IVF coverage?

Fertility groups are trying to get the Ontario government to fund IVF treatments through the province’s medical plan. Their arguments make two main points.

A CBC article quotes Joanne Horibe, co-founder of Conceivable Dreams, who sums up the first point:

Infertility is a serious medical condition with huge economic, social and personal consequences

Infertility is a serious medical condition. But should treatment be public funded? I’m not sure.

Other conditions are easier to reconcile. You break your leg, you have a heart attack, you suffer clinical depression. All of these leave you unable to function as a productive part of society, so society steps in to help you. Does the inability to have children leave you unable to function as a productive part of society? I’m not convinced it does. Perhaps I have a different idea of the purpose of the health-care system.

The second point is economic. IVF treatments can cost $10,000 per cycle. If it doesn’t work, you can try additional cycles or give up. To increase the odds of success, multiple eggs are implanted. This gives multiple chances at pregnancy with a single treatment. The idea is sound. The problem is that it’s too sound. What often happens is multiple eggs survive and come to term. The rate of multiple births from fertility treatments is nearly 30%. Children of multiple births have lower birth-weights and increased risk of health problems. As a consequence, the cost of caring for them is much higher.

Proponents claim that public funding of IVF will allow the government to legislate limits on the number of eggs implanted. This will drastically reduce the frequency of multiple births and reduce the associated medical costs. This is the kind of argument I like to see. Simple to understand and firmly grounded in reality.

But it’s not a perfect argument. Horibe herself hints at what might be a hole in the economic argument:

Many Ontarians could conceive through the use of IVF, but the cost is beyond the financial reach of most families.

I have no numbers, but for the sake of argument, imagine 10,000 women undergo IVF this year. For convenience, let’s assume a 100% success rate. We have 10,000 happy mothers. But since an average of nearly 30% experience a multiple birth, 3000 of those women have more than one child as a result of the fertility treatment.

If government-funded treatments reduce the multiple-birth rate to the non-treatment average of 1.2%, only 120 of those same 10000 women would have a multiple birth, all else being equal. This would result in significant healthcare cost savings. Horibe says the government would save $400 million to $550 million over ten years.

“All else being equal” is an important part of my example above, because all else will certainly not be equal. As Horibe says, most families cannot afford IVF. The CBC article claims that there are 350,000 infertile couples in Ontario. If the government health care plan covers IVF treatments, I see no reason why the number of couples undergoing the treatments won’t increase dramatically.

A reduction of the rate of IVF-induced multiple births to the regular rate (from 30% to 1.2%) would result in the same number of multiple births if 36 times more people underwent IVF treatments and had children. That seems like an outlandish increase, but the amount of reduction in multiple births is an estimate. If it drops to only 5%, a six-fold increase in births as a result of free IVF treatments isn’t nearly as outlandish, and that would wipe out any savings. What if the rate didn’t drop to 5%?

The economic argument is all numbers. Guesses and assumptions, educated or not, are at the heart of it. The health-care savings as a result of free IVF, and the reduction of the frequency of multiple births are chief among them, though the increase in the number of couples taking advantage of the treatments could result in a savings or increased costs, depending on how the variables work out.

With all the unknowns, the situation isn’t as simple as the IVF advocates make it out to be.