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How old is too old to become a mother?

How old is too old to become a mother?

On Friday, Globe and Mail reporter Kelly Grant discussed the Québec Government’s recent proposition to limit In Vitro Fertilization (IVF) to women over age 42.1 Since 2010, Québec has been the only province, and one of the few jurisdictions worldwide, to fund IVF. Not only are they proposing to end IVF funding, the Québec government is proposing to fine doctors who facilitate IVF for older women. This would restrict access to IVF for women over age 42, even if they want to self-fund, and even if they want to avail themselves of the use of eggs from younger donors. One rationale – and herein lies, in my opinion, the major controversy – is that older mothers giving birth are more likely to have maternal-fetal complications, thereby incurring costs for the health system.

A few facts:

  1. IVF is normally self-funded, but has been funded by the Province of Québec since 2010.
  2. Success rates for IVF decline dramatically after age 40 for couples using the mother’s own egg.
  3. Success rates for IVF in the over age 40 group are reasonably comparable to the younger than age 40 group, if eggs from a younger donor are used.2
  4. Maternal-fetal complications from childbirth escalate with age, especially after age 40.

In typical Québec legislative style, the controversial bill threatens to impose a fine on physicians that recommend IVF to women over age 42. The CBC quoted the Québec Minister of Health: “He [Gaétan Barrette] also said that doctors who advised their patients to seek IVF treatments outside of the province would be subject to hefty fines.”3

As you can imagine, there is already outrage. Organizations that represent the roughly one in six couples that have trouble conceiving are reacting. “We are blown away to see that infertile couples – who have long campaigned for recognition of infertility as a disease – are not being considered as they should be,” said Virginie Kieffer, president of a Québec association of infertile couples.

Of course, a big part of this is budget. The Québec IVF program has been a victim of its own success, with initial projections of provincial spending on the program having grossly underestimated the real costs. In my opinion, this is understandable, and could be a rationale for limiting government-funded IVF access. But of course Québec has taken this one step – and in my opinion, one gigantic faulty step – further. Suggesting that they will penalize physicians who advocate for patients who wish to seek IVF outside government-funded programs, rationalized by increased medical costs of pregnancy for older women, borders on excessive state control. One can only hope that the proposed Bill 20, which parenthetically couples this issue with a requirement for a minimum workload for family physicians, is rigorously debated in the legislature and then defeated.5

If you have any views about this controversial issue, comment on the blog…or better yet, please drop by the Macklem House, my door is always open.

 

  1. http://www.theglobeandmail.com/life/health-and-fitness/health/in-vitro-fertilization-age-limit-spurs-debate-in-quebec/article21964436/
  2. http://www.resolve.org/family-building-options/donor-options/using-donor-egg.html
  3. http://www.cbc.ca/news/canada/montreal/new-quebec-health-bill-to-restrict-ivf-treatments-impose-quotas-for-family-doctors-1.2853715
  4. http://www.center4fertility.com/in-vitro-fertilization
  5. http://montrealgazette.com/news/quebec/opinion-bill-20-will-pressure-doctors-to-practise-conveyor-belt-medicine

Amanda

Fri, 06/30/2017 - 13:13

Perhaps a better way of describing what Quebec is doing is as a form of consumer protection. At some point, the chance for success is so low it is unethical to continue to take money from couples desperate for a child. They’ve been continually promised that they can delay childbearing until they are ready only to discover that IVF doesn’t actually have a 100% success rate! Keep in mind that may HCPs are unaware of the success rates of IVF (see: http://www.ncbi.nlm.nih.gov/pubmed/23157704) Should 42 be the cut-off age? I don’t know. But it is worthy to note that the only sex education most women received was way back in high school and focused on pregnancy prevention. Any decision making in health care must be an informed choice, and it isn’t clear that they are always getting the best information when it comes to delaying childbirth.

Amanda

Thanks Amanda,

I agree with you that there is an impotant educational component to this issue. Thanks for your comments.

Richard

reznickr

Richard Rowland

Fri, 06/30/2017 - 13:13

End tax-payer funding of fertility treatments at a certain age as appropriate, but don’t stomp on individual freedom to seek self-funded care of any variety elsewhere. Logically the next step is to outlaw cosmetic surgery. It certainly becomes less successful with age!

Equally dismaying is the incredible move to require minimal workload for family doctors. Is it because they are on salary? Are there no part-time doctors? No semi-retired doctors? What about a minimum work week for legislators?

Richard Rowland

Moira Browne

Fri, 06/30/2017 - 13:14

The comments above are both spot on. As a family physician, I cannot imagine being put in the position of having to weigh giving care to my patient against the fear of monetary sanctions as a consequence thereof. It is unconscionable. My duty is to my patient…not to the state. The state may have the right to decide to delist procedures from coverage, but don’t tell me I am not allowed to help my patient find care elsewhere.

Moira Browne

Ken Collins

Fri, 06/30/2017 - 13:14

Funding IVF is important as a harm-reduction strategy. That it receives funding is not an endorsement of the right to birth a child, especially in someone, who by virtue of their age is naturally less able to conceive. Infertility is not a disease.

The move to punish those, and their doctors, who receive IVF over 42 years is silly. It disadvantages the poor. Those with means seek treatment outside Canada for infertility, bariatric surgery, the Zamboni procedure, etc. and return here with complications anyway.

Ken Collins

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