Alberta doctor says AHS cancelling fertility services is a ‘tragedy of all tragedies’
An Edmonton doctor says the cancellation of non-insured fertility services like in vitro and insemination at northern Alberta’s only public clinic shows the province does not understand how desperate Albertans are to have children.
“This is a tragedy of all tragedies,” said Dr. Tarek Motan, an associate professor with the Department of Obstetrics and Gynaecology at the University of Alberta Faculty of Medicine and Dentistry.
Motan specializes in reproductive endocrinology and infertility. He works at the fertility clinic at the Lois Hole Hospital for Women, located at the Royal Alexandra Hospital in north Edmonton. Last week, Alberta Health Services revealed it will stop offering non-insured fertility services such as intrauterine insemination and in vitro fertilization there.
“It is a loss for Albertans, because we look after all of northern Alberta and this impacts 17 per cent of Albertans — that’s one in six couples.”
Motan said staff learned the news during a meeting last Thursday with union officials and AHS management. The changes will come into effect in February 2018.
“I don’t think Alberta Health Services and the government actually understands how important families are to Albertans.”
What happens to existing AHS patients?
Motan says as a front-line worker, he is in the trenches and sees the pain of the decision first-hand. His patients now have to start the process of getting pregnant at the Pacific Centre for Reproductive Medicine (PCRM), Edmonton’s only other fertility clinic, which is privately run.
“What’s happened now is that these patients really have no choice, it’s the one clinic in Edmonton,” he explained. “Today in the clinic they were tears — tears of sadness from our patients, tears of anger and frustration.”
“A lot of the time we give hope,” Motan said. “And as this clinic disappears, they see their hope of having a family disappear as well.”
Because the province doesn’t cover fertility treatments — patients pay out of pocket, regardless of whether they go to a public or private clinic. In vitro fertilization involves fertilizing an egg with sperm outside of the body. That embryo is then implanted in the woman’s uterus.
In Canada, a cycle of in vitro fertilization costs approximately $10,000 to $15,000. Motan said some of his patients are worried that will cost even more at a private facility.
“The other things that I heard from my patients is, ‘I’m not sure I can afford to pay the 20 to 25 per cent higher fees,’ because in the private sector it’s market forces that drive the value of the service, it’s not cost recovery.”
The PCRM said in a statement it will work with AHS staff to ensure patient transitions occur in a safe and expeditious manner. When it opened last year, the PCRM was seeing between 30 and 40 patients per day and had about 1,000 patients registered for fertility services. The facility also said it is “increasing its clinical capacity in an effort to minimize wait times.”
WATCH: Edmonton’s first privately-run fertility clinic opened for business in 2016, when Su-Ling Goh filed this report.
Motan said in the over 10 years he’s been practicing, he has seen about 7,500 patients, of which about 3,500 are active. “So can you imagine three and a half thousand patients being delivered to the private health facility? I don’t know how they’re going to cope.”
Motan said while two of the five doctors at the AHS clinic have joined the private facility, the other three — including himself — are staying with AHS. “They are not going to easily be able to accommodate all our patients.”
Ken Seethram, the co-director for PCRM, said every effort will be made to accommodate the new workload.
“We don’t know how many will be actually transferred to us – the coordinator at the Lois Hole Hospital Regional Fertility program is working closely with us to make sure those patients wishing to move their care to us, are dealt with promptly and also with compassion for this stressful time.”
No jobs will be lost, as the Lois Hole fertility clinic will remain open and continue to offer insured services to patients, such as cancer screening and high-risk pregnancy care.
Emotional impact of policy decision
AHS said it is a publicly funded health-care organization that must focus on publicly funded services. Motan said he thinks that’s an over-simplification.
“By design, health care is never there to save you money, health care is there to provide quality of life. As are children. I mean, children don’t save you money — they cost you money — but man, do they give you purpose. So I think it was driven by budget and I also think it was driven by some misinformation.”
Motan said the administration is treating the changes like a “clinical, it’s clear-cut” policy decision without looking at the bigger picture.
“Because the thing of having children, it’s not a logical thing — it’s what binds us, it’s an emotional thing. I’ve often said that you don’t need a child for life, but it is children that gives meaning to life.”
Motan would know — he is a father himself.
“I know it’s not logical, but I’m a parent and I can tell you I am ruthlessly logical — but when it comes to my son, that boy defies logic, he renders me a parent.”
“And I think that’s what you’re hearing from people, you hear the raw emotion, that sense of of loss. And I don’t think the government has thought through this completely. I don’t think they realize how important children are to us.”
Friends of Medicare pointed out the clinic at the Lois Hole Hospital is one of the last of two public academic IVF centres in all of Canada. Motan said these changes are a loss for medicine.
“I walk around with five learners. I have medical students, I have residents, and family med, [obstetrics] and gyno, I have endocrinology fellows,” he explained. “We do research at the clinic and we are proud of that research, and that’s gone. I mean, that’s not going to be able to happen.”
Funding IVF would save Alberta money
Motan said in 2013, he was part of a team that put together a detailed report for the government explaining how it would save money by funding IVF for Albertans.
“I know it sounds crazy, but you can actually save money if you fund IVF because you decrease your risk of multiples,” he explained.
Because of the high cost of in vitro, many women choose to have more than one embryo implanted to increase their odds of conceiving. Multiple births, such as twins and triplets, cost the health care system more because babies tend to be premature and need intensive care.
Most countries that do fund IVF only allow for one embryo to be implanted at a time, decreasing the chance of twins from 30 per cent to less than two. According to Motan’s report, funding restricted, single-embryo infertility treatments could save the province up to $115 million per year.
“And now that the government is giving up on publicly funded health care and moved it to private, that opportunity is lost because now it gets more tricky to reverse that.”
Motan joins Friends of Medicare, the Alberta Union of Provincial Employees and patients in calling for the province to reverse the decision.
“I’d ask them to look within themselves and ask themselves, ‘What would life be like tomorrow if I didn’t have a child?’ You know, those special holidays, how would they be deprived? And then to ask themselves, why would they then take actions that might deprive one in six Alberta couples — and then let’s see where that takes the conversation.”
WATCH: The women’s clinic at the Lois Hole Hospital for Women in north Edmonton will stop offering non-insured fertility services such as intrauterine insemination and in vitro fertilization, Alberta Health Services confirmed Friday. Fletcher Kent filed this report last week.
— With files from Caley Ramsay and Su-Ling Goh, Global News
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