Should the health system pay for infertility treatments?

[Darth Wong]

Just wondering what people think of this.

A Fertile Future

As someone with painful personal experience, Danny Roth sees infertility as both a private challenge and a public health crisis.

“Tens of thousands of us struggle with infertility, yet we tend to do so silently and in the shadows,” he says, noting that one in six couples of reproductive age faces infertility issues. Fortunately, activities such as the third annual Canadian Infertility Awareness Week, now underway, and other efforts by the Infertility Awareness Association of Canada are helping change that.

An IAAC board member, Mr. Roth is one of the architects of a letter-writing campaign encouraging people to tell their stories to policy-makers. “The purpose of the campaign is to say, here we are. While the fringe gets the headlines, like the octuplet mom or the 60-year-old pregnant woman, we’re just people who have a genuine desire to create a family, to fulfill our dreams.” The cost of infertility is enormous, he says, both financially and emotionally. “We know several couples whose marriage didn’t survive the struggles. The toll on the relationship is overwhelming, and it clouds all aspects of your life.”

Jeff and Danielle Alderman of Ontario have experienced the anguish of infertility, including the physical, emotional and financial costs of in-vitro fertilization treatments. “Until you’ve been through it, it’s impossible to imagine what it’s like,” says Danielle.

Mr. Roth and his wife Jillian went through four years of unsuccessful infertility treatment before they were able to adopt. “The women who go through this are heroic,” he says. “It is psychologically and physically overwhelming; it’s invasive, embarrassing, debilitating and exhausting. For men, there’s a terrible feeling of helplessness.”

“Until you’ve been through it, it’s impossible to imagine what it’s like,” says Danielle Alderman. She and her husband Jeff decided they were ready to start a family in 2003, but after a year and a half, she mentioned to her doctor that nothing seemed to be happening. “One test led to another, until, in 2005, our doctor suggested it was time to try artificial insemination. That’s when we realized we weren’t going to be able to do this on our own. It was hard to take.”

Before attempting in-vitro fertilization, she decided to wait a year, and founded the Burlington Twist Women’s Masters soccer team, which will go to Australia this October to play in the 2009 World Masters Games. “I wanted to make sure that I could be happy with my life as it is. I’ve been playing soccer since I was five, competitively since I was 10. I was able to immerse myself in a different passion, something that made me feel good and gave me confidence.”

When it was time to start looking into in-vitro treatment again, she says, she felt ready. Yet after the treatment failed, she says, “I had never been that sad. But one of the things athletes say is that fit- ness is not necessarily about how fast or far you can run, it’s about how quickly you can recover when you’ve pushed yourself to the maximum. And I bounced back relatively quickly. Every day, I started by simply getting out of bed; my objective was to get out of bed and go to work.”

Since then, the Aldermans have gone through further in-vitro treatments. If successful, their enormous investment – physical, emotional and financial – will give them something that most Canadians take for granted every day. “Our goal,” says Ms. Alderman, “is simply to have a child.”

Dr. Cliff Librach, IVF director at CReATe IVF in Toronto, says, “Fertility should be treated just like any other disease or medical condition people suffer from. As the director of the Ontario Medical Association Section of Reproductive Biology, I did a survey of our members on this issue: it was unanimously felt this treatment should be funded.”

Infertility affects relationships with friends and family members, says Dr. Librach, partly because it can be so painful for people who can’t have a child to be around those who do. “You can’t help but think, ‘I wish that were me.’ And it can damage your relationship with your partner, both physically and socially, as you concentrate on trying to have a baby versus having a normal, intimate relationship.”

“In this country,” says Mr. Roth, “we’ve made a commitment to fund medically necessary treatments. To then deny this right to a particular segment of our community is unconscionable.”

To date, more than 1,000 letters have been forwarded to the McGuinty government by the Infertility Awareness Association of Canada.

Note: The Aldermans’ second IVF treatment was successful, and they are expecting their baby in October 2009. Ms. Alderman will not be able to attend the 2009 World Masters Games.

I can totally understand why people would want to do this, having two children of my own. And from their perspective, it is a straightforward issue: your body is not working properly, so the health system should pay for fixing it. But at the same time, with budgets being what they are, and the cost of these treatments being as high as they are, one must wonder whether we should be simply telling them to adopt. People can live a normal life while infertile; it is not crippling, except in the sense that you cannot have natural children. Is fertility a right? We certainly react with hostility to anyone who would forcibly take it away from someone. Does that mean the public should pay for it?

[Bedlam]

To me reproduction should not be seen as a right but as something to be earned, thus I would say that public funds should not be spent on fertility treatments.

Many if not all of the enviromental problems the world is currently facing could be reduced or stopped if their were less humans so spending large sums of money to make more humans doesn't seem to make sense to me. As pointed out there are children who don't have parents and adoption is an option open to make of the infertile.

Now at present I have no plans to reproduce and its not really anything that has crossed my mind. If I tried to and found that I was infertile I dont know if this would change my stance or not.

[Surlethe]

Is the problem significant enough that subsidizing it, as other health-care issues are subsidized, would significantly impact population growth? It doesn't look like it, since the article cites "tens of thousands" and only a thousand or two letters have been written, but it's worth (at least briefly) considering the population impact of extending fertility treatment.

[Mr Bean]

Are we not also perpetuating the genes that cause infertility? Thus down the line the sons and daughters of these people will be requiring more resources to aid in their own future reproduction?

I'm looking at this from a blunt human prime example, And I do understand that there are many causes of infertility from accidents to certain chemicals to radiation. But I wonder if not an argument can be made that those genetically incapable of reproducing should not have their genes passed on.

From my own perspective, I would not support paying for fertility treatments unless it is corrective. IE if there's something we can fix to enable you to have kids, then yes I'd support paying for it, totally artificial treatments I do not. Unpopular though my own view is I suspect this issue is still in development as science on the matter is not yet complete.

Gene therapy, to steal a Weber term "tubeing"(IE 100% artificial wombs) and nanotech based treatments might hold the happy cheap answer that such procedures will become much cheaper and require one or two doctor's visits instead of fifteen to twenty.

[Mr Bean]

To elaborate one of my Aunts(Attention anecdotal evidence ahead!) husbands is firing blanks so to speak, to find the right donated sperm, right doctors and the right time took her roughly a year(This was 93) and eleven visits to the doctor to conceive at a rough cost of close to 80,000 which the insurance picked up 80% off. Granted my Aunt is in a position that she could have spent the 80k with a few months of budgeting, but that's not the kind of money most people can pay out of pocket, or without taking out a loan.

[Starglider]

Unlike the bulk of universal healthcare, state-sponsored fertility treatment is not supportable on economic grounds. This is one of the few areas of health that can and should be left to private charities - if people want to subsidise poorer families to try and have children, so be it, but the state already subsidises children enough.

[The Duchess of Zeon]

Also there's the rather pertinent question of where it stops. If universal health care inflexibly pays for curing the results of all medical conditions, then I shall let you extract a few of my stem cells for however many hundred thousands of dollars it would cost in another two decades to modify them to behave like eggs. I do, after all, have permanent sterility caused by the treatment to a recognized medical condition--not like I would have ever had children anyway, of course, but that's besides the point, since universal health care doesn't monitor motivations, and I certainly would have, had my body been laid out correctly in the first place.

Yet I have never expected this to be done for me, and am quite content to adopt in due time. Perhaps in a world where there's far too many children, and there's enough orphans in the third world to provide every infertile person in the First with several children, that these people... should really just grow up and accept that it's far more important that you imprint your children to be raised according to your values and worldview, than that they share a few chemical strands with you.

So no, we should never damn well, not in a thousand years, pay for the fertility treatments of people, and I indeed resent the idea of health insurance covering this sort of frivolous ego-indulgement when I'm paying out of pocket for things far, far more important to my healthy functioning in society, and people like me, in fact do in many countries even that have universal Healthcare, for instance most of Canada. Ultimately what it comes down to is the insecure need of these men to have blood offspring when they could adopt.

[Broomstick]

Are we not also perpetuating the genes that cause infertility? Thus down the line the sons and daughters of these people will be requiring more resources to aid in their own future reproduction?

Infertility is not necessarily a function of genetics - mumps, for example, can cause permanent sterility in males. Testicular injury can also cause male infertility. STD's can cause female infertility. None of those are genetic in origin nor can they be transmitted genetically to the next generation. (Unfortunately, STD's can be passed to children via pregnancy and childbirth, but that's still not genetic and these days we can prevent that sort of thing if the woman is getting proper prenatal care)

Frankly, I find the constant harping that infertility is... well, look at the quotes:

"toll on the relationship is overwhelming, and it clouds all aspects of your life.”

"...it can be so painful for people who can’t have a child to be around those who do. “You can’t help but think, ‘I wish that were me.’ And it can damage your relationship with your partner, both physically and socially, as you concentrate on trying to have a baby versus having a normal, intimate relationship.”

As I've mentioned in the past, my husband is sterile. At one point we discussed the possibility of children, which could have been easily accomplished by donated sperm. We elected to simply not reproduce - it's not like there's a people shortage and we have nieces and nephews on both sides of the family which seems to satisfy our urges to see our genes enter the next generation. There was no gnashing of teeth, weeping and wailing, battles with depression, damage to our relationship, or anything of the sort. I do not find seeing other people with babies painful at all, indeed, I am quite happy to cootchie-coo and bounce the babies in my arms then give them back to their mommies. Not every women requires pregnancy, childbirth, or even motherhood to have a fulfilling and happy life. I can't possibly be the only woman, nor we the only couple, who deal with infertility without emotional storms and crushing upset.

My feelings on this? If the problem is something simple and inexpensive to correct then yes, pay for it. Medical procedures for less than life threatening conditions are perfectly OK, we do it for other problems why not infertility. However - some infertility treatments are very expensive and, as I said, there's no people shortage. There has to be a point where we say sorry, either pay for it yourself, out of pocket, or you don't get it.

I would, however, strongly support subsidized therapy for people who can't be realistically helped to reproduce in order for them to come to terms with their condition(s). I can't help but think that part of the problem here is societal conditioning, particularly the sort that tells women they aren't complete without giving birth and raising a child, and infertile people seeing themselves as defective. Subsidize therapy to help these people achieve peace of mind and move on with their lives. For many infertility problems it's not only cheaper, but holds a much greater chance of success than round after round of "treatments" that, at best, have a very low success rate.

[Cairber]

I think that treatment of underlying problems should be covered; that would mean that things like treatments for Endometriosis and Polycystic ovary syndrome. Perhaps even less expensive fertility treatments used to treat disorders but also help with fertility such as the drug clomid would be acceptable.

However, something like IVF should be covered only by some kind of rider or other program where you could pool people who want this coverage. Not sure if something like that could work though since you would have to want the coverage before you knew you had the problem...(at least in the USA system)

In a universal system, I would not think it wise to cover such expensive and unnecessary procedures. Perhaps there could be some kind of private option for that kind of thing.

Another issue is the high failure rate of some fertility treatments. That would be a very big waste of tax payer money.

[Broomstick]

I think that treatment of underlying problems should be covered; that would mean that things like treatments for Endometriosis and Polycystic ovary syndrome.

Especially since both of those have symptoms and suffering that go beyond just infertility. They both need to be treated regardless of whether or not the woman in question has any intention of reproducing or not.

Perhaps even less expensive fertility treatments used to treat disorders but also help with fertility such as the drug clomid would be acceptable.

Yes, something like Clomid is pretty cheap.

However, something like IVF should be covered only by some kind of rider or other program where you could pool people who want this coverage. Not sure if something like that could work though since you would have to want the coverage before you knew you had the problem...(at least in the USA system)

Nope - I think if you want IVF it should be entirely on your own dime. Most places in the US that is the case now (though I think Illinois got stupid and mandated insurance coverage for it). If it was much cheaper and, more importantly, much more reliable, it might be a different story. At best only about 1/3 of women using IVF ever deliver a baby at all, and most women have significantly lower odds than that.

The only time I could see a health system paying for IVF is in the case where pre-implantation diagnosis is needed to prevent one of the more serious genetic disorders, and even there I'd limit the number of attempts and number of children. I'm on the fence about that one.

[Rye]

IVF costs a lot and enough people have babies normally for it to not be an overbearing concern. The initial diseases like chlamydia or whatever that lead to infertility should definitely be dealt with for reasons already mentioned, but that's relatively cheap. Laser eye surgery is along the same lines; your eyes are defective, so should UHC pay for laser eye correction? Wearing glasses could be seen as equivalent to wearing crutches forever. It's still expensive, though, and people wearing glasses is a "good enough" compromise.

[Oskuro]

Not every women requires pregnancy, childbirth, or even motherhood to have a fulfilling and happy life. I can't possibly be the only woman, nor we the only couple, who deal with infertility without emotional storms and crushing upset.

You probably are not the only one, but we can all agree that instinctive impulses, the so-called biological clock, are hard to resist, and a large percentage of the population let those urges rule their lives.

[Mayabird]

The laser eye surgery/glasses angle probably isn't a good comparison because glasses are freaking expensive, especially for people like me who have really lousy vision, and over the course of a person's lifetime it'd probably be cheaper to just pay for the eye surgery than to get the person a new pair of glasses/set of contacts every year or couple of years.

Also children conceived by IVF do have a greater rate of infertility and requiring IVF for having kids themselves. A lot of times, it really is an underlying genetic cause and that's just being passed on and on.

[Broomstick]

There's also a slightly higher rate of birth defects in IVF children.

The birth defects and generational fertility problems are not such that I would say these people should never reproduce, but I don't think society should pay for them to do so. If they want biological children they can make it a priority and raise the money themselves

[Broomstick]

The laser eye surgery/glasses angle probably isn't a good comparison because glasses are freaking expensive, especially for people like me who have really lousy vision, and over the course of a person's lifetime it'd probably be cheaper to just pay for the eye surgery than to get the person a new pair of glasses/set of contacts every year or couple of years.

Yes and no. Virtually everyone will need at least reading glasses if they live long enough, and according to my eye doctors (a father and son team with the father as a low vision expert and the son having a sub-specialty in post-surgical eye care) laser eye correction often leads to a person requiring reading glasses at an earlier age and needing a stronger lens for that purpose. Also, many people are poor candidates for laser eye correction. I happen to be one such, with several risk factors that greatly increase my chances of complications, most of which would be even more expensive to treat than my current glasses.

There are a very few conditions in which laser eye surgery can, in fact, be medically justified and those of course should be paid for (and when I worked for Blue Cross those conditions were clearly defined and yes, they were covered). Everyone else - if you want it, pay for it.

[Lusankya]

There's also a slightly higher rate of birth defects in IVF children.

Would that be in part due to the average age of mothers using IVF being older than that of mothers conceiving naturally？

I seem to recall that one of the reasons that IVF is used is because women are leaving it later to have children, and some leave it late enough that they need IVF to conceive.

[Broomstick]

Only in part - there's a slightly higher rate among younger woman using IVF, and also when using donated embryos. And by slight I do mean a very, very small increase which is arguably statistically insignificant, except that it's very persistent. On the other hand, because pregnancy with IVF is no accident it should be possible to maximize the mother's health prior to pregnancy which will do a lot to mitigate problems. There are certainly other conditions that are far more likely to adversely the baby, such as certain medications that may be necessary to maintain the health of the mother and thus can't ethically be discontinued during pregnancy.