Quebec's axing of fully funded IVF leads to increase in multiple pregnancies

Since Quebec scrapped its fully funded in-vitro fertilization (IVF) program at the end of 2015, more women are turning to intrauterine insemination (IUI), a cheaper fertility treatment — and more are getting pregnant with twins or triplets or more, as a result.

• IVF treatments drop dramatically since Quebec funding cut 6 months ago

So while the government is saving tens of millions of dollars by paying, on a sliding scale, for a single attempt of in-vitro fertilization (IVF), women are faced with either selectively terminating some of their viable embryos or giving birth to multiple babies, which comes with increased health risks and higher costs to the health care system.

From 2010 to 2015, the five years that Quebec paid for IVF, the multiple birth rate was around five per cent.

The multiple birth rate resulting from IUIs is around 10 per cent, said Dr. William Buckett, head of the MUHC Reproductive Centre, Quebec's largest fertility clinic.

The statistics for 2017 aren't yet in, said Buckett, but in 2016, there were 200 pregnancies resulting from IUI procedures, and 20 of them were multiples.

"It was a shock for us to see this coming back," said Buckett. "We had these five years where we were used to very, very low incidence of multiples pregnancy, relative to the rest of North America."

IUI, by the numbers

At the MUHC, IVF procedures are down 70 per cent since 2015, the last year of the publicly funded program, from 1,922 down to 549 for 2017.

In 2015, there were 1,212 IUI procedures, which remains fully covered by RAMQ, Quebec's public health insurance. The number of IUIs have risen by about 600 procedures annually since then, to around 1,800 in 2017.

Why IUI produces more multiples 

For those Quebecers who can't afford the $10,000 to $15,000 for IVF treatment, which is subsidized only on the first attempt, the only option is intrauterine insemination, or IUI.

Just like with IVF, women take medication to stimulate ovulation. However, many patients over-respond to the drugs and produce multiple follicles, releasing several mature eggs.

They might then get pregnant the old-fashioned way — but if all the mature eggs are inseminated, two or more embryos may continue to grow in the uterus.

When IVF was funded, fertility specialists would see that a patient had several follicles and remove the mature eggs prior to fertilization.

"We'd say to women, 'We'll convert this to an IVF and collect all the eggs, because we're really worried about multiple pregnancy," said Buckett.

Higher health risks

In the past year, Buckett said at least two MUHC patients who underwent IUI treatment had to selectively terminate an embryo or several embryos to avoid the higher health risk of having triplets or quadruplets.​

Those higher health risks also translate into a greater financial strain on health care resources, he says.

The mother may need to spend the later stages of pregnancy in hospital.

As for the babies, more than half of twins are born prematurely and may need neonatal care due to low birth weight and to give their lungs, brain and other organs time to fully develop.

"Most of the studies show that for a twin pregnancy it's going to cost something like eight times as much as opposed to a single-term pregnancy," said Buckett. 

"I understand there's pressure on the budget," he continued. "But if the government was serious about reducing these multiple pregnancies, we'd at least be allowed to, perhaps, offer IVF in cases of [a patient's] over-response to medication."

IUI not always an option

Not all women can be helped by IUI.

Alicja Gulajski had to have her blocked fallopian tubes surgically removed, and she also suffers from a low egg count.

"I knew I wanted to be a mother since I was very, very young," said Gulajski, 32,  who lives in Aylmer, Que.

IVF is her only option.

Gulajski and her husband followed the lead of some American couples and successfully crowdfunded the cost of an IVF treatment earlier this year. The procedure failed.

The couple then sold their home and bought a cheaper one, to cover another IVF attempt. It failed, too.

They have one frozen embryo left, and they'll try to transfer it in early 2018. 

"It's about $15,000. That's like a five per cent down payment on a $300,000 house. It's a big chunk of money," said Gulajski.

"It's already stressful and overwhelming to be told you can't conceive naturally."

• Make IVF free again to boost birth rate, CAQ says

Last month, the Coalition Avenir Québec and the Parti Québécois pledged to restore full funding for in-vitro fertilization if elected next fall. The Liberals say it is simply too expensive.

Gulajski says she hopes whichever party is elected considers a more accessible program.