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Quebec IVF

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Leah Yee

on 11 April 2014

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Transcript of Quebec IVF

Québec Assisted Reproduction Program
Health issues related to this policy.
Overview of the Policy
Stimulation or induction of ovulation
In vitro fertilization (IVF)
For 3 stimulated cycles or
For 6 natural or modified natural cycles
Preimplantation genetic diagnosis (PGD)
Egg and sperm donation or retrieval
Sperm, egg, and embryo freezing and storage
(Gouvernement du Quebec, 2013)
Political and Economic
So What?!
The Quebec government
Premier Jean Charest and Pauline Marois
Quebec Health Minister: Yves Bolduc
Persons seeking fertility treatment
Health Care system - lower level of care required
At the Royal Victoria Hospital
82 infants were admitted to the NICU.
75 of these were the result from multiple implant IVF treatments.
The health issues of these neonates were:
20 were extremely preterm (<29 weeks)
6 deaths
5 severe ventricular hemorrhages
5 developed bronchopulmonary dysplasia
4 had severe retinopathy requiring surgery
After policy implementation twin IVF NICU admission would have only been 4 preterm infants.

(Janvier, Spelke, & Barrington, 2011)
Policy Stakeholders- Supporters
What is Quebec Fertilization policy?
Gives an
to people who are challenged with starting a family.
to fertility treatments
related to fertility
Shown to increase
financial efficiency
in regards to treatment to cost ratios
of inability to be fertile
Increases maternal and fetal
Supports the
reproductive rights
of the individual.
Healthy population
Our Recommendations for This Policy

Why was the policy adopted?
The policy was launched in 2010, in hopes to reduce health care cost by:
Reducing 25% the number of multiple fetal pregnancies resulting from invitro fertilization
To provide screening to couples who may be challenged by congenital defects
(Gouvernement du Quebec, 2013)
Long term health, social, and political outcomes for this policy have
not been determined
as of yet because of policy implementation in 2010.
Reclassification of infertility as a disease can
reduce stigma and improve awareness
of this issue, therefore improving social support and coping.

Research surrounding the policy.
Following policy implementation in 2010, the
rate of multiple pregnancies decreased from 25.6% to only 3.7%
by utilizing single embryo implantation treatments
(Holzer, Manhutte, St.Michel, & Kadoch, 2011)
Multiple pregnancies result in:
costs double
the amount with twins.
Preterm labour/deliveries and cesarean section

are more likely to occur.
Trends towards
lower birth weights
Mom and babies are also more likely to have a
longer hospital stay
(Mistry, Dowie, Young, & Gardiner, 2007)
Bissonnette, F., Phillips, S.J., Gunby, J., Holzer, H., Manhutte, N.,
St-Michel, P., & Kadoch, I.J.(2011). Working to eliminate multiple pregnancies: a success story in Quebec. Reproductive BioMedicine Online, 23(4),500-504.
Davidson, M., London, M., & Ladewig, P. (2012). Olds' maternal-newborn
nursing and women's health: Across the lifespan. (9th ed., p. 373). Upper Saddle River, New Jersey: Pearson.
Gouvernement du Quebec (2013) Quebec Assisted Reproduction Program.
Retreived April 9, 2014, from sante.gouv.qc.ca
Health Minister considers changes to IVF spending. (2013). CTV news.
Retrieved from http://montreal.ctvnews.ca/health-minister-considers-changes-to-ivf-spending-1

Janvier, A. (2011). Quebec stops multiple births by funding IVF.
Retrieved April 1, 2014 from http://www.iaac.ca/en/626-590-quebec-stops-multiple-births-by-funding-ivf-by-dr-annie-janvier-pediatrician-neonatalogist-and-clinical-ethicist-fall-2011
Janvier, A., Spelke, B., & Barrington, K.J. (2011). The epidemic of
multiple gestations and neonatal intensive care unit use: the cost of irresponsibility. The Journal of Pediatrics, 159(3), 409-413.

Mistry, H., Dowie, R., Young, T., & Gardiner, H. (2007). Costs of NHS
maternity care for women with multiple pregnancy compared with high-risk and low-risk singleton pregnancy. BJOG: An International Journal Of Obstetrics & Gynecology, 114(9), 1104- 1112.
Tarun, J. (2006). Socioeconomic and racial disparities among
infertility patients seeking care. Fertility and Sterility, 85(4), p. 876 – 881.

Tulandi, T., King, L., & Zelkowitz, P. (2013). Public funding of and
access to in vitro fertilization. New England Journal of Medicine, 328(20), 1948 - 1949.
Velez, M. P., Conolly, M. P., Kadoch, I. J., Phillips, S., &
Bissonette, F. (2014). Universal coverage of ivf pays off. Human Reproduction, 29(4), 1-7.
Statistics Canada. 2010. Visual census. Retrieved April 9, 2014. 2006
Census. Ottawa. Released December 7, 2010. http://www12.statcan.gc.ca/census-recensement/2006/dp-pd/fs-fi/index.cfm?Lang=ENG&TOPIC_ID=11&PRCODE=24
Budget (Velez Et al. 2014)
Before Policy
After policy
Number of cycles:
Total cost:$31,402,401

Number of cycles:
Total cost:$49,184,098

Before Policy
After policy
Demographics Of Quebec residents using IVF (Kiesewette et al. 2013)
Ethnicity(white): 66.2%
Education: 68.0%
Unemployment: 03.6%
<$65,000 income: 36.7%
Ethnicity(white): 62.8%
Education: 63.1%
Unemployment: 11.6%
<$65,000 income: 47.4%
Quebec IVF Cycle growth after policy:
Quebec's subsidization costs of policy:
IVF and the Populations Health
- Michael's Reflection piece
After the policy change the
mean age
of women receiving treatment was
35.4 ± 5.2 years
The mean age of men was
38 ± 6.6 years
(Kiesewette et al. 2013)
Risks for Women over 35 include:
gestational diabetes
placenta previa
complication in labour
Risks for Men over 40:
Infant Schizophrenia
Infant Autism
(Davidson, London, & Ladewig, 2012, p. 373).
Challenges to Policy
Societal burden
Private companies that provide fertility treatments
Based on a survey done by Tulandi et al. (2013), it was found that individuals of
background made up the majority users at the fertility clinic in McGill University.
What happened in 2013
Social and Political Elements After the policy change
Related political implications
Social Changes

More family households with a
low median income
unemployed individuals
used ART services and there was an increase of couples seeking secondary treatments after the policy change.
Essentially it makes access to fertility treatments
anyone who has health insurance in Quebec
Opens up treatment options for individuals within the population who had
previously limited resources and support

Increased demand for social services
, including low income support, social work, food services, and subsidized health services

Politically shows support for individual's
rights of reproduction

Quebec's population identifies that:
Not a visible minority: 6,781,550
Total visible minority population: 654,355
(Stats Canada census, 2006)

identified as a Visable minority
Kiesewetter et al.'s (2013), study highlights that
of Quebece IVF users 8 months post-policy identified as "white", as such
would be a visible minority.
Increase the
to recieve subsidized fertility treatments,
such as:
Minimum family/individual
Ability to provide good faith in
parenting skills
on challenges and risks surrounding fertilization process, as it is unique from normal reproduction

Class power and Prestige
Potential barriers include:
Level of education and limited access to certain services
(Tarun, 2006)
Couples are willing
invest a lot money
for infertility treatments
Stigmas include:
Society cannot afford
to fund IVF
It is only used by people who
waited too long
"Infertility is
nature's way
of saying that a person is not meant to have children" (Janvier, 2011)
Implications on Overall Health
We like this policy because!
Leah Yee
Wilson Troung
Michael Wright
Jacqueline Rye
Michelle Schuepbach

Social and political factors and Demographics
Full transcript