Not any more

Free in-vitro program alarms doctors

In Canada on August 5, 2010 at 08:42

MONTREAL – With more than 3,000 women already signed up for new fertility treatments available free as of today, medical specialists say Quebec won’t be able to keep up with the demand.

Montreal already lacks gynecologists and general practitioners to cover existing pregnancies. According to the Quebec Association of midwives, about 1,500 women did not find a GP or gynecologist to follow their pregnancies last year.

Gaetan Barrette, president of the Quebec Federation of Medical Specialists, said Quebec’s move to become the first jurisdiction in North America to fund in vitro fertilization is premature, given the lack of gynecology and neonatology services, as well as in vitro specialists.

"We have put in place something with great expectations for the public and we won’t be able to deliver. We don’t have proper resources, not the doctors or the physical resources to achieve that."

Barrette added there are fears the program will drain available practitioners.

It’s a move to boost Quebec’s flagging birthrate, Barrette said: "It’s a diversion of medical practice to political issues."

Under the program, which will cost Quebec nearly $70 million, women will be eligible for treatments until menopause and will be covered for a variety of fertility treatments including three cycles of in vitro fertilization.

Costs range from $7,000 to $15,000 per cycle. Montreal’s fertility clinics have beefed up their phone lines and staff, and are reporting a surge in demand from people anxious for treatment.

"The government has provided general guidelines but you need more than that. You need a protocol, who will have access first and where," Barrette said. "There are 3,000 patients on their wait list. So who will go first?"

Quebec is leaving it up to the medical clinics to determine treatment priorities, said Marie-Eve Bedard, spokesperson for Health Minister Yves Bolduc.

But the province aims to reduce the number of multiple pregnancies caused by IVF from about 30 per cent now to as little as five per cent, by restricting embryo implants to one transfer attempt at a time.

At the McGill Reproductive Centre, now running 1,000 cycles a year (expected to jump to 1,700 a year), the policy is to prioritize women according to age and reason for seeking fertility treatments.

For example, a woman slated for cancer therapy will get priority for fertility preservation, explained Dr. Hananel Holzer of the Centre at McGill University.

It can take up to eight weeks to see a fertility specialist at the centre for an evaluation, Holzer said. "I have no idea when a patient I am seeing now can start," he said. But no panic, he added, women who already went though the consultation and have a treatment plan will go first.

It was nearly impossible

reach the Montreal Ovo Clinic, which has more than 700 patients on a wait list and under the new program expects to double its 850 treatments. "The centre is swamped with people anxious to get into the stream for blood work," said Ovo’s executive director Jeffrey Friedman. "It’s a crazy day."

Quebec’s online registry showing who is waiting for treatment and where, is expected to start running today.

Quebec expects to cover about 3,500 IVF cycles in the next 12 months and up to 7,000 cycles by 2014.

The Infertility Awareness Association of Canada, which supports the program, yesterday declared the new IVF policy the most positive news that the health-care system has seen in years.

Beverly Hanck, the association’s executive director, has said the program will translate into millions of dollars in savings because of reduced health costs related to multiple and premature births.

The program will be self-funded, Bedard added. "You can’t underestimate the economic savings because of the reductions in health complications because of a program like that," she said.

That analysis is "bogus," Barrette countered.

Most multiple births result from ovarian stimulation, not IVF, he said: "I did not find one specialist that believes that the program will be self-funded by the reduction of absolute numbers of premature births."

Robert Sabbah, head of the Association of Obstetricians and Gynecologists of Quebec, confirmed that it can take six months to get an appointment because Quebec is short about 70 gynecologists to follow normal pregnancies. Also, hospital neonatal units are full and there are very few pediatricians to take on new patients, he added.

"Who will follow these women if they have complications? We want to help infertile women, and the program is a good thing, we shouldn’t spit on it, but the resources have to come with it," Sabbah said. "To say it’s available doesn’t mean anything."

cfidelman@thegazette.canwest.com

© Copyright (c) The Montreal Gazette

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