Monday, May 07, 2007

Simple & Inexpensive anyway you slice it

I went to reply to DD's comment on my last post and typed out this big, longggg heartfelt reply, and I hit the wrong key and deleted it, (Sorry DD!) so I figured I'd just blend it into today's post instead, and made it all longer. (Sorry to the rest of you!)

Drug companies are NOT our friends, but I actually don't blame them alone for not promoting these treatments.

Some of the greatest advances in fertility treatment in recent years have been simple, easy, & inexpensive. And some of them ARE expensive and difficult but are more cost-effective & easier than the alternatives, like multiple pregnancies, premature babies, dead children, and childlessness. That old evil cost-benefit analysis bogeyman that every insurance company, every Ministry of Health, and every hospital says they live by should tell them that. They disagree.

Utter fucking bullshit, IMO.

The cost of infertility treatment for all of Ontario in one year, drugs, PGD, ICSI, IVM etc. included, is $20 million. Even if more patients came out of the woodwork, it would still only be $30 million. A new NICU to take care of all the multiples that are resulting from unfunded IVF, unfunded IUI, and unfunded IF treatment has a capital cost of $200 million. The Ontario Government has announced it has to build 2 of these in the next 3 years, just to replace the overburdened ones it has right now. Operating costs for Ontario NICUs is in the range of $100-125 million each year. Each miscarriage costs at least $3,000-5,000, and each stillbirth costs $12,000; selective reduction, somewhere in the range of $2,000 unless there are complications.

And yet the government has come up with the half-assed idea of only paying for part of IVF, no drugs, and only for couples with MF infertility. Lab costs & drugs still won't be covered, so no one will bother doing single embryo transfer which they propose to do, because they will be unable to afford to pay for the other half of the IVF cost. They are estimating they want to spend only $12 million.

This is where the bad analysis comes in. Unless they pay for the whole shot, and require all Doctors to do a full slate of proper diagnostic tests ahead of time, (including clotting factors and genetic panels, and SA, etc.) they are still wasting money. They will still need NICUs and they will still be allowing the preventable deaths of thousands of wanted and loved children.

I can add, so can all of you, how come the people in charge of health care can't?

CBC radio has a series on IF right now, and on treatment issues and ethics surrounding them. They keep talking about expensive it is to do IVF, and how it's all the fault of women who wait to long to get pregnant. They had some unproven stat, that most infertility is caused by women who wait to long to start trying, simply because one of the women they interviewed waited until she was 38. The myth of the women who wait too long is incredibly destructive, as destructive as the myth that teenagers can get pregnant and stay pregnant quite easily. (In reality, they are as high risk for pregnancy as older women.) CBC has an online forum here, that has a whole bunch of comments backing me up. Go visit it and leave a comment. You don't have to be from Canada. I've been incredibly incensed listening to their series last week and the all the misinformation they've spread, so I can't wait to see if they correct themselves. I'm not holding my breath. But even if a woman had waited until she was 38, so what? We treat smokers, we treat drunk drivers who crash cars, we treat drug dealers who start gunfights. There is no concept of fault in our healthcare system, never has been, except for this. They say it's about whether IVF has a high enough success rate to bother funding it. Except that we fund all sorts of treatments that have very very low success rates, so that's irrelevant as well.

So besides funding IVF, what could the system do to help us?

I'm a fan of helping us all prevent IF, myself. For example, if men were funded to freeze sperm earlier in life, or to get tested, there would be less MF infertility, not none, but less. Hell, if men were just less embarassed by MF issues, including sexuality, then reproduction would be infinitely easier. But as long as sex remains a forbidden will all be harder to treat.

We know for a fact that STDs cause fertility problems, but we act like that's an issue of fault. We forget about the women whose spouses cheated on them and brought home chlamydia, PID, herpes, or group B strep. We know that 20% of all women will be sexually assaulted in their lifetime, and it's a pretty safe bet that rapists & pedophiles don't use condoms. Yet, the media cruelly assumes that all women with an STD must've been sleeping around and therefore "asked for it". Crime victims & victims of cheating spouses, get no compensation for loss of fertility, no free treatment, no kindness or dignity. Just kicked to the curb...

For years we have known that folic acid, aspirin, & progesterone are incredibly safe in pregnancy, and are very effective way of helping women get pregnant and stay pregnant, yet the myth that progesterone & aspirin are unsafe in pregnancy continues among GPs. They assume that folic acid is something we are already taking, and governments are so slow to put it into food as a supplement, they might as well be publicly declaring that they don't give a damn if our babies die. Progesterone is mythically predicted to masculinize female fetal genitalia, yet in all the years Motherisk has been tracking it, it has never been proven. What has been proven? That women with a genuine LPD will miscarry without it. Aspirin is safe in the first trimester, and the second, and has only been associated with birth defects in the third trimester. Anyone needing immune system therapy or anti-clotting therapy can use heparin after they become pregnant. But hey, let's all spread unproven myths instead, right?

Vitamin A palmitate is incredibly dangerous for fetuses at any amount larger than a micronutrient and can be safely and completely replaced by beta carotene, yet overdose levels of Vitamin A supplements in multivitamins are sold everywhere. And it's not just fetuses, I know one specialist in adult toxicology who has been begging the government to ban Vitamin A for years simply because of the damage to adults, but they don't listen to experts...shit no, too easy. Politicians would rather pay medical bills and complain about the rising cost of health care.

My favourite examples are the new progesterone treatments for preventing early labour & the nitroglycerine patch for stopping contractions in premature labour. Progesterone is super cheap & easy compared to surgical cerclage, and less likely to leave a woman with cervical damage and scarring, and it's been around as a study for 3-4 years, yet almost no-one uses it. Same with the nitro patch. An old old treatment used for relaxing heart muscles having too many contractions, no one ever bothered to try it on pregnant women whose uterine muscles were having too many contractions. And one day, in desperation a Doctor did a study, and lo and behold, it worked.

But use has been limited. Why?

I think in the cold little bureaucratic hearts of the bean-counters our dead babies & lost cycles cost nothing. They see only the costs of childbirth and educating our living children, yet no benefit to their existence until they wonder where our economy will get workers and taxes 20 years down the road. They see no cost for funerals, or grief, or psychiatrist visits, or alcoholism, or unpaid job leaves, or broken marriages. No cost to the time we take off work for surgery or early morning Doctors visits, and they never bother to calculate the opportunity cost of what we could do with that money if we didn't have to pay for IF treatment.

They certainly don't bother to look at the cost of dropping birthrates, the shrinking tax base, the cost to our economy.

They don't want to give us ANY treatment, early or late, simple or hard, expensive or cheap.



  1. I started to read some of the transcripts of that CBC series, but it was making me too angry. It didn't feel balanced at all to me, but in fairness I did not read the whole thing.

    Where on earth did the statement "delaying childbirth is the number one cause of infertility" come from? I have never heard that before, and I know many, many women for whom their infertility had nothing to with age (myself included).

  2. This post is fabulous. It needs to be published in our newspapers. How do we make that happen?

  3. Like our government down here, they are not stopping you from getting treatment, they say. They just won't pay for it. For capitalist/socialist who are short-sighted, it all boils down to money. Those that have it can afford to have infertility treatment or insurance that pays for it while the rest can go....well I won't say cuz it isn't nice.

  4. Hell, yeah!

    One small nitpick. My doctor won't give me progesterone shots because of a couple of new studies linking the shots with third trimester complications. So I am stuck with suppositories. All this by way of saying that progesterone itself is pretty clearly harmless, but the method of delivery can cause issues, and certainly needs further study.

  5. I'm mystified. I can understand it in the US or the UK - their health care systems leave me bamboozled no matter where I look - but I was shocked and amazed when I learned about IVF coverage (or lack thereof) in Canada. I just didn't expect it.

    And it doesn't make sense.


  6. It call comes down to the short-sightedness of our fellow citizens (Canadian, U.S., pick-your-country). They only look at the direct consequences (cost), not the indirect benefits. Until we have people in positions of power with the ability to look beyond their own noses, policy in this area will continue to be bass ackwards. We need to find those people (or be those people) and dedicate ourselves to getting them where they need to be to make a difference.

  7. Lots of interesting information in this post. You make a great case that the government's priorities and evaluation of costs and benefits are just plain wrong.

    I wonder, though, even if IVF were fully funded (and, in the US, it is under some insurance plans), whether there would be any substantial reduction in the number of multiples unless single embryo transfers were mandated.

  8. I am outraged at that CBC discussion. Thank you for bringing it to my attention. I think you are right. As long as treatment is not covered, only the parents have to bear the cost of miscarriages and still borns. The bean counters see only the costs associated to a live healthy child over the cost of their lives. Why the can't see the cost of pre-term babies is lost on me.

  9. I find this pretty difficult to read, it just makes me so angry to think that these options are out there, and yet I was offered none of them.

    I also think that you should be writing stuff like this for a living. I have no idea if that is of interest to you, but you certainly have the talent and the passion. And you would do a better job than whoever is writing it now. No doubt.

  10. This is a fascinating post. You bring up a lot of great points. The ratio of $ spent on IF vs. $ spent on NICUs is shocking. Like Niobe says, I wonder if the only way to get be fewer multiple pregnancies would be to limit the embryos transferred.

  11. How well put and well written.

    I think one of the problems is looking at it as a purely economic issue and ignoring the human cost. We do plenty of things- WIC and Medicare and the VA hospital systm- spring to mind- to help people's quality of life regardless of the cost. But women are ignored and the government pretends it's the triumph of market forces to do it this way.

  12. Honestly, I don't know "why?". My brain is in a bit of meltdown right now, but perhaps I will be able to contribute something thoughtful in time. Great post, btw.

  13. Comment box working for the time being!!! (not that I have anything profound to say besides [another] great post, Aurelia!)
    I know my own poor mother suffered multiple miscarriages until she gave birth to Yours Truly prematurely @ age 32... & when was her 1st pregnancy, you ask?
    Age 18!!!
    Not to mention my BF, whose gyn overrode the recommendation of the embryologist to only transfer one of her "excellent" embryos; now she is expecting twins & growing increasingly freaked out about it -- I mean, all she was hoping for was a healthy singleton! Now she's going to have premature twin boys, let's just hope she makes it to 32 wks or better...

  14. What a seriously kick-ass post. Thank you.