Thousands of viable embryos in limbo if Quebec changes IVF program

Some health professionals are concerned that thousands of frozen embryos will be in limbo if the provinces goes ahead with Bill 20, which proposes to drastically scale back and restrict access to publicly-funded in vitro fertilization treatments.

• Quebecers hope government is open to compromise over IVF program
• Quebec in vitro fertilization program to be scaled back

When a couple undergoes IVF, extra embryos are often frozen for later use.

More than 15,000 embryos from about 3,000 patients are stored at the MUHC Reproductive Centre.

But as Bill 20 stands now, women over the age of 42 would be banned from having the procedure — and a couple wouldn't be eligible for tax credits if they already have a child.

Dr. William Buckett, the centre's medical director, says the bill's proposed changes could prevent many couples from accessing their stored embryos.

"I would hope that people who had created embryos as a result of the publicly funded program, will be allowed and will not be penalized to have treatment to use those embryos in order to have or complete their family," said Buckett, who hopes the final version of the bill will clarify what will happen to stored embryos already in the system.

When questioned today, Health Minister Gaétan Barrette would not say what will happen to the stored embryos once Bill 20 passes.

"At this point in time, the situation remains as is. We are consulting many people as we speak today. Many people suggested to us to have patients pay for that," Barrette said.

"But as we speak today, nothing will change. They will be maintained, the conservation of the embryos will be maintained as we speak. We'll have to decide what to do after that."

Model for the world

Quebec's publicly-funded IVF program started in 2010 and Buckett says it was celebrated as a model for other countries.

The generous program funded 3 cycles of IVF and resulted in thousands of babies. A single embryo transfer by IVF also dramatically reduced multiple births, which can result in pre-term babies and health complications.

Now Buckett says he's getting calls from from those same colleagues asking him if the changes are for real.

"Honestly, I think it would be a shame, to use the expression, to throw the baby out with the bathwater," he said. "There are ways to reduce costs without overall affecting access."

Buckett thinks there are ways to find savings without dismantling the whole system. He'd like to see some level of publicly funded, medicare covered IVF continue.

"Perhaps cap funded cycles — have an age limit for that. That's different than not doing IVF at all at a certain age," he said. 

Guidelines that spell out what type of tests should be done and what course of treatment to try would also make sense, he added. 

As the current bill stands, women who are over the age of 42 would be banned from accessing IVF, even with donor eggs.

Buckett hopes that doesn't stay in the final bill. 

"If we look at using donor eggs for somebody who is otherwise healthy and good candidates to be pregnant, using donor eggs for someone who is 43 or 44 is not a problem at all. There is no medical reason not to do so," Buckett said.

MUHC reproductive centre's future

When public funding of IVF started in 2010, the centre started to perform about 2,500 IVF cycles a year. 

That would likely drop to about 1,000 if Bill 20 is approved as is, Buckett says, because many couples couldn't afford it.

The government is offering a sliding scale of tax credits for one IVF cycle, but Buckett says it's not realistic.

"The biggest tax credit is for a couple whose collective income is $50,000 or less. The reality of a couple living on $50,000 or less is they are unlikely to borrow or have in their savings the $8,000 to $10,000 to pay before getting the tax credit back," Buckett said

Since the government announced the bill at the end of November, there has been a 10 to 20 per cent increase in the number of patients making appointments and they have added some IVF clinics.

But Buckett says that doesn't mean that they are being rushed to IVF.

"For sure, there is heightened anxiety," he says. "But it's not like someone who wants to have a baby and bang, you do IVF. So that process of evaluation and perhaps other treatments you'd normally do before IVF still needs to be done."

Buckett says until the changes are in place, it's business as usual. 

Superhospital move on hold

The Royal Victoria hospital is moving to the Glen site next month, but for now, the fertility clinic will stay behind at the old hospital

Buckett says they will likely move to a building near the superhospital in the fall. 

By then, the scope of Bill 20's changes will be known and the extra time will give the centre time to do quality control checks in the new lab.

Parliamentary committee hearings

The MUHC Reproductive Centre will make its presentation before the parliamentary committee studying the law next week.

Health Minister Gaétan Barrette says feedback from patients, doctors and health groups will be considered and amendments could be made.

"I am not set in that this is a done deal. This is a process which we can and we will, when it's pertinent, modify the bill in accordance to what was said in those hearings," Barrette said.

The hearings wrap up March 25.

The government could pass the bill as early as this spring.