Survey finds poor choices on fertility funds

AN OPERATION to reverse sterilisation of women over 40 who want another baby is significantly more successful and tens of thousands of dollars cheaper than IVF, an Australian study has found.

The study, published yesterday in the Medical Journal of Australia, called for the Federal Government to reinstate Medicare cover for surgical reversal of sterilisation of women, which was withdrawn in 1997.

Live births after tubal reanastomosis were successful in 40 per cent of women aged between 40 and 47, compared with an in vitro fertilisation (IVF) success rate of just 5 per cent for women aged 40 to 42 and 2 per cent for older women.

The direct cost of a reversal is $4850 per treatment, and $11,317 per live birth, compared with about $6940 per cycle of IVF treatment, and $97,884 per live birth for women aged 40 to 42, increasing to $182,794 for older women.

Of the 47 previously fertile women in the study by the University of Adelaide, seven had a first trimester miscarriage and 21 (44 per cent) failed to conceive.

The study, titled Live birth following day surgery reversal of female sterilisation in women older than 40 years: a realistic option in Australia?, said six live births occurred in women aged 44 or older, an age when the likelihood of live birth from IVF is "extremely low".

One in six women aged 40-45 have a tubal ligation, according to the study, Patterns of Contraceptive Use In Australia: Analysis of the 2001 National Health Survey.

Associate Professor Oswald Petrucco, from the School of Obstetrics and Gynaecology at the University of Adelaide, said tubal surgery was a "better option" and "highly cost effective" compared with Medicare-funded IVF for women over 40.

Professor Petrucco said it should be financially supported by the Government or health insurers and not considered a luxury treatment.

"It's considered to be like breast augmentation and doing other operations which are considered to be like plastic surgery rather than essential surgery," he said.

"Medicare's quite happy to pay for people to be sterilised but not to be unsterilised."

Professor Petrucco said unlike the "abysmally small" success rate for IVF of women over 40, reversing the sterilisation would enable them to try to conceive month by month.

Requests for renewed fertility arise because of a new partner, improved economic circumstances or, more rarely, death of a child, he said.

Most of the IVF cost is reimbursed by Medicare in second and subsequent treatments in the same calendar year. For tubal reanastomosis, the day surgery costs about $5000 in a private hospital.

Ted Weaver, the chairman of the women's health committee at the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, said a reversal was preferable to IVF because improvements in IVF technology had not increased conception among older women.

Dr Weaver said there was about a 10 per cent risk of an ectopic pregnancy for all women.

A spokeswoman for the federal Health Minister, Tony Abbott, said "the Government made the decision some years ago that taxpayers should not bear the cost to reverse a procedure that had originally been funded by them" .

Source: http://www.smh.com.au/news/national/survey-finds-poor-choices-on-fertility-funds/2007/09/03/1188783158685.html

Category: IVF, research, tubal reversal