Re: Why infertility patients deserve our attention. Authors reply

Issue: BCMJ, vol. 60 , No. 6 , July August 2018 , Pages 288-289 Letters

In my editorial, I wrote that it would require a “brave candidness” for physicians to admit that infertility affects us, too. Thank you for your letter, and for your bravery.

Your initiative in writing to the Medical Services Commission is also laudable. Their dismissive response is not only disappointing but also incorrect.

The World Health Organization has stated that infertility is a global public health issue.[1] The Medical Services Plan (MSP) in British Columbia recognizes infertility as a disease for which investigations and surgical management are insured. Unfortunately, MSP does not cover infertility treatments such as insemination or in vitro fertilization (IVF), which are far more efficacious than surgery.

The medical profession in BC has made requests to the Minister of Health to consider insuring IVF. In response to my colleague’s letter, the then-minister, Kevin Falcon, stated that IVF would not be insured because it was “experimental.”

IVF is not experimental; 25 July 2018 marked the 40th birthday of Louise Brown, the world’s first IVF baby. Dr Robert Edwards received the Nobel Prize in Physiology or Medicine in 2010 for the development of IVF. A Canadian randomized controlled trial published in 2004 demonstrated the benefits of IVF over expectant management (NNT = 4).[2]

For women with bilateral fallopian tube obstruction or men with severe male factor, IVF provides high pregnancy rates where conception could not otherwise occur (pregnancy rates that are significantly higher than those resulting from surgical repair of fallopian tubes, which is insured by MSP).

Unfortunately, access to fertility treatment in Canada is suboptimal. IVF utilization rates are less than one-third compared with jurisdictions where fertility treatment is funded (Australia, Belgium, Israel). Cost is by far the largest barrier, as demonstrated by the introduction of provincially insured fertility treatments in Quebec, which increased IVF use by more than 250%.

The persistent refusal of fertility care funding has nothing to do with being experimental or lack of awareness by the Minister of Health. Rather, in spite of the previous Liberal government’s Families First agenda, there was no concern for residents of BC who could not start a family.

While the current NDP government has demonstrated a willingness to improve access and affordability for child care, we hope this letter serves as notice that the medical profession sees a strong need for fully funded fertility care. Many residents of BC need medical help to build their families. Providing MSP coverage for this service will create a future generation of contributing residents (and taxpayers) for this province.

Thank you, Dr Lee, for reinvigorating this conversation.
—Caitlin Dunne, MD, FRCSC
Co-Director at the Pacific Centre for Reproductive Medicine
—Jon Havelock, MD
Co-Director at the Pacific Centre for Reproductive Medicine


References

1.    World Health Organization. Infertility is a global public health issue. Accessed 6 June 2018. www.who.int/reproductivehealth/topics/infertility/perspective/en.

2.    Hughes EG, Beecroft ML, Wilkie V, et al. A multicentre randomized controlled trial of expectant management versus IVF in women with Fallopian tube patency. Hum Reprod 2004;19:1105-1109.

Caitlin Dunne, MD, FRCSC, Jon Havelock, MD, FRCSC . Re: Why infertility patients deserve our attention. Authors reply. BCMJ, Vol. 60, No. 6, July, August, 2018, Page(s) 288-289 - Letters.



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