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Tuesday
Sep212010

Lifestyle choices and healthcare access (IVF and more...)

I don't like to floss. I never have liked flossing. I've gotten a number of holes in my teeth over the years, some of which may be the result of lack of flossing. Each time, the dentist reminds me to floss. But never does he suggest that perhaps the insurance company wouldn't pay for my fillings because I didn't floss. I have now gotten better about flossing, but not because anyone threatened to take away my access to dental care if I didn't floss. No, it is because the last filling I received was so uncomfortable that I now have more motivation to floss. Is it selfish of me to have been raising everyone else's insurance premiums over the years because I didn't floss as often as I should have? Maybe.

I know people who smoke. They started when they were teenagers. They probably knew something about the risks, but wanted to be cool, so they tried it anyway. Then they got hooked and they couldn't stop. Or could they have? Maybe if they tried harder they could have kicked the habit. I think maybe they could have. But who am I as a long-time non-flosser to suggest that they should have tried harder? I'm raising their healthcare costs by not flossing and they are raising my healthcare costs with their asthma drugs or their lung cancer treatments. Not to mention the people who eat too much fast food, the people who don't use appropriate safety equipment during sporting activities, the people who don't drink enough water, the people who can't put down the salt shaker, the people who lay around in the sun all day, and the people who don't exercise. All of them are raising my healthcare costs and your healthcare costs.

There is a role for public health in encouraging good health. There is a role for public health in educating people about the consequences of the lifestyle decisions that they make. But, in a universal healthcare system, we cannot be saying "too bad, so sad, you made the wrong choice and now your healthcare costs will not be covered."

IVF (in vitro fertilization)So when I was listening to Ontario Today (on CBC Radio) this afternoon, I started to get a bit twitchy. The Quebec government recently announced that it will pay for in vitro fertilization (IVF) treatment for couples in the province of Quebec. It is doing this not only to ensure equal access to the opportunity to have a baby, but also because it hopes making the treatment available will raise the birth rate, which benefits the province financially and culturally. On Ontario Today, they were discussing whether Ontario should also be funding IVF. Of course, there were callers and "experts" saying that women shouldn't be waiting so long to have a baby. That their chances of conceiving are lower if they wait until after they are 35 years old and that the government and taxpayers should not be footing the bill for their lifestyle choices (never mind whether they hadn't met the right person earlier or wanted to be in a stable situation before having kids). This, I think is ridiculous.

Giving some women access to IVF because they are young enough or deserving enough and then denying access to other because they put their career first (wanting to be stable financially and professionally) or their relationship first (wanting to ensure their relationship was strong and stable enough to withstand adding kids), is like telling someone with lung cancer that they can only have treatment if they got it from secondhand smoke exposure, but that it won't be covered if they are a smoker. There are a myriad of reasons why people don't make optimal lifestyle choices all of the time and it is not the place of policy makers to sit in judgment of someone's choice of when to procreate anymore than it is their place to sit in judgment of people who light up.

I'm willing to bet that for every couple who needs access to IVF due to "lifestyle choices" there are at least 20 others having bypass surgery, lung cancer treatment, dental procedures and expensive drug treatments that no one questions their right of access to. Plus all of those other procedures only serve to prolong or improve that person's life, unlike IVF which brings another future taxpayer into the world.

Image credit: Einahpets32 on flickr
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Reader Comments (60)

I bet that the people who are critical of women waiting "too long" to have babies are also the people who criticize adolescents for having their babies "too soon." I don't like the idea of people outside of, well, ME, telling me that my timing or my worth is suspect, and that is exactly what this does.

September 21, 2010 | Unregistered Commenterplastikgyrl

I bet it's a lot more than 20:1. Hospitalists (doctors whom manage inpatient care) estimate that 2/3 of admissions of the the over 65 demographic are due to lifestyle choices...too little exercise, too much food, smoking, etc. 2/3 of admissions over 65 years old is A LOT of people!

September 21, 2010 | Unregistered CommenterMeghan

Meghan:

I'm sure it is too, but I don't have reliable stats to go by. All I have is the Ontario Today intro that says: "In Ontario, 20-40 year olds have a 1 in 6 chance of being unable to conceive a baby without medical help."

September 21, 2010 | Unregistered Commenterphdinparenting

I agree! But everyone has an opinion like everyone has an asshole, right?

September 21, 2010 | Unregistered Commenterashley

Annie, BRILLIANT post. You just wrote what I've been trying to say for YEARS -- without being so eloquent.

It's sooooo not all about age either. Not that it should matter, but it's NOT. I don't know the numbers personally (though I do understand the subject intimately) but there's a multitude of reasons couples rely on assistance in fertility treatements. Age is a drop in the bucket. The negative outcry that has come following Quebec's promise to pay has been horrible.

I have had serious issues with the lack of tolerence from fellow Quebequers on this subject. I cannot stand ignorance.

The unfortunate part in this whole debate is that our medical system is NOT equiped to handle the increase in volume... (nor will Ontario if it comes to pass) and if couples aren't currently dealing with being over 35 -- they just might be before they get their turn... but that's not discussed, only the fact that tax payers are paying for it is discussed, cause that seems outrageous?

Oh... and lets not add to the discussion that abortions are too often used as birth control in QC but help in procreation seems outrageous?

(ok, off my soap box. thank you for writting such a great post)

September 21, 2010 | Unregistered CommenterAnnie

As a mother to two children conceived with IVF, thank you for this :)

As it happens I was 33 when my daughter was conceived, and 37 for my son. We were "older". But we started trying to have a baby in our 20s. It took time to figure out the problem, and to come to terms with it. And as it happens, the same problem would have been there regardless of our ages.

I'm personally not totally convinced that IVF should always be funded, considering all the other health issues out there. I'd rather see a sliding scale based on need (and we paid out of pocket for 4 attempts - and would need to based on a sliding scale too). But that's not the point of your post.

The other thing I hear at lot about IVF is "Then why not adopt? There are so many children that need adopting." Usually said by someone who didn't adopt themselves, I might add.

September 21, 2010 | Unregistered CommenterJuliette

Annie:

Beyond the medical system, there is also the question of whether the day care system, the school system, etc. can handle the increase in volume. But those are all more reasons for finding solutions, not excuses for not funding it (not that you were saying that, but others do).

September 21, 2010 | Unregistered Commenterphdinparenting

Thanks for your post Annie. You always make me think.

I haven't really formed an opinion about whether or not IVF should be funded as I haven't done more than cursory reading on the topic. And like many women, I have had some friends who have made use of IVF to conceive. I do have a question that popped into my head as I was reading your post, and I'm curious as to what you think. I wonder, with great respect, if comparing IVF to lifesaving measures currently covered by health care is a "fair" comparison. Infertility is not a life threatening condition like cancer, blocked arteries, broken limbs etc. Is your point that anyone should receive free IVF treatments indefinitely (which I understand to be an expensive undertaking), or is it more nuanced than that?

I hope you understand that I'm not in any way trying to diminish the anguish of fertility issues, and I am in no way assigning blame to the women and their partners who experience this problem. I just wonder if there is more to explore than just a blanket statement, IVF should be covered.

September 21, 2010 | Unregistered CommenterMandy

The difference between IVF, though, is that it's elective. Heart bypass? Fixing a broken limb? Cancer treatments? All can be problems directly related to lifestyle choices, or maybe they aren't. Like you said, it's not ours to judge. The difference in having the treatment funded is that they are necessary procedures. They are restoring health where it has been damaged. IVF, though I'm sure many who've birthed IVF babies would disagree, is optional. It is elective. The government should not be footing the bill for elective procedures. Shall we give everyone an equal opportunity to have tummy tucks? Because frankly, some women may value flat abs over having children. And if the government is paying for one woman's choice and preference in elective procedure, it probably should be consistent and pay for all of them. (That said, I personally don't believe the government should pay for healthcare at all.)

Slippery slope, no?

September 21, 2010 | Unregistered CommenterAmy

I haven't even heard/read those arguments -- though to suggest that suggests that 'we' shouldn't have them if they're not natural? Surely the 'system' should be equiped to handle new children, not related to how they were concieved. If I decide to have 5 children which is about double the average, would half not have space in school? I know -- you're that wasn't your point -- but that argument would hurt the infertile, a heck of a lot.

September 21, 2010 | Unregistered CommenterAnnie

Amy:

There are plenty of elective procedures that are covered by healthcare too, some of which can be caused by lifestyle choices and some that are not. My son's tongue tie clipping was paid for by healthcare, which meant I didn't have to give him formula. That is a small scale compared to IVF versus adopting a child, for example, but same idea. Even if you do not believe in the government paying for healthcare, if you are using any type of insurance, someone at the insurance company is deciding what is covered and what isn't covered.

September 21, 2010 | Unregistered Commenterphdinparenting

Mandy:

I think that medical experts should be consulted to develop a policy on what will be covered that will maximize a woman's chances of conceiving without giving unnecessary treatments that aren't going to lead anywhere. In Canada, for example, cancer patients do not undergo as many rounds of chemo as they often do in the United States because our policies are based on what is medically appropriate, rather than based on what will allow doctors/hospitals to bill the highest amount.

September 21, 2010 | Unregistered Commenterphdinparenting

There was a time when I would have personally argued that having a child wasn't a necessity. But that was a time long before I wanted children of my own. And even longer before I had to resort to hormone treatments to conceive my second child. Mild compared to IVF? No doubt. But I can also tell you that I would have jumped through a lot more hoops if I had to.

Not everyone chooses to have children, and that's fine. But procreation is a fundamental human experience for many of us. And limiting that only to the 'deserving' or the affluent is outright discrimination. I hope that other provinces follow Quebec's lead.

September 21, 2010 | Unregistered CommenterAmber

Here's a great idea - how about the government takes the vast sums they are giving to beef and dairy industries who are using it to pump our food supply full of sketchy hormones and put that towards a) funding IVF treatments and b) funding independent research about what happens to women who spend decades on hormonal birth control as well as ingest all those hormones injected into cows to see if we can solve the big mystery about why suddenly so many healthy women are having such a hard time conceiving.

September 21, 2010 | Unregistered CommenterLauren

I don't think elective procedures should be covered by publicly funded healthcare; that's my point.

Tongue-tie clipping that prevented your son from breastfeeding was detrimental to his health; I wouldn't consider that elective (I won't go into the full schpiel here, there's science to back up the superiority of breastmilk). (I realize the insurance industry hasn't caught on to this yet, but it is in line with my position on this issue). Your post implies that it was considered elective: to that end, I do think reform is necessary when it comes to defining what's elective and what's not. (For example, FSA accounts not covering a breastpump, but covering things like a first aid kit? I think that's ridiculous and absolutely needs to change.) Necessity's definition will always be flawed, as it will always be shaped by policy makers, but we can strive to improve it. I'd rather put effort toward a sustainable, definition-based list of necessary procedures, than keep heaping things on to that list because people aren't separating values and personal opinions from the true definition of what's necessary.

While I respect Amber's comment below, it's important to note that it's values-based. She values childbearing the same way I do: it was a transformative, life-altering experience that for me, was "necessary." But, I'd hardly imply that *my* values about childbearing mirror those of the entire female population; I really do know women who never plan to have children and who value their physique over having kids. Childbearing is still elective, it's still a preference, and it still shouldn't be on tax payers' dollars.

September 21, 2010 | Unregistered CommenterAmy

THANK YOU FOR THIS. I have one living child and have had four miscarriages, and I'm only 23. I get a lot that I'm young and can have more, but knowing the option is there to have a child when I cannot pay for IVF is helpful (though I would never use it). Infertility is so hard to deal with, and with the price tag that comes with most procedures since a lot of the treatments aren't covered by insurance makes it harder. Women and men need the option for this so they can have their families the way they want. Plus, when it is covered, hopefully they can lower the price for IVF so it is less expensive than other elective procedures.

Great post11

September 21, 2010 | Unregistered CommenterKayce

I would recommend reserving your commentary about the US health care system unless you have actual experience as a patient in a US facility. When I gave birth, my insurance didn't cover the services, and you know what the hospital did? Cut the bill in half.

It's not always just about money.

September 21, 2010 | Unregistered Commentershasta

Amy, I don't understand. You say that the treatments you support being paid for by the gov't are ones that "are restoring health where it has been damaged". Surely a malfunctioning reproductive system is like any other body part: If it's healthy, it works properly, and if it does not work properly, then it is by definition not healthy and should be fixed. Why is a uterus or a testicle that doesn't work properly different, in your assessment, than a heart or lung or knee that doesn't work properly?

There are plenty of procedures that are elective that our health care system pays for. Many knee or hip replacements are elective, for example. Exploratory surgeries are often elective. Lots of things are elective. And trying to draw a parallel between a tummy tuck and the biological imperative of our species to procreate... well, there isn't one.

September 21, 2010 | Unregistered Commenterzchamu

This is exactly the frustration I had during the whole "we don't need to include abortion in health care reform" debacle. Many of the people who weighed in on it seemed to be dressing up their antipathy for reproductive health care with "abortions are elective, I just don't feel like paying for these women's irresponsibility". It's fascinating to see how clearly the lines are drawn: if you smoke and get lung cancer, you may be partially at fault (since after all, we could also blame the cigarette company marketing, the addictive nature of cigarettes, etc.) but you are still deserving of health care. Because, I suppose, you're still a human being, if flawed. If you get pregnant when you don't want to be, you are 100% at fault (note - 100%, not even 50-50 with the person who impregnated you) and completely undeserving of health care. Because, I suppose, you're an irresponsible slut.

September 21, 2010 | Unregistered CommenterRebecca

Amy:

I agree with everything that zchamu said.

I also think it is important to recognize the importance of mental health (not just physical health). Infertility, which is a physical health condition, can also be detrimental to the mental health of the person who is not able to have a baby. Is it better that health care funds be used to fund therapists, psychiatrists and anti-depressants instead of IVF? (Note: I think it should fund both, but I just wanted to point out that refusing to treat one health problem can often lead to other health problems that then need to be treated). This isn't just about values and preferences, it is about physical and mental health.

September 21, 2010 | Unregistered Commenterphdinparenting

shasta:

I often write about things that I don't have direct experience with (like infertility for example), but I don't do it without doing my research. My comments on the motivations behind the number of rounds of chemo that someone is given come from an oncologist who has experience with both the Canadian and US health care systems and was part of a debate on the health care systems in Canada and the United States on CBC radio.

I think it is horrible that it is even possible for insurance companeis to not cover the services related to birth. It is nice that the hospital helped you out, but from what I've heard if there is a big insurance company covering the bill, they are happy to bill as much as possible.

September 21, 2010 | Unregistered Commenterphdinparenting

I'm curious how you reconcile the reality that IVF will be out of reach for some people and not others. Do you feel that, since childbearing is a preference, that it's OK for those who can afford expensive treatments, but not others?

That disparity is the crux of the issue for me. If it's something that you personally feel is extremely important and transformative for you, you can imagine what it would be like if you couldn't achieve it. And how fundamentally unfair it would feel if other people could. I suppose that because I believe it can be so important, that it should not be reserved only for a select population.

September 21, 2010 | Unregistered CommenterAmber

Interesting questions...

I'm just popping in to add that if we were smokers, our insurance rates would be a LOT higher than they are because we aren't smokers. I have a friend who was told that everyone on her company's insurance has to have their BMI analyzed and anyone with 30 or more has to pay a higher premium as well.

September 21, 2010 | Unregistered CommenterThe Casual Perfectionist

"When I gave birth, my insurance didn’t cover the services, and you know what the hospital did? Cut the bill in half."

That's nice for you. Don't be fooled into thinking that sort of thing is in any way typical here.

September 21, 2010 | Unregistered CommenterAugust

Another thought on this subject, I wonder what they're estimating the birth 'rise' will be -- While I can appreciate the rise in IVFers, I also fully understand that it's FAR from exact and that doing IVF does NOT mean a succesful pregnancy/baby. They funding hope for patients -- but three cycles for some couples is absolutely not going to build their family.

September 21, 2010 | Unregistered CommenterAnnie

As someone who has been there, done that with IVF, I usually cringe when I see titles like yours but once I read on I am happy to say THANK YOU for making the point that I've tried to make. I did not cause my infertility (at the ripe old age of 27 just a year after graduation from grad school) and I see plenty of people getting procedures covered that they did cause. Covering IVF lowers higher order multiple births from desperate and cash strapped couples that opt for transferring too many embryos or skipping IVF and doing IUIs. There is also a perception in the general public that infertility can be relaxed away as well as that infertile couples should just submit to god's will which is rather annoying. You would not tell a patient with any other disease that it was god's will and that aside from relaxing they should just give up. Here in the US IVF is being attacked as a back door to getting abortion banned. Ok I am rambling.

September 21, 2010 | Unregistered CommenterNepsi

@Phdinparenting Any industry who repeatedly bills insurance companies will try to invoice for hefty sums, my own employer included. And insurance typically pays for it.

@August And I'm not sure what you mean by 'here', but it happens all the time here in US. Cash patients can get some good deals.

September 21, 2010 | Unregistered Commentershasta

That disparity is life. To quote an old coach of mine: "Life's not fair." There are a lot of things I value and are important to me, that others have and I don't. It IS fundamentally unfair.

I am absolutely not saying childbearing should be "reserved only for a select population." That's got a discriminatory tone to it. I'm not saying we should discriminate, I'm saying we need to deal with the hands we're dealt and not assume that the government is responsible for leveling the playing field.

September 21, 2010 | Unregistered CommenterAmy

I think the mental healthcare system in the US is a shambles and needs a complete overhaul for people to get the services they so desperately need. Again, though: that's not something the government should be footing 100% of the bill on. That's too complex an argument to delve into here, and it's somewhat off-topic, so I'll leave it at that.

September 21, 2010 | Unregistered CommenterAmy

Touche: I suppose an unhealthy reproductive system falls into the same logic I gave earlier.

Here's where I was coming from: I was thinking of IVF for women whose completely healthy bodies have naturally aged out of childbearing. I agree that a woman of childbearing age whose reproductive system isn't functioning properly, should have access to the same coverage that, for example, a cancer patient gets. There are still nuances to that (aging out of childbearing, the completely elective nature of childbearing) that I'm just not going to argue further here, because it's clear that we're coming from fundamentally different camps.

That said, thanks for bringing that point up. It has altered my position a bit.

September 21, 2010 | Unregistered CommenterAmy

That is lovely and amazing that the hospital was able to work with you like that. As someone who lives in the US and has watched friends and family struggle with their own medical bills, I have to say that might be the first time i have ever heard of that happening.

September 21, 2010 | Unregistered CommenterMarcy

You know, I normally agree with charging smokers higher premiums, etc. Your post just made me realize how very unfair that is. Sure, smoking is an obvious habit that is highly correlated to expensive illnesses... but then again, I am not the pillar of perfect health, either. So, thank you for opening my mind up on that issue.

As for IVF, I think it is a travesty that couples have to invest so much money into having a child through no fault of their own. I have been extremely lucky-- I've been able to plan both my pregnancies, and achieve them easily. I don't see why others should have to lose out on the experience of pregnancy and childbirth just because their bodies don't work the same way. (And adoption is not such a "simple" alternative, either-- it can also be very costly, and take a long, long time)

September 21, 2010 | Unregistered CommenterMarcy

Thank you for that last line. My husband and I are currently trying to conceive, we are in our mid 20s, both in good health (minus my infertility). No one has raised the adoption question to us yet, likely because we are still young (which bring another set of ridiculous and insensitive statements regarding our fertility), but I want to be prepared for when it inevitably comes up.

September 21, 2010 | Unregistered CommenterBreAnna

That works if you have the cash. Otherwise you get a mountain of medical debt if you require more than basic check ups, even with insurance.

September 21, 2010 | Unregistered CommenterBreAnna

What a great post.
I have had so many fillings, crowns, & root canals, you (or my dentist actually) would think I don't brush my teeth - which is totally not the case. I can't help that I'm susceptible to cavities. Could I take steps to prevent them like cutting out anything with a dash of sugar in it, flossing my teeth, and using a $100+ Sonicare toothbrush? Sure, and I bought the toothbrush. It doesn't change the fact that I still have a pre-disposition to cavities. The same heritage that brought me 3 decades of annoying dental visits also gave me blemish-free skin, thus avoiding dermatologist visits. So, doesn't it sort of balance out?

There is something to be said for health insurance, like my current company's, that gives discounts for lifestyle choices like non-smoking. Also, all preventive health visits are covered - so any wellness visits are covered. Kind of brilliant on the insurance company's part, but thankfully, it works out in the potential patient's favor because it encourages wellness visits and early detection for major health issues, saving the patient horror and the insurance company money.

HOWEVER... the miracle of life is not to be F'd with. If someone, who is dedicated to being a parent enough to go through the process of IVF, can't have a baby without it - insurance should cover it. Until the price comes down to an affordable range, it has to be covered by insurance. If you're a smoker, you know, at some point, you're going to come down with something - whether it's a nasty cold made worse by smoking or lung cancer. You KNOW that. And you continue to smoke. I'm not saying it's simple to quit - I'm just saying, when you light up, you know the consequences. And it's your choice every time you smoke a cigarette.

It's not like you can put the lighter down and say "you know what? I'm not going to get any older today." Women that can't conceive don't have a choice when they decide they want to have a baby - they can't turn back the clock, they can't fix their system. Even women in their 20s have problems, so it's not just an age issue. Who knows? It could be linked to microwaves, plastic shower curtains, or cell phone towers. We don't know what all of these external things are doing to our bodies. But we have solutions - and we shouldn't deny them to the women that need them.

Thank you for bringing up this issue.

September 21, 2010 | Unregistered Commenterfreshmom

I personally don't think that anyone should tell anyone when to have or not have a baby. But I also don't really think that I (via my taxes) should have to foot the bill for IVF. There are alot of great programs that I don't mind supporting, even if I don't partake of them - immigrant support, public education, etc. - but I'd rather pay taxes to support better adoptive and foster programs than for IVF. I think that IVF is a privilege, not a right, regardless of what brings you to IVF.

Of course, if I lived where other peoples' taxes were paying for my maternity care, I might sing a different tune. Because that's pretty equivalent, isn't it? Community pays for me to have a baby and I pay for the community to have their babies.

September 22, 2010 | Unregistered CommenterSarah @ BecomingSarah.com

Okay, I just read through the comments a bit, and Nepsi changed my mind. It never occurred to me to think of IVF that way. So I'd like to change my tune here and say that I now think it's perfectly acceptable for my taxes to help IVF couples conceive. I wish I'd considered the IVF perspective before!

September 22, 2010 | Unregistered CommenterSarah @ BecomingSarah.com

We were 24 when we were diagnosed. People get stuck on the thought that it's all 'women' 'over 40' -- but they only make up a part of the picture!

While I agree in part Nepsi, I also disagree in others. The number of embryos is not typically 'up to the cash strapped patient' in Canada (well, not in QC, not in my experience with qualified medical professionals) Also, many couples CAN benefit from IUIs and NOT have to undergo the extensive 'hell' that is IVF. if it had been an option for us, we would have tried it.

Also, the coverage in QC is for THREE cycles and it is supposed to cover ONE embryo transfer, unless the dr. decides that more is necessary. Three cycles of ONE EMBRYO EACH could very easily result in NO pregnancy. I'm 'fertile' by all accounts, and had to cycle more often than I wish.... It's so far from logical, it's incredibly hard to dictate these things for 'all cases'. I realize this is off topic, but for those who haven't actually 'thought' about what IVF might mean, I wanted to share a bit more details.

September 22, 2010 | Unregistered CommenterAnnie

Hi Amy,

I'm glad to hear I can actually make sense occasionally :)

There are indeed a whole lot of nuances to the concept of "aging out" of childbearing. It's definitely easy to believe that a woman has just "waited too long", but there are so many layers to that too - perhaps the woman wasn't in a place financially or domestically where they could care for a child properly earlier in her life. In that case, is it better to pay for welfare to help a woman of lesser means support a child she could conceive naturally, or is it better to pay for IVF for a woman who is now in a place where she can support that child independently but is older?

There's also an entire other argument about IVF, in that when people pay for IVF out of their own pockets they are more likely to have two or more embryos transferred (because it's so expensive, they want the greatest likelihood of success, understandably) meaning higher likelihood of a multiple pregnancy - a higher risk pregnancy and higher likelihood of medical bills down the road that mother and child will definitely be covered for - and the amount would far exceed the amount IVF costs. Gov't funded IVF would be more likely to (in fact would probably be restricted to) transfer only one embryo, meaning a safer singleton pregnancy and less likelihood of long term medical bills, thus saving the medical system money overall.

Anyway I realize you said you weren't planning on arguing those points but I wanted to get them out of my head once they were bouncing around in there.

September 22, 2010 | Unregistered Commenterzchamu

lifestyle choices, wrong place/wrong time scenarios, unasked for biological missteps, flossing/not flossing .... what concerns me is what is building up for the future. are we building a tidal flow of increased infertility issues, shortened life spans? and who knows what all these extremely powerful hormonal interventions are doing to women's health long term.
ladies - once again we are being the guinea pigs for 'modern' medicine in the realm of population growth control. i for one am not in favour of tinkering with reproductive hormones without there being a shed-load more research. and this is from someone who is aware of how achingly sad it can be to want a child and not have one, and who is staring menopause in the face as her next big life event.

September 22, 2010 | Unregistered Commenterpomomama aka ebbandflo

I do think that the larger problem is that society encourages through discrimination and negative consequences women to "wait too long". It is a huge health concern in my eyes that society pushes women to wait until they are financially stable, have more stability in their careers, etc. but the reality is that if women have their children "young" they aren't able to become financially stable not out of lack of desire or ability but because they hit a glass ceiling. Employers don't give raises, pay women more money, and limit job opportunities for women during their prime reproductive years. Plus daycare expenses are tremendously high (especially in the States) so high that women's salaries when they are younger aren't worth coming back to work since it doesn't always cover the cost of working, commuting, and child care.

It is riskier to women's health and to the children's health if women are pregnant in their later years. However the rest of society gives the message that women who are in their prime reproductive years aren't as "capable" as women who wait until they are allowed to achieve career and financial success. We have to stop discriminating against women by making more incentives for employers to give younger women the opportunities they are denied and incentives for employers to be more family oriented. If we did that then there would be a lot less IVF demand in the later years, more women taking a chance on starting a family during their prime reproductive years, and healthier women and children. We need to stop sending the message that young adults are incapable of functioning as adults.

However that is not to say that women shouldn't have access to IVF and shouldn't become mothers. Society gave them very few options for success and imposed punishments upon those who did have their children during prime reproductive years. So it is unforgivable that we would then punish them for doing the "right" thing to avoid those consequences of "young motherhood" by refusing them the right to conceive children because they didn't risk poverty and career stagnation to have children younger.

September 22, 2010 | Unregistered CommenterLei Zarycki

Good post, my response is short. I think IVF should probably be covered, but I also wonder how many people actually use the service to warrant such public outcry over the amount of money that will be used. It seems more philosophical than financial, but I'll admit I haven't crunched any numbers. Also, as an American, I think its great Canadians have the luxury of debating whether IVF should be covered. Geeze Louise. We were are left debating whether health care at all is a fundamental right (I happen to think it is).

September 22, 2010 | Unregistered CommenterMeredith

This is actually very common. You would be surprised how often hospitals will lower a bill if you ask. Most people don't realize that medical bills in the States are largely negotiable, especially if you don't have insurance. For my first birth, the bill we received from the hospital had a printed bubble on it which said "Ask about a discount." So, my husband called and mentioned it, and they promptly took 20% off. This was with insurance already factored in.

September 22, 2010 | Unregistered CommenterJill

Keep in mind Annie is talking about this issue in the context of the Canadian system of universal healthcare - insurance premiums don't factor in here.

September 23, 2010 | Unregistered CommenterLindsay

Great post, Annie. I had a heated discussion about this topic with my friends earlier this month. I think that IVF should be covered, absolutely. Couples/women who are about to start the process of IVF - which is NO fun at ALL - are doing it without having tried EVERYTHING else first. These couples don't just wake up one morning and decide IVF is the way to go. They've usually been trying to get pregnant for over a YEAR. As a last resort, there is IVF and it is bloody expensive. Of course we should assist people!

September 23, 2010 | Unregistered CommenterLoukia

Hi Annie. If you do not receive lung cancer or any type of cancer treatment (whether you received the cancer due to a lifestyle choice or not), you will die. If you do not have bypass surgery (which is required, for example, for those who have clogged arteries due to smoking, lack of working out and stress), you will die. If you do not receive a filling at the dentist (b.c you have never flossed after being told by your dentist to), you will be in large amount of pain which can impact your quality of life. The same thing will happen for someone who chose to break a limb in an accident that could have been avoided. If you don’t have a baby (b.c for whatever reason you are unable to have a baby), you wil not be in physical pain nor will you die. You simply have to adjust your life with either yourself or your significant other to deal w. the cards that you have been dealt.

And I have a question for you: if you cannot have a baby and you conceive one through IVF ... and then another ... and another ... b.c you've wished your whole life to have 3 children, at what point does my tax payer money stop paying for the treatment you will receive for free?

And one more question: I don't have a husband (or a boyfriend). And I'd like one. Can your tax money pay for one please?

September 23, 2010 | Unregistered CommenterStacey M

Great post!

I agree that IVF should be covered if there is a reasonable chance that a woman can conceive. I've known many women who have conceived naturally and carried the pregnancy full term (myself included) in their early 40s. I don't know what a reasonable cutoff age is, but 35 is too young for most women. There are many hormone tests that help determine fertility and potential responses to meds. I don't think anyone is advocating for unlimited IVF procedures when there is little chance of achieving a viable pregnancy. That would be medically inappropriate and no ethical physician would agree to it.

Another point I wanted to bring up is that using donor eggs with IVF has an incredible success rate. My fertility doc said that there was an 80% chance of conception on the first try (for me -- at 44!). A woman in her late 40s or even early 50s has almost the same outcome as a woman in her 20s or early 30s conceiving with her own eggs. In the US, using donor eggs usually adds about 10,000 to the cost of IVF.
I did a little research and found out that Canada has made it illegal to buy and sell donor eggs, sperm, even paid surrogacy I believe. But I'm wondering, with such a high success rate, shouldn't these procedures at least be a possibility? Most infertile couples cannot find an appropriate donor to donate out of the goodness of their heart, so these restrictions seem harsh. I know that involving a third party complicates things on many levels. But still, if we really want IVF procedures to result in a healthy pregnancy, shouldn't donors be considered? And realistically they would need to be paid. I'm not saying that the taxpayer should foot the bill for donor expenses, but Canada has made it illegal pay them at all. I just wonder if this is even part of the discussion on IVF. As someone who has been trying to get pregnant in her mid-forties, donor eggs have been presented to me as my best option for achieving a healthy pregnancy. My chance of conception using traditional IVF is less than 5% vs. 80% using donor eggs (and close to 100% with more rounds).

September 23, 2010 | Unregistered CommenterRebecca

I think women who want to have kids should do it while they're young and broke so they can suffer like the rest of us.

:D

That said, a hypothetical society in which both IVF and abortion were both unquestioned public goods might encourage more young women to stay at work/in school for longer and actually lead to greater wealth for everyone-- last I heard one of the best predictors of children doing well in school was having been born to mothers over the age of 30.

As it stands now, I considered waiting till my thirties much too big a risk to take. Thanks "Newsweek" article circa 2000.

Consequently, I skimped on both education and job experience and will probably never make much money.

Thanks for the WIC checks, though!

Medically necessary is an argument many use to oppose public funding of IVF but it's unrealistic to think the gov't should only pay for medically necessary procedures. What defines medically necessary? Does that mean only life-saving procedures or does it include life-enhancing procedures. You won't die if you can't walk because you broke your leg and can no longer walk but it sure does affect your quality of life.

What's medically necessary about a vasectomy or tubal ligation? Both of those procedures are paid for by our health care system and both are expensive but convenient forms of birth control. There are lots of other ways to prevent pregnancy but for many couples, there is only one way to get pregnant - IVF. For them, IVF is medically necessary. It is a medical procedure that is necessary to fix a medical condition which prevents their reproductive system from functioning properly.

Those who use the "medically necessary" argument need to have a clear definition of medically necessary. We're not talking about plastic surgery for cosmetic purposes here, we're talking about a medical treatment for a medical condition. For me, IVF is medically necesasry, my brother-in-law's vasectomy was not.

September 24, 2010 | Unregistered CommenterMollygirl

When debating public funding of IVF and what's "medically necessary", I think it's also important to note that up to 35-40% of infertile couples are infertile due to male factor issues. This is so often seen as a women's issue when in fact, much of it is a men's issue. Many men have poor sperm quality, quantity, etc. Does that change your mind about classifying infertility as a medical condition?

If a man has a low sperm count and the only way to make sure his sperm meets an egg is to put them together in a lab, does that seem medically necessary?

September 24, 2010 | Unregistered CommenterMollygirl

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