Friday, November 9, 2007

Blogtivism: My Story (& how mandated coverage could have helped)

As part of a recent initiative by Mel & Flicka, I'm adding my voice in the quest for changes to the way infertility treatments are funded (or not) by governments and insurance companies. I live in Canada, where the health care system is slightly different than in the U.S., but coverage for fertility treatments is equally lacking (and maybe even more so!).

My story (Reader's Digest version): my parents were 20 & 21 years old when I was born. Although I was never told in so many words (and although I knew they wanted grandchildren… someday…!), I knew the early years of their marriage were tough, especially financially, and that they hoped that my life would be different. With their encouragement, I went to university, where I met my husband, and both of us went on to graduate school. When we got married in 1985, at ages 24 and 28, we knew we wanted children -- someday. We were fresh out of university, starting entry-level jobs that didn't pay very much, with student loans to pay off, and a bare apartment in an "adults only" building to furnish. I felt a responsibility to make use of the expensive education my parents had paid for, and find a decent paying job in my field. I was far away from my own family, and my mother in law was dead, so I knew I would have little in the way of practical and emotional support in taking care of an infant.

And so we postponed starting a family, until we became better established, financially and careerwise. We felt it was the responsible thing to do. In a heated real estate market, it was five years before we were able to afford a house -- and then there were those mortgage payments to think about (then at 11.75% and, unlike in the States, the interest is not tax-deductible)… The years passed by quickly, and at age 34, after 10 years of marriage, we decided the moment had finally arrived. Naively, I did not anticipate any problems getting pregnant. There were lots and lots of women getting pregnant for the first time in their 30s now. Everyone I had ever heard of who had infertility problems either had irregular periods or, as I had read in the women's magazines, sexually transmitted diseases -- neither of which applied to me.

We tried for 2.5 years. My family doctor would ask me, "Still trying to get pregnant?" and then add encouragingly, "Don't worry, it will happen." Finally, it did: in March 1998, just turned 37, I discovered I was pregnant. I was shocked, and our families were delirious with joy. Sadly, it was a complicated pregnancy, and our daughter was stillborn in August 1998 when I was six months along. Despite our grief and shock, we picked up the pieces and started trying again almost immediately -- this time, with the clock ticking ominously in the background, in a flurry of basal thermometers, daily charting & inspection of bodily fluids, doses of cough syrup to promote mucus production (!!), and a small fortune spent on ovulation predictor sticks. After another year had gone by, with my 39th birthday fast approaching, I finally sought help from the kind and well-respected ob-gyn who had cared for me during my pregnancy and its aftermath.

I feel fortunate that, as a Canadian with "universal" health care, I have never had to pay or worry about coverage for visits to my family dr and ob-gyn, nor for any of the basic infertility testing that my ob-gyn did for us. This included, over the space of several months, a post-coital examination, endometrial biopsy (ouch!) and HSG (dye through the tubes). We heard that waiting lists for local infertility clinics were months long (and at 39, I didn't feel I had much more time to waste), but my ob-gyn was able to refer us to a young RE who was just setting up his practice. We did several cycles with clomid & TI, then made the decision to try three cycles of intrauterine insemination (IUI), using injectable drugs, then re-evaluate. I did not have to pay for cycle monitoring or bloodwork, and (strangely enough) the IUI was covered by our provincial health plan -- although we had to pay ($350, I think) for the sperm washing procedure (!). As for the drugs, none of these are covered by our provincial healthcare plan. I investigated with my supplemental workplace medical & drug plan, and was told there was a $1,500 lifetime maximum on most infertility drugs. The Clomid was cheap, about $65 a cycle, but once we started with injectables, I think I blew through that $1,500 of coverage in less than a week. Each cycle got progressively more expensive as my RE increased the drug dosage. I think the first cycle cost about $2,300 and the third almost $3,000, including drugs & sperm washing.

So within a little more than a year, we had blown through $10,000, and we hadn't even tried IVF. By the time we had finished our three IUI cycles, I was 40 years old, and a physical & emotional wreck, worried about the physical impact the drugs were having on my health and popping Ativan for anxiety attacks. I knew the stresses of IVF, should we decide to attempt it, would be much, much greater. As for the financial stresses, we knew that what we had just spent in a little more than one year would (maybe) cover one cycle of IVF. Ontario, where I live, is the only province, in Canada that provides any IVF coverage at all – and only in cases where both fallopian tubes are blocked (i.e., we did not qualify). Doing IVF would mean dipping into (& perhaps depleting) the savings that we had worked so long and hard to build, and/or piling on debt, at a point when we were just starting to work our way free from it (with the prospect of retirement looming on the not-too-very distant horizon, especially for my dh). We looked at our chances of success -- the statistical success rates for women my age were not good – and that wasn't factoring in my husband's low sperm count, my wonky hormones or my bicornuate uterus. Even in the unlikely event that I was able to get pregnant AND carry a healthy baby to term, we'd have all the costs associated with bringing up and educating a child on top of what we had spent to get pregnant in the first place.

Taking all of these factors into account – physical, emotional, practical and financial -- we reluctantly made the painful decision not to continue treatment and remain childless. Had we been younger -- had IVF been covered, fully or partially -- we may have made a different decision. We might have decided to go directly to IVF and skip the IUIs in the first place, since it afforded us the best chance of success, albeit at a much higher cost.

I suppose some people might say it is our fault for waiting as long as we did to start a family. I do not regret waiting; we did what we felt was right for us & for our future family at that time. Hardly anyone ever starts out trying to conceive, thinking they will have problems -- it's always the other guy, isn't it? I do regret not seeking help earlier than we did and not pressing the point with my family doctor. Perhaps that would have given us more time to explore more options. And I regret that money had to be a factor in making our decisions related to treatment and how long to continue. In some ways, we were fortunate that we could even consider financing IVF on our own -- there are many, many people out there for whom that would not be an option. The cost is just too prohibitive.

Perhaps we thought too long & hard about the responsibility of parenthood. Yet there is plenty of assistance available from the public purse for parents who wind up pregnant easily with little or no thought given to the matter. Our governments pay lip service to “family values” and fret about plunging birth rates, yet do very little to help couples who would love to help remedy the situation!

Towards the end of the recent Ontario provincial election, Premier Dalton McGuinty promised that, if re-elected (which he was), his party would create an expert panel on fertility, and hinted at the possibility of providing financial assistance to couples trying to expand their families. It is too late for my husband & I (now almost 47 and 50), but for the sake of the many other couples in this province who are struggling with infertility, I hope this is not an election promise that winds up forgotten or broken.

(OK, maybe this wasn't the Reader's Digest version after all...!)

2 comments:

  1. "Yet there is plenty of assistance available from the public purse for parents who wind up pregnant easily with little or no thought given to the matter."

    Your quote above sums up so much of the bitterness that I feel about the nonsense of government spending. I don't hear about plunging birth rates here in the US, but we hear a lot about family planning. Except that if you do plan things, and run into trouble later on, the tables turn quickly and suddenly it's a huge tide of judgment. Grrrr......

    Your story is well-told. Very clear, and well-written. I think it will be a good addition to Mel's campaign.

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