Regulating and treating conception problems

The federal government enacted legislation in March 2004 banning human cloning, rent-a-womb contracts and the sale of human eggs and sperm its most comprehensive attempt to regulate assisted human reproduction.

Bill C-13 had two goals to help people have children safely, and to make sure research into new reproductive technology is ethically sound.

It not only outlines what practices are forbidden, but also what practices are allowed and how they should be regulated. The law bans such activities as human cloning and the buying and selling of human embryos and lays out the rules for practices such as in vitro fertilization and the licensing of research.

It also called for the establishment of a regulatory body that would ensure standards are followed and prohibitions are enforced. The Assisted Human Reproduction Agency of Canada was established on Jan. 12, 2006, with the responsibility of administering a regulatory framework and regime to oversee AHR-controlled activities, as well as to enforce prohibitions under the Act. It is headquartered in Vancouver.

The government says the "AHRAC is about ensuring the health and safety of donors, patients and children born of AHR technologies."

The agency became operational when the federal government appointed a board of directors on Dec. 21, 2006.

Bill C-13 the Assisted Human Reproduction Act (AHRA) is a result of the Royal Commission on Reproductive Technologies in 1993 and was Canada's fourth attempt to pass legislation governing reproductive technologies.

Here is a summary of what is and isn't allowed.

What is not allowed

• Cloning people.
• Cloning stem cells.
• Growing human embryos for research.
• Sex selection.
• Making changes to human DNA that would pass from one generation to the next.
• Creating people who have animal DNA.
• Buying or selling embryos, sperm, eggs or other human reproductive material.

What is allowed

• Surrogate mothers.
• Donating sperm, eggs and other reproductive material.
• Using embryos, sperm, eggs etc. to assist conception.
• Using human embryos and stem cells in research.

The courts weigh in

In 2008, the Quebec Court of Appeal ruledin favour of Quebec's argument that parts of the law are unconstitutional because they violate the right of provinces to regulate health care. The federal government appealed that ruling.

On April 24, 2009, the case went before the Supreme Court of Canada. Quebec supported parts of the law, such as the section that outlaws human cloning. But the province argued that regulating the treatment of infertility falls under provincial jurisdiction. Quebec was supported by Alberta,Saskatchewan and New Brunswick.

"Normally, health services, medical services, regulating the medical profession have for 130 years been the jurisdiction of the province," said Jocelyne Provost, a lawyer representing Quebec.

"Even if [Ottawa's] intentions are good to protect from coast to coast everyone who wants to see a doctor because they can't have children it doesn't allow them not to respect the Constitution."

On July 13, 2010, the Quebec government announced that it would cover the cost of up to three cycles of in vitro fertilization treatment, becoming the first jurisdiction in North America to pay for IVF.

On Dec. 22, 2010, the Supreme Courtreleased its decision on Quebec's challenge of the legislation. It was a split decision, but it upheld the right of the provinces to regulate health care, including fertility clinics.

The ruling means Ottawa was within its jurisdiction, for instance,to ban human cloning and the paying of fees for egg or spermdonation.

TheSupreme Court's judgment clears the way for provincial and territorial governments to re-examine their laws and regulations governing fertility.

But the ruling also leaves in Ottawa's hands the right to determine what expenses will be allowable with respect to surrogacy, organ donation and sperm donation.

Currently, IVF expenses can be claimed as medical expenses on tax returns. But the federal government hasnot issued regulationsdetailing which of these expenses can be claimed.

Common treatments for infertility

After 12 months of unprotected intercourse, 85 per cent of couples should be able to conceive. Over 36 months, half the rest will go on to conceive without intervention.

For the rest, becoming pregnant may require intervention. Depending on the cause of the infertility, approaches can include stimulating ovulation with fertility drugs, including:

• Clomiphene citrate, which stimulates ovulation in women with polycystic ovary syndrome or other ovulatory disorders.
• Human menopausal gonadotropin, which is used for women who don't ovulate on their own.
• Follicle-stimulating hormone, which stimulates the ovaries to mature egg follicles.
• Human chorionic gonadotropin, which stimulates the follicle to release its egg.
• Metformin, which is taken to boost ovulation when infertility is caused by insulin resistance.

Other forms of treatment are referred to as assisted reproductive technology, or ART. They include:

• In vitro fertilization, which is the most effective form of ART. It involves retrieving mature eggs from a woman, fertilizing them with a man's sperm in a dish in a laboratory and implanting the embryos in the uterus three to five days after fertilization.
• Electrical or vibratory stimulation to achieve ejaculation, which is used to retrieve semen from men who can't ejaculate on their own. It's often used on men with spinal cord injuries.
• Intracytoplasmic sperm injection, in which a single sperm is injected directly into an egg to maximize the chances of conception.

If lack of sperm is behind a couple's inability to conceive, surgery or hormone treatment can often help a man increase his sperm count.

The Assisted Human Reproductive Actdid not clearly address theissue ofwhether age should be a factor in determining whether to assist a woman in getting pregnant although for in vitro fertilization, the cutoff age is normally 45-50.

On Feb. 3, 2009, 60-year-old Ranjit Hayer gave birth to twin boys in a Calgary hospital. She had undergone in vitro fertilization in India, after decades of trying to get pregnant the old-fashioned way.

The birth had the specialist who treated her in Calgary asking questions.

"We can do so much but the question is, should we do it just because we can do it?" said obstetrician Dr. Colin Birch, who was excited by the challenge but says he has yet to reconcile the social implications.

"It all sounds very fine when this age group isn't it fantastic what medical technology can do, how we're stretching the boundaries and everything else but there's so much more involved in this. It's not just having the babies and being born," he told CBC.

"There's not just one generation gap here, there's two generation gaps. They're really what would be like the age of grandparents."