In vitro fertilization: A private matter becomes public by ProQuest

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Or, les grossesses multiples posent des risques plus levs autant pour la sant des mres que pour celle de leurs enfants. La mortalit prinatale est 4 fois plus leve chez les jumeaux et de 6 9 fois plus leve chez les triplets. Les complications telles que la paralysie crbrale sont de 3 7 fois plus frquentes chez les jumeaux et 10 fois plus frquentes chez les triplets4. Lorsque ces complications surviennent, c'est le systme de sant publique qui en absorbe le cot alors que les parents et leurs enfants en portent le fardeau motionnel.Ces exemples suggrent que la meilleure faon de rduire les cots des complications lies aux techniques de procration assiste au Canada est d'tendre la couverture des soins universels. Les efforts dploys jusqu' prsent pour rduire le nombre de naissances multiples, consistant simplement informer les cliniques prives du nombre idal d'embryons transfrer, n'ont pas russi optimiser la naissance de bbs uniques en sant. La Socit des obst triciens et gyncologues du Canada et le Conseil d'admi nistration de la Socit canadienne de fertilit et d'andro logie avaient mis leur directive ce sujet en 200610 et pourtant, leurs recommandations n'ont pas entran de diminution notable du nombre de grossesses multiples au Canada.Il est temps de cesser de rfrer les femmes vers des pratiques qui aggravent les problmes de sant et sont dictes par des politiques myopes quant aux cots des soins de sant. Toutes les provinces canadiennes devraient suivre l'exemple du Qubec en dfrayant les cots de la FIV et de l'injection intracytoplasmique de spermatozodes. Dans le contexte de la dcision prise par le gouvernement du Qubec, les cliniques de cette province ont convenu de s'efforcer d'obtenir un faible taux de grossesses multiples. Le reste du pays se doit dsormais de lancer une dmarche de coopration similaire afin d'amliorer non seulement le devenir des femmes recevant des traitements de fertilit faisant appel des techniques de procration assiste, mais aussi celui de le

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									                            CMAJ                                                                                             Editorial
                                                                                                                                                FRANÇAIS À WWW.JAMC.CA

                          In vitro fertilization: A private matter becomes public
                          Previously published at www.cmaj.ca on Aug. 31, 2009.




                          F
                                   or infertile couples, the cost of becoming pregnant is largely     Attempts to reduce the number of multiple births by simply
                                   a private matter in most of Canada. However, the cost of           advising private clinics on the appropriate number of embryos
                                   treating complications from multiple births that often occur       to transfer has failed to optimize the birth of healthy singletons.
                          following advanced fertility treatments is a public one. This para-         The Society of Obstetricians and Gynecologists of Canada and
                          dox is at the heart of the reason why we believe that in vitro fertil-      the board of the Canadian Fertility and Andrology Society
                          ization and intracytoplasmic sperm injection should be covered              issued that guideline in 2006.10 These recommendations have
                          under medicare.                                                             not resulted in a noteworthy decrease in the number of multiple
                               In Canada, the overall live birth rate with in vitro fertilization     gestational pregnancies in Canada.
                          is 27% per cycle, which is higher than that of natural conception.1             It is time to stop driving women toward practices that worsen
                          However, as in vitro technology has improved, the number of                 health outcomes and are short-sighted from a health care cost per-
                          multiple births has increased. This is because our current policy           spective. All Canadian provinces should join Quebec in funding in
                          encourages women to have multiple embryos transfered at once,               vitro fertilization and intracytoplasmic sperm injection. In con-
                          rather than costly multiple rounds of single-embryo transfer.               junction with the decision by Quebec’s government, clinics in that
                          Understandably, women want to maximize their chances of get-                province have agreed to strive toward ensuring that no more than
                          ting pregnant.                                                              a small percentage of their patients undergo multiple gestational
                               Infertility treatment is expensive. On average, 1 round of ovar-       pregnancies. A similar orchestrated, co-operative approach across
                          ian stimulation and the associated medications cost about $10 000,          the country is needed to improve health outcomes for Canadian
                          but the cost can climb to $15 000–$20 000 for women who do not              women undergoing treatment with advanced reproductive tech-
                          respond well to the medication and thus require higher doses. At            nology and their children.
                          such prices, almost 59% of couples would prefer twins2 if transfer-
                          ring 2 embryos increases their chance of pregnancy.3                        Renda Bouzayen MD
                               Multiple gestational pregnancies pose higher health risks for          Division Head, Reproductive Endocrine and Infertility
                          both mother and child. Perinatal mortality is 4-fold higher                 Dalhousie University
                          among twins and 6–9-fold higher among triplets. Complications               Laura Eggertson BA
                          such as cerebral palsy are 3–7 times more common among twins                News Correspondent, CMAJ
                          and 10 times more common among triplets.4 When these com-                   With the Editorial-Writing Team (Paul C. Hébert MD MHSc,
                          plications occur, it is the public health care system that bears the         Matthew B. Stanbrook MD PhD, Ken Flegel MDCM MSc,
                          cost while the parents and children bear the grief.                          Noni MacDonald MD MSc)
                               The refusal by most provincial governments to pay for infer-           Competing Interests: None declared for Renda Bouzayen. See www.cmaj
                          tility treatment is driving higher rates of multiple births and the         .ca/misc/edboard.shtml for the Editorial-Writing Team’s statements.
                          resultant complications of prematurity. In addition, such policies
                          lack a full analysis of cost-effectiveness,5 thereby costing taxpay-        Cite as CMAJ 2009. DOI:10.1503/cmaj.091344
                          ers unnecessary dollars and costing mothers and babies their
                          health. (In Ontario, the province will cover in vitro fertilization
                          only for women with blocked fallopian tubes — a discriminatory              REFERENCES
                          practice that has prompted an expert panel to review coverage of   
								
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