Out In The Open

No national plan for fertility treatment remains challenge for Canadians hoping to conceive

While four provinces have some form of funding available, patients, advocates and policy experts say that Canada has a long way to go when tackling the financial barriers to fertility treatment.

Only four provinces offer some form of government funding for procedures such as IVF

A single cycle of in-vitro fertilization can cost $10,000 to $20,000. (Submitted by Dr. Thomas Hannam)

Canada is often lauded for its universal health-care system. But no comprehensive coverage exists for assisted fertility treatments, such as in-vitro fertilization (IVF). In a country where about one in six Canadian couples experiences infertility, this poses a financial barrier for many. Depending on the province they live in, people can spend between $10,000 and $20,000 per cycle.

Treatment coverage currently exists in only four provinces and varies significantly. Ontario provides funding to cover the first round of IVF. Manitoba offers a tax credit and New Brunswick has a grant to help cover partial costs. Quebec previously covered three rounds of IVF, but rolled back its coverage in November 2015 to a refundable tax credit.

The remaining nine provinces and territories have no coverage.

"The Canada Health Act is there to make sure that we all have access to treatments on an equal level and these inequities are glaring to me between the provinces," said Natalie Montgomery, 40, who has been through seven rounds of IVF.

When there's no choice but to fund IVF yourself

Montgomery, a doctoral candidate in public policy at the University of Ottawa, started IVF in 2012, before Ontario had a funding program in place.

"Infertility is a medical condition. However unlike other health conditions that Canadians face, it's inconsistently covered from province to province," said Montgomery. "In Ontario, at the time, it wasn't covered at all, whereas in Quebec, it was being covered; to me that kind of felt unfair."

She and her husband Cameron weighed the costs of going through one round of IVF versus three. Despite competing financial priorities in their lives at the time, they opted to invest in three rounds. 

The first round of IVF treatment was successful and their son Theo was born in May 2014.

Natalie and Cameron Montgomery with their son Theo in Ottawa in 2017. (Kimberly Hoy)

The couple knew they wanted to have more than one child. But two subsequent IVF treatments were unsuccessful. 

    "We were so naïve at the time, because of that first success, that we thought it's going to be that easy," said Montgomery. 

    Following those self-funded rounds of IVF, Montgomery went through another with assistance from the Ontario program introduced in December 2015. That too was unsuccessful.

    After trying in Ottawa, they sought treatment in Toronto. With the provincially funded round of IVF exhausted, they tried three more self-funded rounds — the final one in September 2019.

    "Fortunately we had the resources to do that," said Montgomery, "That also kind of felt unfair because I felt, well okay, that's great for us, but what about all those other couples out there that don't have equity to leverage to do this or investments that they can cash out on?"

    Other costs that add up

    Tara Wood, 37, shares similar concerns.

    In 2016, the founder of a Toronto-based communications firm used Ontario's fertility program to go through one round of IVF, intending to have a child on her own using a sperm donor. It resulted in three frozen embryos, which are now available for her to use.

    Tara Wood and her partner Anton Dyck. (Submitted by Tara Wood)

    But soon after, she met her partner Anton Dyck and they have been trying natural conception for a year and a half with no success. In the past six months, Wood has also gone through two rounds of another fertility treatment known as intrauterine insemination (IUI), which were both unsuccessful.

    "We're lucky because the Ontario fertility program does cover unlimited IUIs for individuals. The good news is the procedure itself is covered. But any drugs and the sperm washing is not," said Wood, who spent about $1,000 on such additional costs.

    Similarly, the Ontario-funded IVF cycle doesn't include drug coverage, which can range from $5,000 to $7,000 out of pocket, according to Wood.

    "I was really lucky at the time. I wasn't self-employed. My employer covered 80 per cent of my drug costs. It was huge. I think I still spent about $2,000 on drugs at that point for one IVF cycle," she said.

    With her government IVF funding now used up, Wood has decided, along with her partner, to pay out of pocket for another round.

    "That's what I can afford. I'm not willing to go into debt for this process. There are other ways — whether that's an egg donor, adoption — that I am comfortable moving forward with, to make a family," she said.

    Beyond their personal experiences, Montgomery and Wood both advocate for broader infertility treatment support in Ontario as board members of the not-for-profit organization Conceivable Dreams.

    For Canadians experiencing infertility issues and living in one of the nine provinces or territories with no coverage, accessing IVF treatment means either self-funding it at home or abroad, or traveling to a province with coverage.

    Montgomery said that infertility treatment causes high stress and puts a large burden on people's emotions and relationships. Adding travel on top of that can pose additional stress, she said, because beyond the costs of traveling or relocating to get treatment, people can lose their support systems.

    "There's no time like going through fertility treatment when we need our support systems the most. And to be going through the threat of losing all those just to get access to treatment — to me it doesn't make any sense."

    A case for consistent coverage across provinces

    With health care under provincial jurisdiction, implementing a standardized IVF policy across every region can be a challenge.

    "Provinces decide what they consider to be a medical necessity," said Dr. Francesca Scala, a political science professor at Montreal's Concordia University. "Infertility is not high up on the priority list of what they deem to be the most pressing health issues facing their communities."

    Scala, whose work focuses on public policy with an emphasis on science and health, said that having a standard, publicly funded system across provinces would improve the safety and quality of IVF services and lower health-care costs in the long run.

    "I think that one of the fundamental benefits of having something that is uniform, that is national, is that every individual Canadian and IVF patient is going to be treated similarly and have access to the same kind of treatment," she said.

    Dr. Francesca Scala says a standard, publicly funded system across provinces would improve the safety and quality of IVF services and lower health-care costs in the long run. (Concordia University)

    Scala points to Sweden as an example of a country with a national fertility framework in place.

    "One of the things that Sweden did was limit the number of embryos that could be transferred during treatment. So rather than having three or four embryos transferred, which could lead to a higher risk of multiple pregnancies and therefore higher medical costs, you can only transfer one embryo and maybe two depending on the age of the woman," she said.

    "When you have government more involved in IVF programs, you can make sure that the medical risks are reduced by ensuring that certain practices, like the number of embryos that are transferred, be respected."

    Montgomery also thinks Canada needs a national coverage plan.

    "I think there is a huge stake because we're all taxpayers. And Canada has a problem because the natural population growth in this country is on the decline. Government has a huge role to play in today's economy," she said. 

    "When they're not taking responsibility for this consistently across the provinces and at a national level, it's telling Canadians, 'You know what, we don't care.' And it's really important to send a different message. If we're going to do something about the stigma of infertility, government has a huge role to play in that conversation."

    When CBC reached out to Health Canada for the story, it provided the following statement:

    "Provinces and territories are responsible for health care delivery and questions regarding services that are covered under provincial or territorial health insurance plans should be directed to the provincial or territorial Ministries of Health."

    The need for more education

    For there to be any kind of major policy changes, fertility lawyer Sara Cohen says Canadians, including those who haven't dealt with infertility issues, need to be educated. Cohen's also the vice president of Fertility Matters Canada, an organization that provides support to people struggling with fertility issues across Canada.

    "When we're making policy, we want people to understand why this is important, why this is relevant," she said. 

    Cohen thinks there are still a lot of people who don't understand what those struggling with fertility are going through, and what that might mean for them emotionally, physically and financially.

    "The more educated people are, the better the community that is affected by it will be supported," she said.

    Montgomery adds that it's also important to educate the provincial governments on this issue. 

    "I firmly believe that we need a national fertility strategy in our country so that we can have that consistency. Because the inequities that are felt between the provinces are glaring."

    With files from Oliver Thompson