Cost of funding IVF in Quebec a cautionary tale for other jurisdictions: study

The cost to Quebec taxpayers for a single baby born toa woman aged 40 and older ranges from almost $45,000 to more than$100,000 under the province's publicly funded IVF program, a studyhas found.

And while no live births were recorded for women age 44, the meancost of failed in-vitro fertilization among this age group hitalmost $600,000.

Those findings, say researchers, represent a cautionary tale forany other jurisdiction considering whether to fund a similarprogram.

In 2010, Quebec became the first jurisdiction in North America tocover the costs of IVF for couples unable to conceive on their own.The program funds three cycles of the procedure stimulatingovulation, egg retrieval and embryo transfer that results in alive birth.

The actual cost is higher: The program does not reimbursepatients for medications needed for IVF, which typically run between$3,000 and $5,000 per cycle and are often paid for by privateinsurance.

In all, 246 babies were born to women 40-plus during the2010-2012 study period, said lead researcher Dr. Neal Mahutte,medical director of the Montreal Fertility Centre.

Researchers found that each live birth achieved through IVF forwomen aged 40, and using their own eggs, cost the government$43,153, a figure that increased exponentially with age, reachingalmost $104,000 for 43-year-olds.

In contrast, IVF treatment that resulted in a live newborn forwomen under age 35 averaged $17,919, say the researchers, whosestudy will be presented Monday at the American Society forReproductive Medicine (ASRM) annual meeting in Baltimore.

Because the Quebec government didn't put an upper age limit onits program, older women whose prognosis for conception even withIVF continues to diminish with each birthday are also eligible forfunding.

"So you had an awful lot of patients in Quebec who actuallyunderwent more than three egg retrievals, and particularlyin your forty-two-year-old and older patients, where they have highcycle-cancellation rates, they can have high rates of having aretrieval but no egg, or an egg that doesn't fertilize or nothing totransfer," Mahutte said.

"You had patients who would repetitively cycle because they hadbasically everything to gain and nothing to lose by trying again."

Mahutte said there's a clear relationship between the live birthrate per IVF cycle start and a woman's age.

"And because the live birth rate per cycle start goes down quitesubstantially at age 40 and above, funding those cycles comes at avery substantial financial cost to the public," he told a mediatelebriefing.

"So our conclusion was that any government that's planning to introduce public funding should be aware of this relationship andshould at least consider age eligibility criteria in order tomaximize return on their investment."

Ontario recently announced it will begin funding one cycle of IVFto achieve egg retrieval and one-at-a-time transfer of all viableembryos to allow for the possibility of multiple chances forpregnancy. Women age 42 and under are eligible for coverage, whichbegins in December.

Meanwhile, the Quebec government is poised to overhaul itsprogram under Bill 20, which would remove most IVF coverage from theprovinces's health coverage.

Bill 20 would cap the eligibility for IVF at age 42. Women olderthan that would have to pay for the assisted reproduction procedureout of their own pockets.

Under the proposed legislation, women who qualify for IVF wouldbe offered tax credits based on family income. Those with an annualfamily income of less than $50,000 would receive an 80 per cent taxcredit to cover the cost of treatment, while those with higherearnings could receive a credit as low as 20 per cent.

While clearly expensive for Quebec's public purse IVF coveragewas initially budgeted at $30 million a year, but had hit $70million by 2013 it did manage to achieve one of its major goals.

In part, the program was aimed at reducing the number ofmultiple-fetus pregnancies from transferring more than one embryo ata time in the hope of producing a singleton birth.

That's because twin, triplet and other multiple pregnancies oftenresult in premature and underdeveloped newbornswhose fragilehealth can be costly for the already overburdened health systeminitially for neonatalintensive care and sometimes due to lifelongmedical conditions.

A second study to be presented Monday at the ASRM meeting foundQuebec's IVF program met its goal of reducing the multiple birthrate to less than 10 per cent of all IVF deliveries down from 25per cent before the program began.

"The first incomplete year of the program, it goes down to 13.1per cent, then it goes down to 9.5 per cent the first full year ofthe program," said lead researcher Dr. Michael Dahan, a fertilityspecialist at McGill University's Reproductive Centre.

Provincial health records show there were just over 1,000 IVFbabies born per year before public funding, a number that jumped by64 per cent to 1,723 in the first full year of the program, whilebirths from spontaneous conceptions continued to hover around 84,000each year.

Pre-program, there were 218 multiple births resulting from IVFtreatment in the year coverage was instituted; that figure fell by60 per cent to 165 in the first year after, said Dahan.

"Even though more IVF is being done and more babies are beingborn, the number of multiple births is going down."

Yet despite that drop, the study found the proportion of womenadmitted to hospital after becoming pregnant through IVF rose eachyear after the program's introduction.

"We thought because the multiple pregnancy rate dropped sosubstantially that we would see a decreased rate in the antepartum(pre-delivery) admission. In fact, we did not," said Dahan. "Itwas a little surprising and we have a little trouble explainingit."

Researchers say the publicly funded IVF program has had anotherpositive effect raising the province's live birth rate by almost0.8 per cent "a very significant increase," said Dahan.

Quebec's fertility rate in 2011 was close to the national averageof 1.61 children per woman, according to the most recent figuresfrom Statistics Canada, but fell below the two children needed tomaintain population levels without immigration.