Sunday, April 02, 2006


Reader mail - funding for reproductive technologies

Last week after I posted about demanding public funding for IVF, I exchanged a series of e-mails with Janet, a regular blog reader from elsewhere in Ontario. I'm posting chunks of our conversation here, with Janet's permission, because while I disagree with her, I think she raises some interesting points worth debating and I'd be interested in your opinion, too. A lot of you are familiar with the state of reproductive technology in Canada, and a lot of you are not. I'd love to hear from anyone who has a thought to contribute.

Janet's original e-mail (which, rest assured, was very polite, respectful and full of compliments about my writing style) and reply to my response have been edited together here:

I simply don't think taxpayers should be paying for these treatments at this point in time, and here's why:

I am the parent of a child with a developmental disorder, and along with that comes many issues, not the least of which are long waiting lists (1-3 years, no joke) for services like speech therapy. There are wonderful services out there, but they are expensive and right now, unfortunately, are"only for the rich" (to quote the link on your post today).

I do think more potential parents need to become aware of the risks that go along with multiple birth pregnancies that are often a result of IVF. And I know that this education is not happening. And if it is, not effectively so.

Also, in our province (I also live in Ontario), autism funding is cut off at the age of six (as if these children will somehow have no need of services after six). One of my friends has to pay $7,000 PER MONTH out of her own pocket for her daughter's treatment, simply to ensure her child will be able to communicate with others, never mind function in society. None of this is covered.

As a parent, I really do realize that the emotional side to this issue cannot be ignored. But by asking for government and taxpayer involvement (and suggesting that a potential under-population propblem could be resolved through IVF), the issue is now open for practical debate, and there are some very practical issues involved.

The other issue, which I think is a real hot button, is one of personal responsibility. As a 37-year old woman (and not in my ideal age range for reproduction without inherent risk) I'm not sure that taxpayers should pay for my fertility treatments because I've decided to wait until my natural fertility has declined significantly to address my reproductive desires (N.B. I'm talking ONLY about age-related infertility here).

I have been thinking about this a lot lately, and I really believe that in this kind of a situation, I should be paying for fertility treatment out of my own pocket if I really choose to have another child, at an "advanced" age, reproductively speaking. For God's sake...I'm finding new, wiry grey hairs on a daily basis!! Is this the best time for me to be having another child? As much as I may want to? I don't know. It's such a personal decision, and that's one reason why I think it should have a personal solution.

There does seem (among women our age) to be a belief out there that just because the technology exists, we can and should use it. I'm just not so sure that is always the case.

Until our society can afford to take proper care of its existing citizens, I'm not sure we should be asking society to fund potential pregnancies. I certainly don't want to fund overseas adoptions for couples/individuals who decide to go that route, and I'm not sure what the difference is here. Maybe I'm missing something? I would love to hear your point of view on this.

And here's the bulk of my replies:

I think comparing funding for autism and special needs to funding for reproductive techologies is like, to use a tired old metaphor, comparing apples to oranges. They have more differences than things in common. While I don't argue that maybe we should be funding special needs more - I'll readily admit my ignorance on this subject - I do believe that IVF should be funded and here's a few reasons why.

First, and I know people hate this argument, but unless you've been through the hell that is infertility, you really have no idea what a basic human right it is to want to parent a child. When you have spent your entire existence simply assuming that the largest part of your life, and perhaps, if you are like me, your singular goal, will be mothering and then to find out for medical reasons beyond your control you are about to be denied that.... as I said, it's impossible to put into words if you haven't been there.

ARTs are funded unevenly in our country. In Ontario you get full funding for three attempts at IVF if you have two blocked tubes, but you don't get that same coverage if you live in other provinces. And if your IVF is due to male factor, or other factors beyond bilateral blocked tubes, you don't get coverage. The government has seen fit to bless some forms of ARTs, the older ones, with funding but still calls IVF - a procedure that is 25 years old! - experimental. You mention (and I have to admit, I bristled at the suggestion) that maybe there are dangers to the children that are conceived under ARTs. One thing about IVF, which is not funded, versus IUI, which is funded, is that with IVF you have much greater control over the number of embryos, therefore significantly reduced numbers of triplets or other high-order multiples. Almost all of the risks inherent to IVF (and believe me, this is something I've researched very very carefully) are from the risks associated with conceiving multiples and most of the fertility clinics I know of, certainly the Ottawa Fertility Centre, do not take the risk of multiples lightly. I had only three embryos and my clinic refused to transfer more than two due to the risk of triplet pregnancy. To say that there isn't enough education of patients going through the process is insulting to both the doctors and the people they are treating.

So, while I appreciate you taking the time to write, I wholeheartedly disagree with you. For what it's worth, by the way, we do have tax credits to trim the costs of adoption, both domestic and overseas, and I'm in support of those, too!

One last point from me, and only because it's one that drives me crazy. Of all the families I know who have gone through IVF, and I know at least 20 in real life and know of hundreds of others through contact on IVF message boards (and blogs!), 'advanced maternal age" is almost never the issue. I'd say never, but maybe there are a few of them out there - but at least of the 20 or so in my tight little circle, all have had things like burst tubes or severe endo or male factor infertility - there was no real factor of personal responsibility, just of medical necessity. I think the image of the career girl who finally gets the urge to procreate in her mid-thirties and turns to IVF when it takes too long the old fashioned way is a creation of the media. Even factoring out the cost, the uncertainty and the needles and the hormones and the intrusiveness of an IVF cycle makes it far from a casual undertaking.

What do you think? Consider the debate officially opened, but please be respectful. It's a sensitive issue on all parts, and I'm extremely proud of the high level of respect commenters have always shown here.