This is the latest article in a Global News investigation into fertility in Canada, and the emotional and financial impact infertility has on Canadians struggling to conceive.
In December 2015, the Ontario government introduced a $50 million Fertility Program that would fund the costs of one cycle of in vitro fertilization (IVF), and unlimited artificial insemination (AI) and intra-uterine insemination (IUI) treatments for all Ontarians, regardless of gender, sexual orientation or family status. For the nearly 17 per cent of the province’s residents who struggle to get pregnant, whether due to preexisting medical conditions or age-related issues, the news came as a Godsend.
Available in 51 fertility clinics across the province, the program is, on the surface, exceedingly altruistic. Especially when you consider IVF can cost up to $10,000 dollars for one round, largely restricting it to people of means. But like any pilot project, it has been addled with issues, including wait lists that stretch to 2018 and beyond, and harsh criticism from doctors and experts who claim it flies in the face of the Canada Health Act by effectively promoting a two-tier system. (Patients can still opt to pay out of pocket.)
A flawed program?
“The program was flawed from its inception,” says Dr. John McNaught, founder of London Women’s Health Care in London, ON. “A tax credit is a more equitable way to fund a program, rather than imposing a harsh cap on spending.”
Earlier this year, McNaught pulled out of the program. He said he received a lot of angry emails from patients who couldn’t get care, and he called the program “a career killer.”
“I had over 200 people ready to enter the program but only had 30 spots for the year. I had to refer the bulk of them to the local hospital, and when I do that it ends my relationship with my patients,” he says.
In addition, he takes issue with the fact that the present system allows patients to choose to pay for IVF on their own.
“This is a completely two-tiered system and I’m surprised more people aren’t making more of a fuss,” he says. “I would re-enroll in the program if I felt it was truly universal and the wait times were based on availability of resources instead of money. But I’m completely disenchanted with this program.”
He’s not the only one who has found the discrepancy between supply and demand problematic.
“From the opening days, we couldn’t accommodate everyone,” says Dr. Tom Hannam, founder of the Hannam Fertility Centre in Toronto. “We had a lot of patients who were simply unable to access care, and they were sad and angry. It was an overwhelming time.”
At first, Hannam’s clinic randomized the wait list and pulled names every three months in a process he described as “relentlessly fair and unpleasant for patients.” Now he’s following a first-come-first-served model, which helps patients gauge a realistic time frame and organize their lives around treatment, but his wait list is still about five years long.
How fertility programs have been funded in the past
Until now, the country’s only previous iteration of a funded fertility program was in Quebec, and it didn’t run all that smoothly, either. From 2010 to 2015, the government implemented a plan that covered up to three full IVF cycles, but received so much interest it quickly ran over budget. Now, the government offers tax credits for one cycle of IVF to childless couples only.
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“The program in Quebec failed because the promise didn’t match the reality,” Hannam says. “The government thought it was going to save money by curbing multiple pregnancies, but it didn’t work out that way.”
In both Quebec and Ontario, the programs allow for one embryo to be implanted per cycle. The purpose of this restriction is to prevent instances of multiple births, which can put both the mother and the babies at higher risk, including premature births and developmental issues, and in turn cost the taxpayers more money.
But as Hannam points out, that’s flawed logic.
“Most multiple births aren’t the result of IVF but of low-intensity fertility treatments” that include drugs and injectable hormones, he says. “The pregnancy rates were actually not that high in Quebec and it ended up costing the province a ton of money.”
The price of treating infertility
Ontario has preempted any possibility of going over budget by instituting a cap — the initial $50 million was estimated to cover roughly 5,000 IVF cycles. And Ontario Health Minister Eric Hoskins recently announced that the province would be investing an additional $50 million in 2017 to service approximately 4,000 more patients.
“For many families, access to fertility services has not been possible because of the high costs involved,” he said in a statement. “I am proud that our government has expanded access for all Ontarians. The ministry is performing ongoing monitoring and evaluation of the program, and will also be undertaking a full-scale review to evaluate the success of the program after its first year.”
The problem, McNaught says, is that the budget is not proportionate to the province’s population.
There’s also an age restriction that can provide an extra barrier to patients: the program does not extend to women over 43. That means women who are on a waiting list could age out of the program before they’re selected. This adds another layer of complication to a doctor’s decision on who’s up next.
“Clinics are handling that pressure in their own way,” Hannam says. “The government was careful to make sure fertility clinics could make their own decisions on how best to handle the wait list. It’s very complicated because, in my opinion, nobody wants to do IVF. Anyone who puts their name on a list is doing it out of desperation.”
That’s precisely the reason why Alana Cattapan, a Canadian Institutes of Health Research postdoctoral fellow in the Faculty of Medicine at Dalhousie University, thinks the government should be spending their dollars elsewhere.
“There should be a strong focus on the social factors that lead to infertility, especially age-related infertility,” she says. “I understand there will always be cases where people have medical issues, but why not focus on why people are having children later in life because of things like student debt, lack of accessible childcare and a rise in sexually transmitted infections? Instead of addressing those issues, the government is intervening later on.”
When the program works
In many cases, however, the issue isn’t so clear-cut. For Sandra*, a 37-year-old Ottawa resident, it seemed easy to get pregnant the first time.
“We went to Montreal for the weekend, had a nice bottle of wine and I got pregnant,” she says.
After she lost her baby in the second trimester roughly four years ago, however, it became quickly apparent that it was going to take more than a weekend getaway and a good vintage to get pregnant again. Sandra and her husband spent three years doing IUI treatments to no avail. When her doctor told her about the IVF program, they agreed to be put on both the funded and the out-of-pocket wait lists.
Less than two months later, Sandra and her husband were accepted into the program. In August, she gave birth to twins.
“The program doesn’t take a cookie cutter approach,” she says. “Standard things are done for everyone, but if you need additional blood work or a different hormone dose, or as was our case, ICSI — when sperm is injected directly into the egg prior to implantation — the government pays for it. The coverage was phenomenal. We’re thrilled.”
It’s success stories like Sandra’s that gives doctors hope for the program, despite its obvious setbacks.
“The government provides an incredible amount of care,” Hannam says. “The people at the Ministry are very committed to this, the team responsible for introducing it are committed to it, and the doctors are committed to it. Everyone wants it to work.”
*name has been changed