Re: Physicians suffer infertility too

I wanted to thank you for shining a light on the darkness of infertility, which affects 12% to 15% of couples in Canada.[1] Physicians are disproportionately affected, as highlighted by Dr Dunne’s editorial.[2] In addition to the financial burdens of infertility treatment, infertility among female physicians can cause myriad downstream effects, including increased burnout; mental health effects[3] with depression and anxiety rates similar to those in people with cancer; and feelings of regret, sadness, and shame over career decisions made while family planning.[4]

I am a physician in BC and have undergone multiple treatments for infertility. I know firsthand the grief and hardship that come from a multiyear struggle with infertility. I am happy to report that since my previous correspondence several years ago,[5] I have had successful treatment. Unfortunately, despite multiple letters, I have not been successful in convincing the BC Ministry of Health to cover infertility treatments so that others with lesser financial means can receive the same opportunities for treatment. This is despite the Ministry of Health’s first expressed mandate being “to make life more affordable. Too many families were left behind for too long.”[6] Many infertile patients in BC continue to struggle to afford the high costs of treatment, which is not covered by MSP. Those without the financial means to undergo treatment when medically indicated may spend years saving resources, only to have their chances of success decline in those intervening years. It is time that BC stops making excuses and define infertility as a disease, as recommended by WHO,[7] worthy of care under the universal health coverage that we Canadians are so proud of.

One of the responses I received from the Ministry of Health was that “MSP relies on the advice of the medical profession in determining the medical necessity of procedures. To date, there has been no indication from the medical profession that it considers IVF to be medically necessary.” Interestingly, one of my obstetrician-gynecologist colleagues was able to determine, that in fact, the Obstetrics and Gynecology Section of Doctors of BC has been advocating for coverage for over 30 years, as shown in a letter from 1988 [Box]. How long do physicians need to make a request before it is considered? Surely 30 years is too long.

Unlike some other diseases, infertility lacks a vigorous, well-funded advocacy group.[8] The reasons are multifactorial, although one could speculate that financial depletion, emotional exhaustion, and stigma may contribute. At any rate, the infertile population would benefit from more physicians speaking up for them, so I thank the BCMJ and Dr Dunne for doing just this.

To support physicians struggling with infertility, I have written several requests to the Doctors of BC Health Benefits Trust Fund to stop singling out infertile patients for exclusion of coverage. Currently, infertility is the only disease category with a lifetime maximum for medication coverage (limited to $2400, which may not even cover medications for one IVF cycle). Removing this lifetime maximum would be a small but meaningful step toward demonstrating that physicians of BC are supporting each other in the face of infertility.

Thank you again for bringing attention to this heart-wrenching yet common problem that British Columbians face. I wish all those struggling with infertility the very best with achieving their family goals, but most of all, I hope they will be treated fairly and compassionately by their physicians and our health care system.
—Susan M. Lee, MD, FRCPC, MAS
Assistant Clinical Professor, UBC

This letter was submitted in response to “Guest editorial: Physicians suffer infertility too.”

References

1.    Bushnik T, Cook JL, Yuzpe AA, et al. Estimating the prevalence of infertility in Canada. Hum Reprod 2012;27:738-746.

2.    Dunne C. Guest editorial: Physicians suffer infertility too. BCMJ 2020;62:318.

3.    Fallahzadeh H, Zareei Mahmood Abadi H, Momayyezi M, et al. The comparison of depression and anxiety between fertile and infertile couples: A meta-analysis study. Int J Reprod Biomed 2019;17:153-162.

4.    Kaye EC. One in four—the importance of comprehensive fertility benefits for the medical workforce. N Engl J Med 2020;382:1491-1493.

5.    Lee SM. Re: Why infertility patients deserve our attention. BCMJ 2018;60:288.

6.    Horgan J. Ministerial mandate letter to Honourable Adrian Dix. 18 July 2017. Accessed 17 December 2020. www2.gov.bc.ca/assets/gov/government/ministries-organizations/premier-cabinet-mlas/minister-letter/dix-mandate.pdf.

7.    World Health Organization. Infertility fact sheet. 14 September 2020. Accessed 9 December 2020. www.who.int/news-room/fact-sheets/detail/infertility.

8.    Adashi EY, Dean LA. Access to and use of infertility services in the United States: Framing the challenges. Fertil Steril 2016;105:1113-1118