Vanessa Gruben identifies a number of issues that must be addressed in developing an equitable and effective policy for safe fertility services in Ontario.
The Government of Ontario recently announced that it will develop a new policy for fertility services. The stated purpose of the new policy is twofold: to improve affordability and access to services, and to protect the health and safety of women and their babies.
Currently, the government funds intrauterine insemination for all women as well as in vitro fertilization (IVF) for women whose fallopian tubes are blocked. IVF is a process whereby a woman’s ovaries are hyperstimulated with medication to produce more than one egg, the eggs are surgically retrieved and fertilized with sperm, and then one or more embryos are transferred to the uterus. Supplementary embryos may be frozen for future use.
According to the government press release, the government will contribute to the cost of one cycle of IVF. The government will not fund the cost of associated drug treatments, which can be as high as $10,000 per cycle. Nor will the government fund ancillary services, which may include freezing and storage of embryos. As well, the press release refers to single embryo transfer as the principal way to reduce multiple births, which threaten the health of women and their babies. Thus, it appears that the government’s new policy will include a funding component and a regulatory component.
This announcement comes five years after the release of a commissioned report on infertility and adoption. That report recommended, among other things, that the government fund up to three cycles of IVF (including ancillary services) for women 42 years and younger. Not only will Ontario’s new policy differ from these recommendations, it will also differ from Quebec’s policy which funds both the medical procedures and medications for three stimulated cycles or up to six cycles for natural or modified natural cycles. Notably, in Quebec, single embryo transfer is required for women under 36, or where exceptional circumstances exist.
There are a number of threshold issuesthat Ontario lawmakers must consider in developing the details of this policy, a few of these are briefly addressed here.
The first issue is how will lawmakers improve the affordability and accessibility of fertility services and for whom? Lawmakers must recognize the wide range of people who use fertility services and must be sensitive to the diversity of their needs in accessing these services. In particular, the policy must be responsive to the unique needs of same sex couples and single mothers by choice, and should not simply focus on the needs of heterosexual couples who suffer from infertility.
Further, lawmakers must determine the extent to which fertility services should be more accessible and affordable. For example, will the new policy simply subsidize one cycle of IVF, or will it also improve affordability by regulating the price of all fertility services regardless of who is paying for the services? In my view, social policy regulating the price of fertility services is much needed and likely will be more effective than partial funding for one cycle of IVF. Importantly, in developing a policy that achieves this purpose, lawmakers must be careful not to privilege the use of reproductive technologies over other forms of family building such as adoption.
Second, to what extent will this policy protect and promote the health and safety of women and their children? In particular, what aspects of fertility services will be regulated? The press release explicitly mentions multiple births. However, there are many other as yet unregulated aspects of fertility services that may threaten the health and safety of women and their children. For example, the hyperstimulation of a woman’s ovaries is associated with many risks, the most serious being ovarian hyperstimulation syndrome which can be fatal. Despite the complex nature of fertility services and the serious risks involved, there is no licensing regime that is specific to health care professionals who provide fertility services. Nor is there a requirement for specialized training for physicians who provide these services.
In addition, there is no legal mechanism for children conceived using donated gametes to receive medical or other information about their sperm or egg donor, which is directly relevant to their health and well-being. Further, there are few mechanisms in place to protect and promote the health and safety of those who donate gametes, especially women who donate their eggs. Finally, the regulatory aspects should apply to all fertility services, not simply those that are funded or subsidized by the government.
Third, how and with whom will lawmakers consult in developing fertility policy for Ontario? The press release refers to an advisory body that will assist in this process. This advisory body should include health care professionals who provide fertility services; those who have used fertility services to build their families; sperm, ova and embryos donors; women who have acted as surrogates; and adult children conceived using donated gametes. In addition, a consultation process that encourages public submissions, like the recent review of Quebec’s fertility program, will promote a diversity of views on these issues and will go a long way in promoting a policy that is both equitable and effective.
Vanessa Gruben is an Associate Professor at the University of Ottawa, Faculty of Common Law.