Thursday, October 1, 2009

Fertility Treatments

I was a little late in reading our national medical journal and so came on this editorial.

Essentially the editorial recommends as way to prevent multiple births from fertility treatments (thus shutting down half the reality TV shows) that the procedure should be covered in Canada. Currently prospective parents wanting in vitro fertilization treatments have to pay for the procedure. Because the procedure is expensive, in order to improve the odds multiple embryos are implanted. The hope is that only one will survive to babyhood. Often as we read from the tabloids more than one and in some cases many more than one survive.

Now as the editorial says, there is a significant risk to the mother with multiple gestations. Further as the editorial points out:
Perinatal mortality is 4-fold higher among twins and 6–9-fold higher among triplets. Complications such as cerebral palsy are 3–7 times more common among twins and 10 times more common among triplets. 4 When these complications occur, it is the public health care system that bears the cost while the parents and children bear the grief.

I have two perfect children so I can be smug. I can't really feel the anguish of a couple who is unable to conceive and how empty my life would be without my kids (empty of early morning hockey, school concerts, expensive hobbies?).

The bottom line is however, what are these infertility specialists thinking? Any other specialty who had an elective procedure which could predictably worsen the life of the mother and children would probably be under investigation by licensing bodies, the government and the press. While I hope most infertility specialists entered that subspecialty with a goal of enriching the lives of infertile couples by providing them with children, I suspect a lot of them are Ob-Gyns who at some point in their residency realized that delivery babies in the middle of the night really sucks and they should find a nice well paying subspecialty with good hours. Very few of these infertility specialists actually deliver the babies they implant.

And why is the procedure costly. Part of it is the cost of the infertility drugs. Why are they expensive? Is it the cost of production or is it because some economist with the pharma company calculated that that was the amount that desperate couples were prepared to pay. Another is the private fee that the doctor collects. Again based on what the market will bear rather than any relativity to what other doctors earn for work of similar complexity.

Public health care in Canada was introduced by Tommy Douglas an NDP premier and later national leader of the party. When the NDP government in Ontario decided as a cost cutting measure, that they would no longer cover fertility treatments (one reason was the observation that couples on the wait list conceived as frequently as couples under treatment) there were editorials about how Tommy Douglas was rolling in his grave at the violation of the right to public health care. Tommy Douglas who started out as a Baptist Minister would have no doubt frowned on test tube babies.

Somebody else pointed out years ago that a screening program for clamydia would markedly reduce the rate of infertility and would be a whole lot cheaper.

The whole issue that nobody wants to address is that there are two many damn people on the planet already. If we are going to maintain our standard of living while not exhausting our food and energy we are looking markedly reducing our fertility rate not creating new octomoms.

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