452 needles, thousands of tears, one corrective surgery, four Clomid/Letrozole attempts, two IVF rounds and three failed (embryo) transfers.
This is just one snippet from the countless stories shared by those struggling to conceive.
Infertility, a medical condition that is defined as the inability to conceive after a one-year period of unprotected intercourse, affects roughly one in six Canadian couples. The condition can be traced back to either the man or the woman, with various causes such as age, low sperm count or problems with the uterus, and has caused countless couples to seek medical assistance and become reliant on fertility treatments.
In vitro fertilization (IVF), which is the most common method of assisted reproductive technology, involves the development, retrieval and fertilization of human eggs followed by the hope of a successful embryo transfer. The average cost in Canada of one round of IVF is estimated to be $15,000, with a success rate of less than 50 per cent per embryo transfer for women under the age of 35. Multiple rounds of IVF are not uncommon as the success rate depends on factors such as age and past medical history.
In Canada, only four provinces offer financial assistance for IVF and coverage varies significantly. Ontario covers one cycle of IVF per patient under the age of 43, not including fertility drugs that cost an additional $5,000. New Brunswick offers a one-time grant for individuals to claim 50 per cent of incurred costs related to IVF capped at a maximum of $5,000. Manitoba offers a tax credit of 40 per cent geared toward the cost of fertility treatment, at a maximum of $8,000 per year. Quebec is also offering a tax credit based on household income, limited to those who do not have children. However, the governing Coalition Avenir Quebec is attempting to bring back publicly funded IVF, revoked in 2015. If passed, the bill would provide one cycle of funded IVF per couple.
The disparity across the country is easy to track. For example, Prince Edward Island and Newfoundland do not have any IVF clinics, leaving those struggling with infertility no choice but to travel out of province to access the care they need. However, P.E.I. recently announced it will provide up to $10,000 a year for people travelling out-of-province for fertility treatments.
The unequal access extends to wait times, which can reach upwards of two years depending on the clinic. One couple taking part in the Faces of Fertility social media campaign across Newfoundland and Labrador said, “There doesn’t seem to be an end in sight. Our hearts are breaking for the baby that we want so badly and can’t have … the waiting is excruciating.”
Establishing wait times is the responsibility of individual clinics, which prioritize patients based on physicians’ judgements and their own policies, resulting in wide wait-time discrepancies between various government-funded clinics. And then there are those who have the ability to pay out of pocket and jump to the head of the line. Fertility is largely influenced by age, so how can it possibly be fair for an aging woman to be told she is no longer eligible for treatment after years of waiting simply because she could not pay?
There is a solution to these problems – a publicly funded, comprehensive coverage plan that would create consistent criteria and standards across all clinics in Canada. This would not only create equitable access but also improve the overall safety and quality of treatments.
Public funding would also ensure that the eligibility criteria remain consistent between clinics as well as provinces. Furthermore, a national standard would save money by implementing control measures geared toward the number of embryos transferred. The more embryos transferred, the higher the risk of multiple pregnancies, thus increasing the cost to the health system. A plan enforcing only a single transfer, such as Ontario’s program, reduces the risk of multiple births.
Canadians’ medically necessary procedures are covered under the Canadian Health Act. However, the term “medically necessary” lacks a clear definition and is left to the discretion of each province. The expense of treatments means money is often the determining factor in access; the lack of a comprehensive coverage plan has made IVF a private commodity rather than a medical procedure.
Denmark has pioneered one successful way forward. Under its comprehensive coverage plan, the first three rounds of IVF are completely covered for any of its residents. The result has been a higher success rate and a larger proportion of babies born through IVF. Though the cost has been higher taxes, the Danes have registered little objection in exchange for the guarantee to receive services when they need them.
Despite the praise that Canada receives for its universal health-care system, the current patchwork of financial coverage and unequal distribution of clinics is failing countless individuals and couples. As young women, we face the possibility, and the fear, that treatment may not be feasible should we need it. A comprehensive coverage plan would ensure that IVF is considered a medical service with equitable access for all. After all, fertility should be a “right for all, not just a privilege for some.”