Global News is launching a series today that will look at fertility in Canada, and the emotional and financial impact infertility has on Canadians struggling to conceive.
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Couples and individuals who are struggling with infertility across Canada face many challenges.
There are invasive medical procedures, emotional setbacks, long wait times and the prospect that they will simply never conceive a child – no matter how many treatments they undergo.
But there is also a significant financial burden. A single round of in-vitro fertilization (IVF) treatment — where eggs are removed from a woman’s body and fertilized with sperm in a laboratory before being implanted back into the womb — can cost around $10,000, including the drugs needed to stimulate ovulation.
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More often than not, more than one try is needed. Add to that the costs associated with travelling for treatment, and the bills can add up quickly.
In Canada, the provinces and territories are responsible for the administration of health care. While some jurisdictions will help pay those bills, others won’t.
“You can’t just move provinces to get funding,” said Dr. Jeff Roberts, a fertility specialist and president of the Canadian Fertility and Andrology Society.
“You have to be generally a resident within the province to get access to those programs.”
There is some good news. Every province and territory will cover the cost of consulting your doctor about fertility problems, for instance.
Patients usually do this after trying to conceive naturally for a full year. If the doctor recommends follow-up tests, like sperm counts or ultrasounds, that’s also covered under all public health plans.
If it turns out you have a blocked Fallopian tube, or a growth on your uterus that’s preventing conception, provinces and territories across Canada will foot the bill for surgery (but they won’t normally cover the reversal of a procedure designed to cause infertility, like a vasectomy).
For many Canadians, that’s where it stops.
Who offers what?
Quebec and Ontario remain the only two provinces that specifically cover IVF, and both place significant restrictions on who qualifies for financial help. Ontario’s system allows a woman to take advantage of one covered IVF cycle in her lifetime, while Quebec’s offers a sliding scale of tax credits.
Manitoba and New Brunswick, meanwhile, have opted to provide assistance in the form of tax credits or grants that cover a portion of any infertility treatment, including IVF.
Everywhere else, IVF and associated treatments must be paid for by the patient (Alberta and Nova Scotia have both confirmed they’re considering their options in terms of funding programs).
Few private health plans offered by employers will assist in lightening the burden.
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According to Dr. William Buckett, director of McGill University’s Reproductive Centre in Montreal, it’s been rare for people to actually move to his province in order to take advantage of Quebec’s coverage plan.
Buckett said he thought he might see patients moving from Nova Scotia or even Ontario when IVF coverage was introduced, but it didn’t happen.
“I think moving from Halifax to Montreal, you have to find a job and somewhere to live,” he said. “It’s not always that easy.”
Some form of provincial IVF coverage should be made available across the country, Buckett argues, mainly because it allows people who can’t necessarily afford treatment right now to receive it, rather than waiting a few years until they can pay out of their own pockets.
Those few years can mean the difference between needing one IVF cycle and several, as a woman’s fertility decreases over time.
“If it was covered, she would be able to have (treatment) at a younger age, and that would be less expensive in terms of treatment and more likely to succeed,” Buckett reasoned.
“And obviously she would be younger as a mother and have less pregnancy complications, etc.”
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According to Roberts, simply covering as many IVF cycles as needed for anyone who wants the treatment is not affordable.
“I don’t think any province can afford free coverage for an unlimited number of cycles for everyone. That’s just not going to be possible, and I think everyone realizes that,” he said.
“It’s a matter of finding a system that allows some access to care.”
While Ontario’s one-IVF-cycle-per-lifetime model seems to find a good balance, Roberts said, the drawback is that fertility clinics must deal directly with the government, instead of patients paying up-front and then seeking reimbursement from the province themselves.
“It’s been quite onerous,” Roberts said.
“Most clinics have to hire extra administrative staff just to manage the wait lists …which (are) extending out years now.”
If Alberta joins Quebec and Ontario in providing some form of IVF coverage, Buckett speculated, then “the pressure on other provinces will be immense.”
A similar pattern developed in Europe, he noted. Once the United Kingdom, France and Germany moved to cover IVF, Belgium followed suit.
“I think that’s what leads to countries funding things, or in our case provinces.”
Urban/rural divide
Roberts also noted a clear urban/rural divide in Canada when it comes to access to treatment.
People who live outside an urban centre almost always need to travel for IVF and other advanced infertility treatments, and that can affect which procedures they opt for.
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IVF, which has a slightly higher success rate, is usually favoured by these couples over the cheaper intrauterine insemination, where sperm is injected directly into the womb.
“Patients, certainly if they’re coming from northern B.C., are not going to fly down for an intrauterine insemination, which depending on what medication they’re using, provides a pregnancy rate of probably under 10 per cent,” Roberts said.
According to Buckett, there are many people living in the far northern reaches of Quebec who are experiencing trouble conceiving and will simply never get treatment.
“That is the case in many large countries,” he noted. “Often people who are living in these remote communities are not wealthy either, so that’s one barrier to care.”