Public funding sought for in vitro fertilization
It’s another busy day for Dr. Christina Williams at the Ambulatory Surgical Centre Vancouver. Wearing her scrubs and fresh out of surgery, she sits down for an interview with the Georgia Straight to discuss a subject uppermost in her mind on most days: endometriosis.
She explains that as a gynecologist in Langley in the 1990s, she developed a keen interest in how this poorly understood disorder contributed to pain and infertility.
“It was a very enigmatic disease,” she says, “and we didn’t have good answers. I could see that a lot of the treatments weren’t working.”
It’s also far more common than most people realize, striking 10 percent of women and present in 39 percent of women experiencing infertility.
Normally the ovaries generate hormones that send messages to the uterus’s endometrial cells to start swelling. During a woman’s period, these cells are removed from the body.
Williams, director of Williams Fertility at the Crossroads Clinic, explains that problems can arise when these endometrial cells become implanted elsewhere, such as the ovaries, fallopian tubes, or peritoneum, for example. This can lead to infertility, irregular bleeding, and severe pain.
She pulls out photos of the pelvic area that show tiny black dots with some whiteness in the surrounding area. To the untrained eye, there’s nothing remarkable. But Williams points out that the different vein patterns demonstrate something is awry. Endometriosis is confirmed by laparoscopy, which involves the insertion of a tube to withdraw tissue for biopsy.
“It’s like having an internal sunburn,” she says.
Williams emphasizes that even though these small lesions can cause infertility, there aren’t always symptoms. She and her team published a study last year in the Journal of Obstetrics and Gynaecology Canada compiling the results of more than 400 laparoscopies at her clinic.
“It turned out that 20 percent of the patients had endometriosis proven in the laparoscopy—and those patients had not even one menstrual cramp—but they were infertile for no other reason,” she said.
According to Williams, one of the best ways to treat endometriosis is through in vitro fertilization, particularly for those with an advanced stage of the disorder, which can include tubal adhesions. That’s because the start of an IVF cycle suppresses estrogen, which is at the root of the problem.
IVF isn’t cheap. Williams says one cycle costs $5,000 to $8,500, depending on the fertilization method. Medications add another $3,000 to $4,000 to the bill if they’re not covered by insurance.
And that’s why she advocates public financing for the procedure in B.C., not only to help couples conceive, but also to address the effects of endometriosis. Quebec is the only province to make IVF funding available through its publicly funded health plan. It covers the cost of implanting one embryo at a time, thereby eliminating the likelihood of multiple births.
Williams suggests that reducing the incidence of twins or greater multiple births through the implantation of more than one embryo, as is common with IVF, saves taxpayers enormous costs of keeping these low-birth-weight infants in hospital for long periods of time. In addition, Williams says that premature twins have a higher likelihood of developing learning disabilities.
But not everyone is thrilled with Quebec’s approach. Julie Depelteau of Montreal’s Institut de recherche et d’informations socio-économiques noted in a paper last year that the private sector generates significant profits from public financing of IVF treatments and other procedures linked to reproductive health.
The Infertility Awareness Association of Canada, on the other hand, retained health-economics analyst Lindy Forte to conduct a cost-benefit analysis of publicly funding IVF in B.C. Her report noted that where assisted-reproductive technology is covered under a public health plan, “there has been a corresponding reduction in the rate of multiple births by at least 50%.”
Taking that into account along with an expected increase in IVF utilization, Forte forecast net savings of $13.5 million in the fifth year of publicly funded IVF treatment in B.C.
Williams says single-embryo transfers are having much better outcomes than in the past. “That’s because there is technology now to grow embryos longer—and to select the more advanced embryos—so you only need to transfer one and get the same pregnancy rates,” she states.