Users of Quebec's publicly funded assisted reproduction program should pay a fee for the service based on their income, a new report says.
A three-person committee tasked with examining the program also says there should be new limits on who can gain access.
"Without putting these criteria in place, the program will not be viable or socially acceptable," said Ghislaine Cleret de Langavant, who produced the report with along Ingeborg Blancquert and Quebec's health commissioner, Robert Salois.
The costs have skyrocketed beyond the original estimates. The program that was supposed to have cost $43 Million in 2012-2013 ended up costing the public health care system $66 Million instead.
Some proponents had originally said free in vitro-fertilization would pay for itself by allowing the state to limit the number of embryos that could be implanted, and so reducing the number of multiple births and, as a result, the number of premature babies that end up in prenatal care.
However, the committee says although multiple births have gone down, the uptake in the program means the public system is not saving money.
People should not be eligible for free IVF treatments if one parent within a couple already has a child, says the committee.
Also, people who have succeeded in having one child through publicly funded IVF should not be able to obtain more free treatments.
The committee says the government should introduce minimum health standards for women, that would consider the likelihood that IVF would work, as well s the added risk factors for women and their potential children.
In particular, their report mentions obesity, smoking, and the chance of passing on genetic diseases. They say fertility clinics should adopt a moratorium on women over 42 who use their own eggs, and that there should be a general minimum and maximum age for the program.
People who have chosen to be sterilized should not be eligible for state-funded assisted reproduction, they say.
And, the committee says Quebec needs to take measures to track patients to prevent them from "shopping around" to different fertility clinics.
"People are going to clinics, and if they are refused, they will go to another one. And, since there was no possibility to follow-up to know what other clinics would do, they would have another option to say 'yes' or 'no'," says Cleret de Langavant. "That situation has occurred."
All parents should also have to sign a declaration on their past psychological and social history, says the report. In cases of serious doubt, there should be an independent evaluation on potential risks for a child.
The committee says these measures should reduce the public cost of IVF by 20 to 30 percent. Still, they also says that users should pay a fee for the service based on their income.
However, the program should be kept, in the committee's opinion, because it does reduce the number of multiple births, improving the health of mothers and children.
Their report does not provide a recommendation on gay couples who use surrogates to access the program, though it does say that a woman should have to go through other forms of fertility treatments before being allowed to access IVF.
Surrogate mothers would normally go directly for in vitro fertilization treatments.
Ready to reflect
The health minister is not committing to any part of the report, and is not saying whether he would even maintain the program.
"I am ready to reflect and make a decision at a proper time," he says.
However, Gaétan Barrette sounded open to limiting access based on certain health standards. "This is not discrimination...it is about sound, secure, medical practice."