Prepared by Toronto Health Insurance broker Olga Ryjkova
Two and a half years have passed since December 2015, when the Ontario government launched a $50 million Fertility Program to help Ontarians build their families.
A statement by the Ministry of Health and Long-Term Care noted, “The Ontario Fertility Program has been successful in helping people grow their families by increasing access to fertility services.” More than 28,000 people have utilized fertility services, at a cost of $70 million a year.
According to the numbers provided by the Ministry, each year more than 5,000 patients are now able to access funded in vitro fertilization (IVF) services, compared with the fewer than 1,000 patients previously accessing insured IVF under OHIP each year.
The Ontario Fertility Program funds the costs for the following:
- IUI – Intrauterine Insemination – Unlimited: A procedure during which sperm is injected directly into the uterus with a catheter.
- FP – Fertility Reservation – Once per lifetime: The freezing of egg or sperm samples to be used later in IUI or IVF for patients requiring it for medical reasons.
- IVF – In Vitro Fertilization – Once per lifetime: It is a process by which an egg is fertilized by sperm outside the body – in vitro (“in glass”). The process involves monitoring and stimulating a woman’s ovulatory process, removing an ovum or ova (egg or eggs) from the woman’s ovaries and letting sperm fertilize them in a liquid in a laboratory. The fertilized egg (zygote) is cultured for 2–6 days in a growth medium and is then implanted in the same or another woman’s uterus, with the intention of establishing a successful pregnancy [3].
Access to funded fertility services is available for all forms of infertility (including medical and non-medical infertility), regardless of gender, sexual orientation, or family status.
Science-based facts about fertility treatments success
A large-scale Danish study found that three in four (3 in 4!) women starting fertility treatment will have a baby within five years.
Between 2007 and 2010, researchers analyzed 19,884 women with carrying out follow-ups for live births at two, three and five years. The results showed that after two years 57% of the women had had a baby, with 46% of conceiving by in vitro fertilization (IVF) when IVF was the first fertility treatment, and 34% conceiving after intrauterine insemination when intrauterine insemination (IUI) was the first fertility treatment. Age was the greatest factor in determining success, with further research showing that at five years, total birth rates were 80% for women under 35 years, dropping to 60.5% for those aged 35-40, and 26% for those aged 40 and over [1].
Costs of infertility treatments
The costs to treat IVF could be up to $10,000 dollars for one round, largely restricting it to people of means. The infertility program is exceedingly generous making infertility service available for the families that could not afford it because of the high prices involved. (Patients can still opt to pay out of pocket.)
Access to infertility treatments in Ontario
According to the Ministry of Health and Long-Term Care, it’s nearly 17% of the province’s residents who struggle to get pregnant, whether due to preexisting medical conditions or age-related issues. Available in 51 fertility clinics across the province, OHIP funds one IVF cycle per eligible patient per lifetime. One cycle includes one egg retrieval, which may yield multiple eggs and result in multiple embryos. The funding would include the one-at-a-time transfer of all viable embryos to allow for the possibility of multiple chances for pregnancy and to reduce the occurrence of higher-risk multiple births [2].
Eligibility for government-funded fertility treatments
To be eligible for government-funded fertility treatments, you must live in Ontario and have a valid Ontario health card. Sex, gender, sexual orientation or family statuses are not considerations in fertility treatment eligibility. Depending on the type of treatment you choose, there may be additional requirements for coverage, as well as some limits on coverage.
What is covered by the fertility program and what is not
Let’s go over what is covered by the fertility program (and what is not). The costs which are not covered by the government may be covered by some private health insurance plans.
All fertility treatments
Covered:
- Physician/nurse assessments and counselling
- Certain blood and urine tests
- Certain Ultrasounds
Not Covered:
- Any fertility drugs needed: about $5,000 per IVF cycle; about $1,000 per AI (or IUI) cycle
- Genetic testing
- Storing sperm, eggs and/or embryos
Intrauterine Insemination
Covered:
- Cycle monitoring
- Insemination procedure (excluding sperm washing)
Not Covered:
- Sperm washing/preparation before insemination
- Purchase, shipping, or storage of donor sperm
Fertility Preservation
Covered:
- Up to two attempts at cycle monitoring
- One attempt at egg retrieval
- Freezing of one batch/sample of eggs or sperm
- Sperm collection or, if required, one attempt at surgical sperm retrieval using certain techniques
Not Covered:
- Preservation of additional batches/samples of eggs or sperm
In Vitro Fertilization
Covered:
- Up to two attempts at cycle monitoring
- Embryo freezing, thawing and culture
- One attempt at surgical sperm retrieval using certain techniques (if required).
- Fertilization and embryology services, including intra-cytoplasmic sperm injection (ICSI), assisted hatching and blastocyst culture
- One-at-a-time transfer of all embryos (fresh/frozen)
Not Covered
- Purchase of donor sperm or eggs
- Storage or shipping of eggs/sperm/embryos
- Any services performed on other people participating in the patient’s funded IVF cycle, if they do not also hold a valid Ontario health card.
***
I hope that this overview about fertility treatments in Ontario you’ve found useful.
Please contact me if you have questions about health insurance plans or to get a quote for one that you are interested in. It’s absolutely free and you are under no obligation to accept the quote you’ll receive.
Toronto Health Insurance broker Olga Ryjkova
1183 Finch Ave West, Unit 301, Toronto, ON M3J 2G2
416-822-2698
info@insurancestoronto.ca
References:
- http://medicalxpress.com/news/2016-07-women-fertility-treatment-baby-years.html
- https://news.ontario.ca/mohltc/en/2015/10/improving-access-to-fertility-treatments-for-ontario-families-1.html
- https://en.wikipedia.org/wiki/In_vitro_fertilisation
