Tom Hannam saw a change in his patients after the Ontario Fertility Program (OFP) was introduced three years ago. It wasn’t a clinical change; it was more emotional. The OFP allowed people to see in vitro fertilization as a “real thing,” says Hannam, who founded and runs one of Ontario’s largest fertility clinics, “something that they really could pursue for themselves in their lives.”
IVF involves the harvesting, extraction and fertilization of human eggs, followed by the implantation of embryos into the uterus. Shortly after the first IVF-conceived baby was born in Canada in 1983, Ontario began funding the procedure. Then in 1994, the province de-insured IVF, in part because it did not consider it to be medically necessary (except for women who had complete bilateral anatomical fallopian tube blockage, for whom three cycles of IVF continued to be covered).
In the subsequent two decades, the use of private fertility services for IVF treatment proliferated in Canada. (The national infertility rate is estimated to be about 16 percent—one in every six couples experiences infertility, and there are many people who are single or in same-sex relationship who rely on assisted reproductive technology to have a baby.) In 2001, 22 fertility clinics in Canada initiated 7,884 IVF cycles; in 2017, 36 clinics initiated 33,092 cycles. In the past five years alone, there has been a more than 30 percent increase in the number of IVF cycles initiated in Canada. Currently, between one and two percent of live births in this country are the result of fertility treatments (though not exclusively IVF).
Alongside this growth, there has been ongoing debate over whether or not IVF should be funded. In 2009, an expert panel convened by the government of Ontario strongly recommended that the province significantly expand funding for IVF. The panel found that the high cost of private IVF was the biggest barrier to people wishing to build their families through assisted reproduction, and that it also contributed to elevated rates of multiple births (as patients often opted for multiple-egg transfers).
In 2015, Ontario delisted IVF from the Ontario Health Insurance Plan (or OHIP, the public insurance plan which covers doctors’ fees) and moved it to a separate program, the OFP, whose overall budget is $70 million annually. (This allotment is also for intrauterine insemination, or IUI, which was previously covered quite expansively under OHIP, and which has also been moved to the OFP.)
The OFP covers one IVF cycle per lifetime for women who have an OHIP card and are under 43 years old, and for single men or men in same-sex partnerships of any age who have an OHIP card. A cycle is defined as starting with ovarian stimulation and ending with the transfer of all embryos resulting from fertilization until either a pregnancy results or the embryos run out. The OFP only allows single-embryo transfers. This is meant as both a safety and money-saving measure, aimed at cutting the roughly 30 percent multiple-birth rate that results from IVF. Most paying patients opt for multiple embryo transfers because they increase the likelihood of a pregnancy. But they also increase the likelihood of multiple births, which in turn can lead to low-birth weights and consequent hospitalizations.
OFP funding is allocated to fertility clinics according to the volume of patients they treat, and the clinics are responsible for determining eligibility. The funding is limited to 5,000 cycles annually—this means that if more than 5,000 eligible people apply for it in a given year, some will receive it, and some won’t.
Those who don’t, can opt to pay for it out of pocket, which amounts to between $10,000 and $20,000 per cycle (not including the necessary drugs). And this is what makes OFP so unusual: It renders IVF a service that is both publicly and privately available—to the same people—in Ontario.
Impact of OFP for patients
Taunya Johnston and her husband, Rob spent more than $35,000 trying to get pregnant. “We sold our house,” says Johnston. “I took time away from work and from school. Everything we could think of that would possibly give us the hope of having a child, we were doing.” The couple conceived their daughter through IVF after being in fertility treatment for five years. She was born five years ago.
Johnston and her husband tried for a second pregnancy with the remaining frozen embryos, but it didn’t happen. And just when they were thinking about how they could afford to pay for a new cycle—Taunya, now 34, is a college professor and Rob, who is 37, is an insurance protection specialist—their fertility clinic called, asking whether they wanted to sign up as potential candidates for a funded cycle. They started one in January 2016.
“It was a completely different experience,” says Johnston, who is on the board of Conceivable Dreams, a fertility advocacy group in Ontario. When you’re paying out of pocket, she says, “You get that desperation of, ‘Oh my goodness, we can’t afford to keep paying for this, this has to work.’ That’s not helpful stress.”
Johnston and her husband had five embryos from the funded cycle—two were transferred but ended in loss; one was an unsuccessful transfer. With the fourth, they conceived their son, who was born in October 2017. “[The funded cycle] gave us a feeling of validity, that this is something that’s important,” she says. “We were prepared for the possibility that the cycle wouldn’t work. But we were still so grateful that we had the opportunity to try.”
In some ways, the OFP is more inclusive than funded IVF was 20 years ago, when providers had the power to withhold the procedure (from people they thought would make poor parents, for example). It is available to single people of any gender and to non-heterosexual couples (men in same-sex partnerships are effectively eligible for two cycles). But for people without means—and especially for those without employee drug coverage—the cost of IVF remains prohibitive. Clinics sometimes recommend corollary treatments such as genetic testing which aren’t covered, and which can run into the thousands of dollars.
And then there’s geography. Fifty clinics participate in the OFP but only about half actually perform IVF (with the rest offering other fertility treatment services such as IUI and IVF monitoring), and most of these are south of Barrie.
It is noteworthy that there is no legislation governing assisted reproduction in Ontario, no mechanism for quality assurance in this sector, and no requirement for fertility clinics to report outcomes (though many clinics from across Canada voluntarily send data for measures such as treatment cycles completed, clinical pregnancies, and multiple pregnancies to the Canadian Assisted Reproductive Technologies Register, or CARTR). The need for better regulation and data collection was addressed by the advisory group appointed in 2014 to help the province set criteria for the OFP.
When the OFP first came in, more people applied for funded cycles than there were funded cycles available—clinics had to establish wait lists, and some of those wait lists were three years long. In effect, there are people who have been waiting for funding since the program started; some have opted to pay out of pocket rather than wait (after age 35, a woman’s fertility decreases significantly every year).
Impact of OFP for providers
Despite some skepticism among fertility physicians as to how the OFP would work, most are highly supportive of the program, says Shawn Winsor, a bioethicist who conducted surveys of patient and provider perceptions of the program with respect to quality of and access to care. (The results will be out later this year.) Tom Hannam says: “You can only imagine how great it was to be able to offer [people] the right care, the care that they needed, without finances being as much of a barrier.”
But the volume of people who applied for a funded cycle caught fertility clinics off-guard, says Winsor, who also co-founded ethics programs at fertility clinics in Toronto and Mississauga. “It was like a floodgate opened. And my sense is that some clinics could have used more time to develop a more effective, robust process [for managing their wait list].”
A survey of how fertility centres prioritized patients for funded IVF during the first three months of the program found that of the 22 (out of 25) that responded, eight managed their wait lists on a first-come, first-served basis; two used a lottery; and 11 used multiple factors, including age and how long they had been patients of the clinic. The survey asked the clinics who was involved in deciding what process to use. All 18 clinics that responded reported that physicians were involved; 15 included other members of their teams (nurses, embryologists, social workers and admin staff); six consulted ethicists; and five consulted lawyers. None of the clinics reported consulting current or past patients.
Hannam originally used a lottery to determine when people would receive funding. “Because it was super fair,” he says. “And it was a complete nightmare. It was horrible. It was fair to a fault; it was joyless. No one knew what to do. ‘Oh, your name didn’t come up—we’re doing another draw in four months, good luck.’ So I just moved to a regular old first-come, first-served.”
The wait lists have improved considerably, says Winsor. “There was a backlog originally,” he says. “People worked very hard [to reduce the wait lists]. Some patients dropped out, but a lot of patients have been seen.”
But wait times vary clinic to clinic. Hannam says his is six years long—“I was getting calls this summer from colleagues at competing clinics asking if we had patients for them,” he says. He would prefer to see a system whereby funding was assigned to patients rather than clinics. That way, he says, the patients can then choose the location they want to go to.
This may not do away with wait lists if the number of funded cycles remains finite, but it would give people more control over where they receive treatment. People we interviewed said they chose to receive IVF both at clinics with longer wait times and further away from home on the basis of their comfort level with the setting and staff. Fertility treatment is a very intimate and sensitive process, says Johnston. With respect to clinic choice, she says, “Peace of mind is very, very important.”
Shortly before this article went to press, the Globe and Mail reported that the Ontario government has indicated that it plans to continue funding IVF through the OFP indefinitely.
The comments section is closed.
Hi I’m interested in doing the IVF treatment, VERY interested as my fiancé and I have been trying for a few years now to have a baby, and trust me we have tried all kinds of things and just about if not all we can do to try and get pregnant, well as much as we could afford that is and still a few yes later we have not had any luck. The more times we try and try new and different things to get pregnant and wat we can afford just to have it turn around and not get pregnant and that nothing worked it’s is affecting both of us but I think it’s definently effecting me a whole lot more. We try and try and try and when we do the pregnant tests to find out if I’m pregnant and it says we are Not I’ll be honest I’ve been getting so upset and so stressed and so depressed I’m starting to think the worst and that is I’ll never be able to get pregnant and I definently cannot afford to do the IVF treatments, it’s just that they are SO very expensive and I or should I say we cannot afford to pay for these IVF treatments. Then I was talking to a friend who said that it was covered on our OHIP health cards, I didn’t think nor did it sound right so I began to look it up online and I’ve read so many different things and some things I have read says that it is covered on our OHIP health cards and so on. I came across your article and stuff and read it all. And well I’m here to ask and hope that you guys are in fact one place that this is accepted at and if so what do I do, how do I go about doing this and what’s needed and these kinds of questions. I hope to hear back from you soon and I pray to god that you can help me and my fiancé.
Thank You
Crystal
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The medication should be funded too. I have had to create a GoFundMe account just to pay for the medication as my benefits through work do NOT cover any of them. It’s truly sad the we have to go through so much to have a baby.
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The medications should be covered along with it, I’m 30 years old I have no children. I’ve been struggling with infertility for years and have pretty much given up before I’ve even started treatment due to just the sheer cost of the medications per cycle. It’s sad that those who aren’t wealthy enough pretty much have no option. Just because we can’t affford it doesn’t mean we don’t deserve to have children of our own.
Does an ODSP approved can transplant a uterus is it covered?
My husband and I did IVF in 2014, right before the funding was available. We could have waited another year if we had known..We spent close to 30 000$ and it never worked…why was there no public knowledge this was coming????
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I just want to clarify this statement:
“A cycle is defined as starting with ovarian stimulation and ending with the transfer of all embryos resulting from fertilization until either a pregnancy results or the embryos run out.”
Does it mean that even though I failed on the first embryo transfer, I can still do the second embryo transfer for free as long as I still have the frozen embryos?
Married in 2016, I am 27 years old. i am so happy to be a mother of my first baby girl weighed 8 pounds, 8 ounces and was 20.5 inches long when she was born on Oct. 29, i have been trying to conceive for over 2 years now, after i suffered a miscarriage. But after holding our sweet girl in my arms and being told everything went well and she had made it to us safely I could have cared less. My/our world no longer has anything to do with us but everything to do with her. It’s all for her, one day i was just on the internet searching for how i can get pregnant fast. i came across some testimonial giving by some women and it was all about Dr micheal casper then i said to myself let me give it a try and know if it will work for me, after using his recommended natural pregnancy herbs and medication am so proud to be a mother, thank you so much Doctor for making me a happy mother. I will forever do anything for this girl that I love more than I ever could imagine. A love no one can ever prepare you for, if you know you are having the same problem i had before conceiving
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I want to have IVF. I’m a single mom of 10yrs old boy living in Quebec.
I’m am from Quebec too and I got 2 IVF completely free with all the drugs and test (sperm, follicles ultrasounds etc.) at 0$, all covered by the provincial health card plus back then there was no age cap and everybody had the right to 3 sessions. But all that was prior to the Nov. 2015 legislation that changed everything. The 2015 new legislation gave only a tax credit of 10 000$ maximum up 80% for those of 50 000$ max yearly income and only 20% for 120 000$ income and only to those who don’t have children, never went through a vasectomy and it caped the age at 43. It was still doable for many since IVF treatment in Quebec only range between 6000$ to 12 000$ (You can check all treatment prices on OVO CLINIC website for your case, that’s the clinic I had both IVF’s). This spring or summer 2020 another program will be reinstalled that may allow up to 2 Invitro session completely free. Good luck
IVF should be funded for 1 pregnancy. I went through 1 cycle of meds, followed all the protocols, everything was going great until the egg retrieval procedure where NO eggs were retrieved out of more than 30 follicles. There was no explanation as to why and my clinic was shocked. Now my cycle is used up and I didn’t even get a chance to do a transfer. It’s been 6 years of trying and all of our med coverage is now gone.
My funded ivf gave me 3 embryos but I didn’t get pregnant. Can I do fertility preservation in my round which is covered by Ohio?
You can only do one round no matter what you choose. Preservation is never covered unless you’re a cancer patient.
What this article fails to mention is that Ontario ONLY funds a SINGLE cycle and the embryos which MAY come from that cycle.
If you’re like me and many women I know, you could end up with absolutely nothing. IVF is a tough process and even the doctors can’t always predict how our bodies will respond.
Statistically, it can take multiple cycles to be successful.
It would be great multiple cycles could be funded with the loominf reality of a failed cycle. Instead, if it fails, you have to pay out of pocket and potentially rely on multiple transfers upping the risk of twins.
Yes I think government should fund one child per couple so if first IVF doesn’t succeed they can continue until they do. I also had a failed funded IVF wish they would fund the medications or at least 50%.
the Ontario gov doesn’t even fund meds for transplant patients which they need to survive, they aren’t going to fund medications that assist a treatment. Having one funded round is much more than other countries have, even more than other provinces! One funded round without medications is better than no funded rounds at all. And most benefit companies cover the medications (or a portion of the medications) used for IVF.
Actually very few companies cover fertility meds and many that do cover a very small portion. My benefits cover a lifetime 2500 in fertility meds. My IVF cycle cost me over 6000 in meds.. then the thousands more I have spent in meds for transfers. A funded cycle of IVF is amazing but still cost most people thousands of dollars on meds and extras like genetic testing ect. I know very few women who have had IVF and had their meds covered by insurance.
I’m a 36 year old woman ( soon to be 37) my husband and I have been trying to conceive for 7.5 years now. I was still young and in my late 20’s when we started trying. I’ve had 6 misscarriages, 2 emergency surgeries, 3 emergency D&C’s, 2 ectopic pregnancies, 3 failed IUI’s. My last pregnancy ended in a miscarriage at 12 weeks pregnant putting me in ICU and almost dying. I had multiple blood transfusions and emergency surgery. We desperately want a child. But it’s been quite a scary journey for me and my husband. We’ve done all the test, meds, treatment, ect… but all unsuccessful. All our tests come back normal. I’m a medical mystery at this point. This IVF funding has given us a sliver of hope.I have a fairly good job, good benefits but they don’t cover any thing fertility related. I’m glad this IVF funding is finally available to us after all these years but I feel it should be triaged. They should look at everyone’s personal story to determine who needs and should get it first. Who’s a priority. Questions such as age, # of misscarriages, years trying, medical history etc… to determine where they stand in the wait list. I’ve been told now I’m on a 2 year waiting list which means I’ll be almost 40 by the time I get my chance at IVF funding. The cut off age for this funding is 43. So although I’m very happy that the government of Ontario has finally brought back IVF funding I feel that more thought and planning should have been put into this. Hopefully they can get things figured out so that in the future it will be a more promising option and less stressful process for those who are yearning to have a child.
Yes Katrina that’s my question is. Now can we do fertility preservation covered by Ohip?
Yes some fertility preservation is covered by OHIP.
Stop funding IVF for people who decided to have vasectomy or tubal ligation
Unfortunately things happen in life I had a tubal done after my last baby at 25 years old and she passed away at 4 months old did I no she was going to pass way no I regret it so bad I miss my daughter so much and this is my only hope to keep going
I did a tubal due to domestic violence so keep your comments to yourself. I found someone worth having children for now, why can I be funded for a IVF Doug tell me?
This is a ridiculous government program. It benefits middle and upper middle class rich people paid for by taxes received from all people.
I understand the emotional draw: who could possibly oppose children? I get it. My sister and her husband paid for IVF and we have a wonderful child in our family as a result. But our family is wealthy enough to afford it. Why should poorer taxpayers pay for that?
It is also an excellent example of private medicine: all IVF services were delisted under OHIP so we now have a partial/limited government subsidy with private pay for the rest.
Doctors of course are making tons of money off this.
Adam, I find your expression of concern for the poor one of moral contradiction.
If I understand you correctly, IVF should go back to being privately funded so as to lessen the financial burden on the poor that comes with paying (additional?) taxes for this funded program. Doing this would benefit the poor.
However, if IVF goes back to being privately funded then these same poor people who are also infertile will not be able to have children because they cannot afford the high costs of private IVF. Doing this would harm the poor. Pre-public funding, many Ontarians went childless who could not afford the high cost of IVF.
There are many alternatives to scrapping the program that also address your concern about inequitable tax burden. One would be to introduce means testing to determine eligibility. Another is to use the existing eligibility criteria but introduce a means test to fund individuals on a sliding scale based on income. Of course, all these options add cost and complexity which, if paid for out of the program’s fixed budget, would reduce the number of Ontarians who can participate in the program.
The program is not perfect. Far from it. But remember, its goal is to increase access to IVF services for infertile Ontarians. Two years in, more Ontarians who could not have afforded to it otherwise accessed IVF and successfully became parents. If as you say, ‘who could possibly oppose children?’ then on balance the program has provided more benefit than harm.
So you propose a program to means test a medical system to enable poor people to have children with public funds. but then those children are born into poverty that our society kicks to the curb (our child poverty rates in this province are reprehensible)?
I am pointing out the inherent foolishness of this program. This program does not create access. It subsidizes access by mostly wealthier people paid for by mostly less wealthy people, it gives false hope to parents who would not otherwise pay for it, and enables participating physicians to make lots of money off the hopes and dreams of potential parents. All in the name of children.
This is private medicine at its most morally bankrupt and subsidized in part by everyone else.
There is a distinction that needs to be made between “poverty” and a person who cannot afford 10-35k on a medical procedure. There are many middle class families that are denied funding because they earn “too much” for the rebates and extras the poor receive, yet do not make enough money to afford the extravagance of a 100k/year salary. It has nothing to do with artificially allowing “poor” to conceive children that will be “born into poverty”.
With all due respect, wise up that there is a whole economy of people who fall between the poverty line and your overbloated entitlement.