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Two board members of the Canadian federal agency 'Assisted Human Reproduction Canada' have unexpectedly quit. This follows the resignations of four senior staff members last year. The agency was founded in 2006 to police Canada's growing reproductive technology sector. It was the response to a process that began 17 years ago with a Royal Commission report calling for urgent regulation of the fertility industry.

The two board members are Professor Françoise Baylis, Canada research chair in bioethics and philosophy at Dalhousie University, and Barbara Slater, a former manager of health sciences policy with the Ontario Health Ministry. Both refused to comment on their resignation, referring to a confidentiality agreement they signed on assuming their roles three years ago. Speaking on behalf of the agency, Health Canada also said it was unable to comment. Professor Baylis stated: 'I really do believe there is a story here, but I have to stay true to this confidentiality agreement'.

'This is a critically important agency,' said Dr Jocelyn Downie, an ethicist at Dalhousie University in Halifax. 'Are we losing the independent, non-ideological voices? I don't know. But when you look at the profiles, that is a legitimate question to ask ... Why have these people left, and what does it leave us with as a board?'

Canada should extend universal health coverage to fund in vitro fertilization (IVF) and intracytoplasmic sperm injection, writes Dr. Renda Bouzayen, Division Head, Reproductive Endocrine and Infertility, Dalhousie University in an editorial http://www.cmaj.ca/press/cmaj091344.pdf with the CMAJ (Canadian Medical Association Journal) editorial writing team.

For infertile couples in Canada, the cost of becoming pregnant is largely private but the public health care system bears the cost of caring for mother and children. Infertility treatments are expensive, with an average cost of $10,000 which can climb to $15,000 to $20,000 for women who require more medication to spur ovulation. Because of high costs, many couples choose to transfer multiple embryos, which can result in multiple births.

However, there are higher health risks for both mother and children with multiple gestational pregnancies. The mortality rate after birth is 4 times higher for twins and 6-9 times higher for triplets than singleton births. Complications such as cerebral palsy are 3-7 times more common in twins and 10 times more common in triplets.

"When those deaths and complications occur, it is the public health care system that bears the cost while the parents and children bear the grief," Dr. Bouzayen writes.

Quebec has recently introduced legislation to ensure the province's health insurance system will pay for in vitro fertilization. After Finland decided to fund single-embryo transfers, multiple births after in vitro decreased from 24% in 1996 to 14% in 2002 with an unchanged live birth rate.

Canada must do the same. A cooperative, coordinated approach across the country is needed to improve health for Canadian women attempting to conceive with in vitro fertilization and the children who are the fruits of this technology.

Abstract

Background
Family and pregnancy planning issues are important among human immunodeficiency virus (HIV)-positive individuals and couples. However, access to fertility services may be limited for this population. The objective of this study was to estimate the types of services available in fertility clinics in Canada for these individuals.

Methods
A survey was sent to all registered fertility clinics in Canada to assess the availability of services (investigations and treatment) for infertility and/or viral transmission risk reduction in achieving pregnancy. The proportion and location of clinics willing to carry out investigations and treatments were determined. Logistic regression analysis was performed to assess differences in response rates, investigations, and treatments by province and by couple scenario.

Results
Completed surveys were received from 23/28 (82%) of clinics across eight Canadian provinces. Seventy-eight per cent (18/23) were willing to accept HIV-positive individuals in consultation, and 52% had actually seen at least one HIV-positive man or woman in the previous year. Clinics in every province were willing to offer infertility investigations, but only clinics located in five provinces were willing to offer fertility treatments. The most commonly available treatment was intrauterine insemination for couples in which the female partner was HIV-positive (52%). Other techniques, such as sperm washing (26%) or in vitro fertilization (17%), were less commonly offered. A smaller number of clinics were willing to offer risk reduction techniques in achieving pregnancy.

Conclusions
Access to infertility investigations and treatments in Canada is limited and regionally dependent.

MONTREAL, July 16 /CNW Telbec/ - Following the announcement on July 13 by Québec's Minister of Health and Social Services, Dr. Yves Bolduc, that assisted reproduction treatments (ART) will be covered by the public health system of Québec as of August 5, 2010, many comments have been made about how this new policy will stress the public health system, and neonatology units in particular.

The Infertility Awareness Association of Canada (IAAC), which advocated for the new law on behalf of infertile couples throughout the country, would like to clarify that, in addition to the benefit of the birth of a child for an additional 1,655 couples per year in Québec, where the birth rate is low, the new measure will clearly translate into savings for the public health system.

The following conclusions have been reached based on a Canadian study, namely, Too early ... too small, released in 2009 by the Canadian Institute for Health Information.

The new Québec program, which includes a single embryo transfer policy, will actually result in savings for Quebec tax payers due to an 83% reduction in multiple birth pregnancies: 77% fewer twins and 95% fewer triplets. In addition, there will be 1368 fewer low birth weight babies.

The savings which will be realized as a result of reducing multiple births down to 5%, as indicated by Bolduc, are as follows:
* Annual savings of at least $27 - $36 million in perinatal hospitalization costs related to the birth of premature multiples.
*Annual savings of $15 - $18 million in post-natal health costs for the first year of care for surviving low birth weight multiples.
* Annual savings of $46 - $60 million in long-term health and social services costs of caring for children with permanent disabilities as a result of pre-term birth.

Lindy Forte, MSc and Health Economics Analyst concluded in her paper thus:
* The full expense of funding Quebec's IVF program ($35 - $71 million annually in the first 5 years) will be completely offset each year by savings in hospitalization, post-natal healthcare, and long-term disability costs related to the care of low birth weight multiples.
* The above figures are conservative in that they do not include the tax revenue lost when a parent of multiple babies leaves the work force to care for their children or the cost associated with the added stress of caring for children with permanent disabilities.

At the moment, women undergoing IVF, either in Canada or abroad, are often having two or more embryos implanted. The high cost of the procedure encourages them to do so, since they hope that implanting a higher number of embryos will either maximize their chances of conceiving and/or allow them to create their new family all at once. This, in spite of substantial medical risks for their babies and themselves.

When he made his announcement, Dr. Bolduc was right to point out that the new Act makes Québec the first place in North America to cover assisted reproduction treatments. However, elsewhere in the world, an increasing number of countries have been offering extensive and often complete coverage for ART through public healthcare. Historically, countries such as France, Belgium, Sweden, the United Kingdom and Israel were quick to offer partial or complete coverage of ART within their national healthcare plans. Other countries such as Slovenia, Croatia, and Turkey have started to publicly fund ART to some extent over the past decade. Reducing the costs of multiple pregnancy was the driving force behind the introduction of public-funding for ART in Belgium and in Quebec as well.

In view of these data, IAAC wishes to convey that funding ART is both a highly justified and ethical use of public funds.