MONTREAL - The Quebec government will start funding in-vitro fertilization next month, but the new measure announced by Health Minister Yves Bolduc yesterday also has raised questions about who will be prioritized for treatments and whether couples who can afford it can still pay for the service privately.

Bolduc was adamant the costly treatments would no longer be offered privately in Quebec, despite concerns raised by one of the pre-eminent specialists in the city that private fertility treatments should continue to be provided to couples who can afford it.

Instead, couples who want to go to private clinics will now have to go out of province or to the United States, Bolduc said yesterday.

Seang Lin Tan, chief obstetrician and gynecologist at the McGill University Health Centre, said if patients can turn to private clinics for MRIs and other procedures, they should be able to do the same with in-vitro fertilization.

Otherwise, he said, the system will be overwhelmed.

"Medicare can't cope with many areas of medicine," Tan said. "The price we pay for free treatments is waiting lists. It will just be more of a burden on the system if we eliminate (private treatments)."

Yves Robert, secretary of the College des medecins du Quebec, said he understands why the procedures might not be allowed privately.

"This is an announcement of a new waiting list," he said yesterday. "The physicians will be so overwhelmed, no one will be able to offer services privately."

But Tan said that each day a woman waits for treatment, her chances of successfully conceiving drop. He says private treatment should still be an option for women who aren't happy with their place on the inevitable waiting list.

Bolduc, however, said waiting lists will be based on medical criteria.

Karine Rivard, Bolduc's press aide, said the government has established agreements with private clinics so that even if fertility treatments are performed there, they will be subsidized.

Jeffrey Friedman, the director of the OVO Fertility Clinic, said he can't understand why women can't choose to spend money to have the treatment done privately and spare the government the cost. In-vitro typically costs anywhere from about $7,000 to $15,000 per cycle.

Bolduc's announcement at the Royal Victoria Hospital yesterday was full of hope for increasing the number of successful fertility treatments for couples in Quebec. He said the annual number of in-vitro fertilizations covered by the program is expected to double from about 3,500 this year to 7,000 by 2014. It is estimated that the program will cost the government about $25 million the first year, and up to almost $70 million by 2014.

The province said it hopes these measures will result in 2,000 additional births a year in Quebec.

Quebec is the first jurisdiction in North America to cover the cost of fertility treatments. The program will cover egg harvesting, in-vitro fertilization (up to three times), pre-implant genetic testing, embryo transfer and sperm sample collection.

Despite the cost of the program, Bolduc said there would be significant savings due to the way fertility treatments will be managed; with the new system, there won't be as many embryos implanted at once, which is expected to reduce the number of multiple births. In fact, the proportion of multiple births is expected to drop from about 30 per cent to less than 10 per cent.

However, Robert said it's usually ovarian stimulation that accounts for multiple births, not the in-vitro fertilization, which he says is one of the pitfalls of the new system.

Still, for couples struggling to conceive, the new program represents a relief.

After spending $23,000 on fertility treatments, Michael Kriaa and his partner, Josee Goupil, felt they had to wait for the new program because they just couldn't afford any more treatments.

"It's great news, but I hope it's not too late for us," he said. "There are many couples like us who were waiting for the announcement."

TV personality Julie Snyder, who has been lobbying for fertility treatments to be covered by medicare, attended the news conference yesterday and recalled the palpable suffering she could feel in fertility centre waiting rooms.

"There are some people who can only afford one treatment, so you cry with them," she said. "It's deeply unfair. I promised God that if I had my baby I'd do my best to help others."

Caroline Amireault, a spokesperson for the Association des couples infertiles du Quebec, presented Bolduc with a stack of papers to illustrate how many Quebecers wanted the government to cover the medical costs associated with infertility.

There were 25,000 signatures on the petition, she said.

"This is a big day for our association," Amireault said. "The recognition of infertility as a sickness is a very big victory for our association."

kseidman@thegazette.canwest.com