Ontario should focus on preventing infertility instead of treating it
Early last month, the Ontario government announced its intention to go forward with an expanded plan to fund in vitro fertilization (IVF) in the province. While Ontario has long funded three cycles of IVF for women with double blocked fallopian tubes, the new program, set to begin in December 2015, will enable all women in the province (under the age of 43) to receive one funded cycle of IVF and the subsequent use of any remaining embryos.
The new program has been widely lauded for its potential to improve access to IVF and to address increasing rates of infertility. This is a particularly important concern given that studies have shown that the rate of infertility in Canada is on the rise, increasing from a rate of 5% in 1984, to nearly 10% in 1992, to approximately 16% in 2012. With this growing rate of infertility has come a rise in the use of reproductive technologies like IVF, with more and more clinics offering a wider range of services.
By focusing on treatment rather than prevention, however, the new program fails to address the problem posed by growing rates of infertility at its source. As the province moves ahead with funded access to IVF — a treatment that is expensive and has risks of serious complications — the government of Ontario should think carefully about what it is doing to prevent infertility in the first place.
Age is one of the most important causes of infertility. Saddled by student loan debt and without access to affordable childcare, it is challenging for many women to imagine how they might have children. Many people don’t achieve financial stability until their education is complete and their career is at least somewhat established. And as women start their families later and later in life, they are more likely to face difficulties in getting pregnant.
The problem posed by delayed childbearing, however, is not best solved by accessible IVF, but rather a rethinking of the social circumstances that lead women to have children at an older age. The government of Quebec’s extensive funding program for IVF was established only after other measures had been taken to improve the provincial birth rate—including heavily subsidized childcare and a robust parental leave program, not to mention relatively low tuition fees. These measures appear to work — birth rates improved in Quebec and are generally high in countries with economic supports for parents. It was only when birth rates plateaued once again that the public funding of IVF was expanded in Quebec. Ontario should take a lesson from Quebec and rethink its priorities to ensure that women are able to make meaningful choices about having children earlier in life, supported by robust social services, rather than simply offering them treatment for the infertility they may experience at a later date.
Sexually transmitted infections (STIs) are another cause of infertility and the rates of STIs among young Canadians are increasing. The growing prevalence of chlamydia and gonorrhea are of particular concern, given that infertility can result from these infections if they’re left untreated. The government of Ontario should not wait for women to have STIs and experience infertility. Ontario has taken an important step forward by updating its sex education curriculum, but family doctor shortages continue in many regions of the province, not to mention the lack of pharmacare. Improving primary care provision and access to treatment for STIs could go far to addressing rates of STIs, and with them infertility, before they start.
Expanding access to IVF is an important issue, and this is something that the government of Ontario should have considered only in a context where preventative measures are taken and the rates of infertility begin to stabilize.
In a publicly funded health care system where where cuts to nursing jobs are jeopardizing the quality of hospital care, and where critical health interventions like eye exams have long been delisted, we must think carefully about how best to promote the health of Ontarians. And it is in this context that the emphasis on IVF as a means to address infertility demonstrates the shortcomings of a health care system focused on treatment rather than prevention. As Ontario finalizes the details of the new funding program, and as other provinces will surely be considering whether they should fund IVF as well, we need to consider what is being done in terms of preventative care. There is much that the provinces should be prioritizing prior to, or at the very least, in tandem with, the public funding of IVF.
Alana Cattapan is a postdoctoral fellow in the Faculty of Medicine at Dalhousie University.