Vanessa Gruben argues that Ontario’s new IVF policy should take further steps to ensure the safety and well-being of women and children.
On October 1, 2015, the Ontario Ministry of Health announced its policy on in vitro fertilization (IVF) funding. Although many details of the policy are yet to be worked out, we do know that the province will provide funding for one cycle of IVF for every Ontarian. It will cover all forms of medical and social infertility, regardless of sex, gender, sexual orientation, or family status. However, only women under the age of 43 years will be eligible for IVF funding.
The policy defines one cycle as one retrieval. A retrieval may result in multiple eggs and, in turn, multiple embryos. “The funding would include the one-at-a-time transfer of all viable embryos to allow for the possibility of multiple chances for pregnancy.”
There’s much to commend in the new policy. However, in my view, two important issues must be addressed to protect the health and safety of women using fertility services and children conceived as a result of IVF.
First, the province should require clinics to collect anonymized data regarding who is using fertility services, the success rates and complications. It should also make that information available to the public. Currently, fertility clinics may provide IVF data on a voluntary basis to the Canadian Assisted Reproductive Technologies Register Plus (CARTR Plus) database. In Ontario, this data is linked with Ontario’s Better Outcomes Registry and Network (BORN). The Advisory Process for Infertility Services (a group of experts convened by the province to provide recommendations on the funding of fertility services in the province) recommended that this reporting process be mandatory. I agree. In addition, I believe that data collection should be expanded to include anonymized health information about the women who undergo fertility services (including intrauterine insemination). This data will provide information that is necessary to ensure that fertility services are safe, thus protecting the health and well-being of women and children.
Second, the province must address the information needs of children conceived using sperm, eggs and embryos donated by a third party. Donor conceived offspring have an important interest in the donor’s information. The donor’s family medical history plays an important role in promoting the health of the resulting child. For example, if an individual knows that he or she has a family history of colon cancer, she can make lifestyle choices and undergo earlier screening to mitigate her increased risk. In addition, some individuals who are donor conceived may have a strong interest in obtaining other non-identifying information about the donor, such as the donor’s education or occupation. This information may not necessarily be available to the child. The province should introduce an information registry in order to address this important information gap.
Finally, the province must introduce a mechanism that would help donor conceived offspring to identify whether they are genetically related to another donor conceived offspring, in cases where they are contemplating having a sexual relationship with one another. The province’s failure to address the information needs of donor conceived children will have a particularly negative impact on lesbian couples, gay couples, and single mothers by choice, who often use sperm and eggs from anonymous donors to build their families.
In short, by failing to address these issues, Ontario’s new IVF policy jeopardizes the health and well-being of women and children.
In my view, the province must act on the recommendation of the Advisory Process for Infertility Services and begin consultations on the mandatory data that must be submitted by clinics to an assisted human reproduction database. Further, the province must also consult key stakeholders, including: families who have used donor sperm, eggs, and embryos; health care professionals; lawyers; and ethicists regarding the creation of a donor registry, which will meet the information needs of donor conceived children.
In crafting a donor registry, the province can look to the repealed provisions of the federal Assisted Human Reproduction Act, which anticipated the creation of such a registry. The province should also look to similar information registries which provide adoptees with non-identifying information about their birth parent(s), and which are already in place in a number of provinces.
It’s time to think beyond funding to the broader issues of safety, accountability and transparency.