The Board of Directors met in Montreal on June 17th and 18th. We present here a short summary of that meeting as well as any plans that may be of interest to members.
Brief Summary of the Board of Director’s Meeting, June 17-18, 2016
2016/17 Budget: The Finance Committee proposed a balanced budget for 2016/17, which was approved by the Board. The budget included the following noteworthy items:
- Funds allocated to develop a standard exam for embryology. The exam, which will be developed over then next 12 months, will be professionally developed and administered.
- Funds allocated to support development of a nurse education and training strategy. A Committee, chaired by Eileen McMahon, a nurse practitioner from Mount Sinai and Board member, includes representation from BC, Alberta, Quebec, Ontario and Halifax.
- Funds allocated to support publication of Clinical Practice Guidelines: Under the direction of Dr. Min, CPG Director, money has been set aside help accelerate the process of guideline development. Specifically, funds are available to bring committee members together where most of the work is accomplished.
- Funds allocated to support media relations – Funds will support the CFAS in its effort to augment the Society’s voice and be more present to the media, public, and key stakeholders.
The CFAS would like to acknowledge and thank Merck, Ferring, and EMD Serono for becoming Platinum level sponsors again in 2016/17. The generous support of these three companies in particular is enabling the Society to commit financial resources in a way that benefits members and the Society as a whole. CFAS will invest intelligently in its future and in the future of ART in Canada.
Clinical Practice Guidelines: At the most recent Board meeting, it was agreed that the CFAS should make clinical practice guidelines accessible to the general public. Guidelines are now available to the general public on our web site and will be available in French and English. While publishing guidelines underscores our commitment to transparency, the Board also believes guidelines help promote the excellent work done by the CFAS and its volunteers. On June 30, 2016, CFAS issued a press release announcing that the release of Clinical Practice Guidelines to the Public. (See press release http://bit.ly/29hRwkI )
Upcoming Clinical Practice Guidelines: Two guidelines currently under development by the CPG Committee include one on ‘Obesity’ and another on ‘Age limits and Fertility Treatments’.
New Process for CFAS Document Production – The Board approved a new guideline and policy on how documents endorsed by the CFAS will be developed and approved for publishing. The new process allows for engagement of the Special Interest Groups early on in the development process and ensures appropriate input from other disciplines, if needed. The Communications Committee will review a first draft prior to distribution of a guideline to member, who will also have an opportunity to comment. All CFAS documents require Board approval before being published.
New Terms of Reference published for Special Interest Groups (SIGs). In an effort to level the playing field and establish common terms of reference for all SIGs, the Board released a standard template of terms. Of import to members, the terms include the following:
- 3 year elected term for each position: Chair, Vice-Chair, Secretary-Treasurer.
- 2 successive terms permitted
- Flexibility to accommodate smaller SIGs that may not be able to comply with 1 and 2 above
- Sub-Committees are at the discretion of each SIG
- No exclusions of a members from a SIG
- Clear mandate for each SIG, to be developed by SIG Executives and submitted to the Board
Update on important activities:
- Nominations to the Board of Directors – An announcement for nominations went out July 6 and will close August 7, 2016. Three new directors will be elected and three will come off the Board, as per CFAS By-Laws
- SIG elections – With the introduction of new SIG Terms of Reference, elections for vacant positions will commence in the next few weeks. The CFAS office will send out a notice to members to call for nominations. Elections will take place completely electronically.
- Seed Grant program to award another $15,000 in grants – The Seed Grant program, initiated in 2015, was launched again in 2016. Eight (8) applications were received, three of which will be selected by a sub-committee. Winners will be announced at the annual meeting and each will receive $5,000 in seed grant money for their respective project.
- Abstracts – Members who submitted an abstract for the Toronto Conference will have been notified by now whether their abstract was accepted. Abstracts were evaluated by 56 volunteer judges using a blinded scoring system. This year, 93 abstracts will be on display.
- Award nominations – Nominations for awards were received up until the close on June 30. For a list of awards, go to https://cfas.ca/about-cfas/awards/ . In an effort to promote the importance of these awards, winners will be highlighted on the CFAS website, with permission of course.
Upcoming Professional Development Opportunities:
- Epigenetics Workshop, Vancouver 2016 – The Epigenetics workshop will traverse the country with the final meeting culminating in Vancouver in November 2016. This is in keeping with our commitment to engage all corners of the country
- Gatekeeper’s Dilemma – After two successful workshops in Toronto (2013, 2016), plans are underway to holding a Gatekeeper’s Dilemma workshop in the west in early 2017.
- Embryology Biopsy Workshop – This one-day workshop, sponsored by Illumina will allow for 20-25 embryologists to attend a workshop on embryo biopsies. Two sessions targeted to novice and experienced embryologists will occur on September 20 (Experienced) and September 21 (Novice)
- ESHRE Semen Analysis Course – A 4-day course in semen analysis is being planned for early 2017. This course was delayed due to challenges of finding lab space in Toronto.
On June 29th, the CFAS hosted an ethics workshop where members tackled challenges associated with allocating and prioritizing IVF funding to Ontario patients. The program was organized by the CFAS in conjunction with the Department of Bioethics at the University of Toronto. The sold out event was attended by CFAS members from all disciplines and included Ministry of Health representatives from the Ontario Fertility Program.
Key themes emerged during the workshop, which we think are relevant for clinics and policy makers to consider.
Goals of the Ontario Fertility Program – Access or Outcomes: As stated on the MOHLTC website, the focus of the Ontario Fertility Program is about access. “The government is contributing to the costs of fertility services to improve affordability and access.” However, it was acknowledged at the workshop that interpretation of the purpose of the program varies among stakeholders – including patients – and thus implementation strategies vary accordingly. Programs vary between an outcome-centred approach (e.g. triaging younger patients) and an access-centred approach (e.g. triaging older patients) or something in between (e.g. lottery or first-come-first-served). Framing the program in terms of these two potentially competing alternatives are an important consideration for policy makers and healthcare providers.
Good Ethical Practices: Despite the variation in allocation models adopted by clinics, the general consensus at the workshop was that despite these variations, current processes represent an array of different ethical approaches reflecting good standards, yet in need of further review and refinement. No single ethical solutions were identified. Certainly, having an ethical framework from which to assess allocation models helped participants to clarify issues.
Complexity of patient’s needs: Part of the challenge for clinicians and the Ministry in allocating scarce resources for the Ontario Fertility Program is that patient circumstances are complex. Participants agreed that sorting through the permutations and combinations of clinical criteria to prioritize patients is practically and logistically impossible. Add to that, the importance of social, personal, financial and other patient needs as well, and it is easy to understand why different approaches to the allocation of funding exists in Ontario. The complexity of the issue may not have been fully appreciated by the Ministry when introducing the Ontario Fertility Program. While the government relegated decisions concerning access to the clinicians, the clinicians were left with decisions that are not simply clinical in nature, but potentially include socio-economic, cultural, and other value based factors – factors the system is not equipped to address.
Transparency: According to participants in the workshop, the various allocation strategies employed throughout Ontario have resulted in added stress for the patient population it has aimed to help. While clinicians have been transparent about which allocation models have been employed within their respective clinics, there was agreement that the lack of system-wide transparency has been a missing element for patients. The lack of system-wide transparency can significantly add to anxiety as patients attempt to select a program that will enhance their likelihood of accessing funded treatment. Enabling patients to easily identify which models are used in clinics across the province would mitigate some of the negative and stressful aspects associated with patient’s selection of a clinic.
Dialogue with the MOHLTC and the Ontario Fertility Program. Participants from the Ministry of Health benefited from the discussion and we expect they will share lessons learned internally. The CFAS and its Ontario representatives can continue a dialogue with the Ministry and help inform any upcoming changes or improvements to the program. In particular, we feel that there is a good opportunity to better outline the goals of the program while considering both access and outcomes. Both concepts are relevant in terms of government accountability for the $70-million-dollar annual investment in the program.
Oral Presentation and CFAS: At the workshop, Dr Tom Gotz, Gynecologic Reproductive Endocrinology & Infertility fellow at the University of Toronto, presented a survey of clinic practices on funding allocation models. He will be presenting the results of the study again at the annual CFAS meeting in Toronto. A follow-up survey may be in the works as a number of clinics have shifted allocation strategies since the program was first introduced.
Future Ethics Workshops – A majority of the workshop participants expressed an interest in having a follow-up discussion on the topic of funding allocation at the end of the first year. The CFAS will endeavour to hold another meeting and invite the Ministry of Health to attend again. In addition, we have received numerous suggestions on future ethics workshops.