some weird speech about how we shouldn't use my husband's brother as a sperm donor as "that would be weird" (that came from a GP, pretty much out of the blue; we never considered a sperm donor, and for sure not anybody related to us). And the general public mostly completely ridicules or completely ignores the topic. I'm not sure that that's any better than the attitude towards women. It's both bad.

 

From the funding perspective there really is no difference IMO. And I really do think that male IF is considered even less of a medical condition than female IF, like I said in my previous posts. Nobody ever thinks that men often have an equally huge desire to have a child as women do

Anyway, this is really OT and I'm rambling, lol.....it's an emotional topic and there is just so much insensitivity around it.

[JacMac]

I'm enjoying this discussion about IF. It's wonderfully intelligent and insightful rather than full of baby dust and sticky vibes.

[CdnHockeyGal]

I really enjoyed your perspective Merry...our Dxis a bit of a mix...I only have the one tube now b/c of the hydro...but...I have so many friends that conceived naturally or with minimal intervention that I don't perceive that to be a big hurdle whereas my DH has low normal counts with poor morphology...so I suppose intend to think of us as male factor as well...but b/c he's NID and so busy with school I tend to view it as "my"/our problem since the reading/research and organization falls to me...so I suppose despite our male factor issues...like the general public I still see it as "my" issue. I'm sure it does bother my husband but with him being so busy with school he can't really devote much time to it...so....I suspect he's not as upset as he would be if it was a more tangible part of his day to day reality?

I should stop being so surprised at hearing these terribly insensitive stories our families have with the public or health care professionals...but I still am. For what it's worth I'm just horrified that your GP would make those kinds of statements. I really enjoyed hearing your views though. Thank-you for sharing the other side!

[Merry33]

They day-to-day experience is still completely different, no matter who has "the diagnosis" (or a combination of the two), since it is us (as in  "the women") who go through everything. I could write books about how many times I was dreaming about getting one of these over-sized sling shots contraptions they used in Medieval times to shoot my dear hubby out of the window 

 

I've always seen our IF as "our issue", not his, because it really is a couple's condition, like JacMac said as well. For my husband his IF is quite undeniable/cannot be easily ignored, because it's so severe that we weren't even sure if we could even do IVF in the beginning. He doesn't struggle as much with the treatments (at least not the same way as I have; although the repeated failures have been devastating for him as well, just in a different way) but it's been a huge insult to his self-wort/self-confidence (for a while I was seriously concerned that it would literally break and destroy him, it was that bad). And that's what all these stupid comments target - a man's self-worth "as a man". The one with the affair came from a doc at a fertility clinic by the way. I don't even think that people say these things out of malice, I think they assume that they can just joke around "among guys". That also touches on what I mean with that the topic of male IF is ignored/ridiculed. I find that there is zero awareness about how devastating these kinds of comments are to men. I don't know how many times I was mortified that some stupid comments on TV for example would trigger some emotional mess within DH again. Or all these recent movies around "sperm donors" for example - did you realize that they are all comedies? That's what I mean with ridicule.

 

This is a great place because we do hear so many perspectives , and I definitely enjoy hearing yours as well. Personally I feel like as time goes on I seem to care less about insensitive comments, or maybe I just built up an entire coping arsenal. But I certainly wish that one day there will be more awareness around the topic of infertility.

[JacMac]

I totally see how those comments to a man could be harmful. My husband gets offers to "help us out" all the time. A little less since the miscarriage it seems, but still offers of them coming over because they got their wife pregnant in less than a month or have twins, or offers to wash my underwear with theirs because apparently that can cause pregnancy. I guess this is another way in which we need to educate people in what not to say to infertile people. We always worry such much about what they say to women but men can be affected by off colour comments as well.

[s00n]

This is a very complex and great discussion.  I'm pretty coloured by my experience but from a logical standpoint if the numbers bear that there would be savings to healthcare then I believe that is positive news.

 

I like the thought of SET as a funded procedure.  It's interesting that I also like the idea that you have to

 

Voter-wise Canada's population is aging and those people don't usually care if you can have kids or not, they want pension protection guarantees.  They may even think people aren't entitled to have kids, or god's will thinking or things like that.

 

Approximately 27.3M of Canada's 35.1M are voting age.  14.5M of those are within the childbearing years that may consider fertility treatment. (Ages 20-49)  So only half the voters are there, and if we remove people under 30, the number shrinks to ... 9.7M.  An issue that might be important to 25% of Canadians - and let's say 1 in 2 are touched by infertility (friends, family, selves) - we get fewer people.

 

Alienating voters is such a big risk versus helping a small population.  The support has to be there to influence everyone positively - like saying things like "reducing the number of women with high risk pregnancies thanks to a reduction of multiple births through single embryo transfer will keep more money in the healthcare system for funding other priorities important to Canadians of all ages."

 

To play devil's advocate, the cheaper solution (and I know this is inflammatory) would be mandating selective reduction.

 

I think that if a party made a choice to delay having children advanced age should not be an infertility condition covered.

I don't think the public should be on the hook for that, but for sub-fertility to a determined maternal age, I'd be cool with it.  The numbers have to bear out.

 

Thanks for the challenging debate!

[Merry33]

Those are some interesting thoughts s00n, especially about the ageing population. What came to my mind when I read it was that, if they were smart, more senior voters should promote anything that helps population growth. It's no secret that one of the reasons why we have such issues around pension funding is that there is not enough young people in the workforce to contribute to pension funds/there is an imbalance between "the young" who should fund pensions and "the old" who benefit from pensions. In that sense, they should care a whole lot about people being able to conceive

We should write a letter to policy makers, making them aware of this argument, lol.

 

I sort of agree what you say about advanced maternal age, although I think it is more complicated than it sounds. Eg, what if a couple only starts trying to conceive at age 36 and they find out that the man is azoospermic. If you put a strict "age limit" to funded IVFs (let's say until age 35), this couple would not get funded for all the wrong reasons. I don't know how one would establish a clear diagnosis of "too old to have children" versus other diagnoses, or where one would set the threshold.