Paying the price for late motherhood (National Post, August 11, 2004)

Halle Berry wants a baby, but intends to wait until she is 40. That's a foolish decision: The odds of conceiving at 40 are low. Indeed, her attitude is telling of the general ignorance on the subject of women's fertility.

Society changes, but reproductive systems don't. Nature is no respecter of women's time-devouring academic and professional apprenticeships.

Young people are marrying later and, amongst educated women, it is now common to start one's family over the age of 30. But a woman's fertility window opens widest between the ages of 13 and 25. Then it begins to close. After 35, the odds are stacked against her in increasing increments until, by her forties, the instances of natural conception are rare.

Thus, between 1996 and 2000, assisted reproductive technology (ART) conceptions increased by 67%, according to a U.S. study. In spite of highly publicized celebrity pregnancies through ART, the reality is that the overall conception rate for fertility clinics in Canada is low. Approximately one in five couples fail to conceive naturally within a year of trying. Of those, 80% will succeed if they keep trying or use non-invasive fertility aids like Clomid. Of the 20% who move on to invasive ART such as in vitro fertilization (IVF), the success rate is only 25% to 30%.

Nevertheless, IVF is the only recourse for a growing clientele of anxiety-stricken career women. Many were unaware of their statistical vulnerability, because there have been no public campaigns to inform them of the risks of late conception. Apparently, our government and women's groups regard the trend (if they do at all) not as a burgeoning social problem, but rather an aggregate of individual choices whose consequences are either benign or irrelevant to their mandate.

We can't turn back the clock on women's liberation. Late marriage and small families are doubtless a permanent fact of life in all countries where women's rights flourish. And yet, unless we prefer immigration to be the sole and permanent solution to sustainable population growth, we must admit that fertility treatment is the sobering corollary to the triumph of women's rights, and hope that its success rates expand as technology improves.

But the question then arises as to who should bear its considerable financial burden.

While certain basic treatment is covered by medicare, IVF and other advanced techniques such as embryo transfer are presently available only to those who can afford the required $10,000 to $20,000 treatment cost. (There is one exception: since 1994, Ontario pays for three cycles of IVF, but only for certain women with completely bilaterally blocked fallopian tubes.)

The Nova Scotia Court of Appeal has already ruled on a challenge from a couple who felt the infertile husband's need for introcytoplasmic sperm injection should be covered by medicare -- claiming, in a nutshell, that medicare's refusal to pay was justifiable discrimination. Leave to appeal to the Supreme Court was denied.

And yet the need for infertility treatment is partly a consequence of governments' longstanding policy to encourage women to abandon homemaking and get into the work force, where establishing a career tends to discourage early pregnancy.

Moreover, if gay marriage becomes legal, homosexuals and lesbians will be particularly well-placed to demand ART coverage, since all of them who want children will need it, and withholding ART funding will be viewed as doubly discriminatory.

Coverage is already available in many other countries with universal health systems. France covers four IVF cycles; Scandinavia as well, where ART conceptions account for 2% of total births, while Germany pays 70% of four cycles. The UK is sporadically generous according to region. Human rights legislation that came into force in England and Wales is presently being used in legal challenges to force full coverage.

Once on the topic of procreation, here's a parting paradox to think about: Canada's Assisted Human Reproduction Act (2004) states that, to be eligible for IVF, couples -- or single women -- must sign a personal health information registry and must undergo a psychological evaluation. Yet when Robert Merrifield, Conservative candidate from Yellowhead, said he thought counselling would be "valuable" for women considering an abortion, an indignant journalist asked if he intended to resign over the statement.

To summarize the current situation: You need help to create a life? It's such a serious undertaking that you must receive mandatory prior counselling -- even though it's your body -- and you pay the full cost of treatment. You need help to end a life? You will not be insulted by mandatory prior counselling -- this is, after all, your body -- and the government foots the bill for the abortion.

Maybe feminists can find the logic here. I confess I am stymied.

© National Post 2004