In public policy discussions of in vitro fertilization (IVF), the potential for multiple pregnancies (i.e. pregnancies with twins, triplets, or more babies) continues to stir up controversy. In some cases, multiple pregnancies can cause physical, mental, and financial strain for intended parents and their families, and can present medical risk to both the mother and the babies. These are risks the Canadian government seeks to minimize through its universal health plans and, in some provinces, through public policy.

In 2010, Quebec became the first province in Canada to fund in vitro fertilization through universal healthcare. Public policy in Quebec mandates the use of single-embryo transfer (SET) in the IVF process. Single-embryo transfer involves harvesting multiple eggs for fertilization, but only transferring one embryo per IVF cycle; the remaining embryos are kept frozen for potential future use.

Prior to Quebec’s decision to fund IVF, couples could opt to transfer multiple embryos at once—but at their own cost. Once full coverage was available through universal health insurance, however, SET became much more popular in Quebec and was used in 32 percent of IVF cycles in 2011, jumping from 2 percent in 2009. According to Dr. Bradley J. Van Voorhis, director of the IVF Program at the University of Iowa Carver College of Medicine, this increase in SET cycles confirms that these cycles are more likely to occur and will ultimately reduce birth rates of multiples. When public policy first started mandating the use of SET during in vitro cycles, the rate of multiple births dropped from 30 percent to 7.9 percent.

Why Implant Multiple Embryos?

10-20 percent of the population in Western Europe and North America currently experiences infertility, which has led to a rise in the number of intended parents seeking fertility treatments, such as IVF. In 2002, Canada’s crude birth rate—that is, the number of live births occurring among the population of a given geographical area— dropped to an all-time low of 10.5 live births for every 1,000 population.

In provinces where IVF is not covered by universal health insurance, the cost of one cycle is approximately $10,000, and the results are not guaranteed. Thus, intended parents may seek out additional assurances of success, including the transfer of multiple embryos with each IVF cycle.

In Ontario, debate is underway to determine whether this province’s universal health coverage will include the costs of IVF. Some officials are promising coverage of IVF at the beginning of 2015. According to CBC News in Ontario, Health Minister Deb Matthews estimates that Ontario will spend $50 million annually, covering 4,000 or more people, once the program is fully implemented. Today, however, this policy change is still under debate.

If you have experience with IVF—single-embryo transfer or multiple embryo transfer—we’d love to hear from you. Which route did you choose and why? What are your thoughts on public policy changes under consideration in Ontario?