Insurance/IVF funding

Updated: Jul 16/10

CANADA
Although public awareness of infertility has increased in recent years, provincial and private health insurance, as well as employers, have been slow to recognize infertility as a legitimate medical problem.

Provinces generally pay for the investigation of infertility and some surgeries (e.g. to remove endometriosis or repair blocked fallopian tubes). Some also cover at least part of the cost of ovulation induction and/or intrauterine insemination. Only Ontario currently pays for any IVF.

The 1993 Royal Commission on New Reproductive Technologies found evidence to support the use of IVF as a treatment for women with blocked fallopian tubes, and called upon the provinces to fund it under these circumstances, while also providing IVF – as controlled trials, rather than as 'treatment' – for other causes of infertility (e.g. endometriosis, male factor, etc.) in order to ascertain its safety and efficacy in those situations. However, the only result of this recommendation was the 1994 decision by Ontario to stop funding IVF except for women with bi-lateral blocked fallopian tubes, whereas prior to that date, Ontario had paid for all IVF.

Over the years, patients in various provinces have tried meeting with their MP and/or MPP, and some have also started petitions to secure more funding under medicare. One Nova Scotia couple appealed their province’s refusal to fund any IVF all the way to the Supreme Court of Canada without success. So far, there has been no significant change in the level to which infertility treatment is funded. This situation seems unlikely to change for the better in the foreseeable future, given the current problems with the economy, and the ever-increasing, quite overwhelming demands on our healthcare system which already consume more than 45% of each province’s total annual budget and are growing at a clearly unsustainable rate. As a result, patients must often bear significant costs in order to access treatment. Out-of-pocket expenses for infertility treatment & drugs can be claimed on your income tax return as a medical expense.

Costs vary by clinic. Be sure to get a detailed list, in writing, before you start treatment. Fertility drugs cost an extra ($3,000-$7,000) on top of clinic fees. These may be covered under private health insurance through your employer; if not, it is usually impossible to get private insurance for a pre-existing condition (i.e. after a diagnosis of infertility). See Fertility Drugs for ways to minimize the cost of drugs.

Some doctors charge only for what provincial health insurance does not cover (e.g. sperm wash, donor sperm), while others add a “monitoring” or “administration” fee. Some clinics:
• allow you to pay by credit card, which lets you spread the payments out over time (albeit, with interest) and perhaps earn “points” with the credit card company which can then be redeemed for merchandise or travel.
• arrange easy bank loans.
• offer reduced fees to patients unable to pay.
• offer “egg sharing” which enables you to have some/all of your treatment paid for in return for giving a number of your eggs to another patient. However, this is illegal under the Assisted Human Reproduction Act (2004) due to ethical concerns that a woman who can only access treatment by giving up some of her eggs is not in a position to freely give consent. Moreover, egg-sharing decreases the number of embryos left over for freezing and future transfer(s), and hence your own chance of conceiving. It is also a decision you could come to regret: if you never get pregnant, you could spend the rest of your life wondering whether someone else is raising (what is, after all) your biological child; if you do get pregnant, you then have to deal with the fact that someone else may have children (conceived from your donated eggs and born into other families) whom you and the child(ren) you are raising will likely never know.

Alberta
• Generations of Hope fund
• Petition for IVF funding (posted 2009-12)

Manitoba
• Petition for IVF funding (posted 2009)
• Fertility Treatment Tax Credit (posted Mar 29/10)

Nova Scotia Department of Health

Ontario (the only province in Canada which funds any IVF treatment)
In 1994, a joint decision by the Ontario Medical Association and the Ontario Ministry of Health amended the Ontario Health Insurance Plan (OHIP) fee schedule to cover IVF only for 3 "fresh" cycles (from egg retrieval through to embryo transfer) and only for women who meet all of the following criteria:
• have not reached their 40th birthday by the time of treatment
• both fallopian tubes are both blocked/missing (not due to sterilization); this must be supported by medical records demonstrating the tubal status.
• residents of Ontario
• Canadian citizens, landed immigrants or refugees

NB. Even for women who meet these criteria, OHIP does not cover the the total cost of IVF: there are signifcant additional fees for such things as fertility drugs, laboratory services, ICSI, TESE, assisted hatching, embryo freezing and storage, etc. which must be paid for by the patient.

This change to the OHIP fee schedule marked the end of a long, exhausting battle waged by our organization to maintain full funding, a campaign which included meetings with politicians and policy makers, petitions, an intensive letter-writing campaign, countless media interviews, formal briefs to the government panel on de-listing, etc.. In the end, we managed to keep IVF at least for the one instance validated by the Royal Commission on the New Reproductive Technologies (based on out-of-date data that failed to recognize its success in treating other causes of infertility). Without our aggressive campaign, it seems likely IVF would have been totally dropped from the OHIP fee schedule. The effort to mount this campaign drained our limited financial resources; we simply do not have the money or staff necessary to pursue this issue further at the present time. Some people have appealed to the Ontario Health Services Review Board and male factor couples have appealed to the Ontario Human Rights Commission on the grounds of sexual discrimination; so far, appeals have been rejected because IVF is not considered a 'medically necessary' treatment, and also because of concerns over the safety of ICSI on the children conceived using this procedure.

See also:
• Challenge to the Ontario Human Rights Tribunal by Amir Attaran (posted Nov/09)
• Conceivable Dreams - the OHIP for IVF Coalition (posted 2009)
• Expert Panel on Infertility & Adoption
• "The right to bear children and, of course, we'll pay" Op-ed by Margaret Wente (Feb 23/10. Globe & Mail)

Quebec
Currently, some private insurance plans cover the cost of IVF treatment; coverage ranges from 1 attempt/life-time to a pre-established amount applicable to the treatment &/or medication. There is also a 50% tax credit. The government has announced it will fund IVF as of Aug 5/10. However, no details have yet been provided re:
• number of cycles
• what criteria may apply (e.g. age; cause of infertility; chance of success; sexual orientation; marital status; whether payment will apply to cycles using donor eggs or sperm, or a surrogate; etc),
• whether accompanying costs will be included (e.g. medication, ICSI/TESE, assisted hatching, donor sperm/eggs, embryo freezing/storage/thawing, etc)
• whether treatment will be funded at private clinics, or only at hospital-based programs

See also:
• Saying 'no' to the funding of assisted reproduction services in Québec (A commentary by Prof Abby Lippman, McGill University; FQPN. May 25/10. BioNews 560)
• Quebec women to get free [IVF] fertility treatments (starting Aug/10) (Jul 13/10. Canadian Press)

British Columbia
The University of British Columbia (UBC) Centre for Reproductive Health and the Vancouver General Hospital & UBC Hospital Foundation have established the Hope Fertility Fund, to assist BC residents who can’t afford treatment.

Canadian Forces (Terry Buffett's successful appeal to the Canadian Human Rights Commission)

Other than those listed here, we are unaware of any other sources of financial help (e.g. charities, foundations, etc.) to assist patients pay for the high cost of fertility treatment. Unfortunately, as a small charity, operating on a volunteer basis with only a shoestring budget* and with no funding from government, fertility clinics or the pharmaceutical manufacturers of fertility drugs, we are unable to assist patients with the cost of treatment.

* PDF file. Requires Adobe Reader - download it free here.