Press release

Governments ignoring infertility treatment?

p. 1397  Effectiveness of in vitro fertilization with intracytoplasmic sperm injection for severe male infertility — R.C. Pinheiro, MD; et al [full article]

p. 1411  New reproductive technologies: Why are we limiting choices for infertile couples? — A. Leader, MD [full article]

In vitro fertilization (IVF) was developed as a treatment for couples with infertility caused by the complete blockage of the fallopian tubes. Since then its use has expanded to include other conditions such as male infertility, endometriosis-associated infertility, immunological infertility and unexplained infertility.

Canadian authorities, citing challenges to efficacy raised in a 1993 report by the Canadian Royal Commission on New Reproductive Technologies, currently only recognize IVF for use in cases of tubal blockage, which accounts for about 45% of all in-vitro treatments. To address the commission's concerns, Raimundo Pinheiro and colleagues compared 122 couples affected by male-factor infertility treated by IVF with intracytoplasmic (ICSI) sperm injection of fresh sperm from ejaculate, 27 couples with obstructive azoospermia treated by IVF with ICSI of epididymal sperm, and 98 couples with bilateral fallopian tube blockage treated with conventional IVF. The authors found no difference in rates of implantation or pregnancy for the 3 groups and suggest that the commission's recommendation to discontinue coverage of IVF for indications other than tubal blockage be revised.

In an accompanying editorial, Arthur Leader criticizes the lack of progress since 1993 and suggests that most infertile Canadians are being denied reproductive choice.

p. 1403  Use of beta-blocker therapy in older patients after acute myocardial infarction in Ontario — P.A. Rochon, MD, MPH; et al [full article]

Despite its proven effectiveness, research shows that beta-blocker therapy remains underused among the elderly after myocardial infarction (MI).

In their study of 15 546 patients aged 66 or older who survived an MI between 1993 and 1995, Paula Rochon and colleagues found that almost half (48%) were not treated with beta blockers. They also found that the odds of not receiving this form of treatment increased for patients older than 85, for those who also had other forms of illness and for those who lived in long-term-care facilities. The authors also found that almost 30% of the women in the study with no identifiable contraindication to beta-blocker therapy did not receive it. The authors suggest this finding is particularly troubling, given that short-term prognoses after MI may be worse for women than for men.

p. 1414  Time to put the Canadian Institutes of Health Research on trial — D.L. Sackett, MD [full article]

Lost amid the applause concerning the creation of the new Canadian Institutes of Health Research (CIHR) is the recurring failure of the organization's predecessor — the Medical Research Council of Canada — to support randomized controlled trials (RCTs), writes internationally renowned researcher David Sackett.

In his editorial, Sackett takes the MRC to task for turning down 40% of the RCT applications in the last 2 competitions even though they were deemed scientifically sound by the council's own committee. He recommends the CIHR expand its funding for RCTs from the current 3% of its total budget, to 12%, matching the proportion spent by US National Institutes of Health.

p. 1409  Recent versus historical trends in preterm birth in Canada — K.S. Joseph, MD, PhD; M.S. Kramer, MD [full article]

Preterm birth rates in Canada (birth prior to 37 weeks' gestation) have increased slightly over the last decade, apparently contrasting with a dramatic reduction reported between the early 1970s and mid-1980s.

K.S. Joseph and Michael Kramer report, however, that historical reductions in preterm birth in Canada were due to inaccuracies in gestational age information in the 1970s. Graphical examination of the 1972 data indicates that true gestational age was rounded to the nearest lunar month (9 months or 36 weeks), and thus a number of term births were misclassified as premature in the earlier data set.

The authors state that the recent increase in preterm birth rates in Canada parallels that of other industrialized countries and is likely explained by increased obstetric intervention and multiple births.