It was a promise on a truly motherhood issue. In the spring of 2014, the Ontario Liberals, fighting to hold on to power in a minority government, pledged to fund one cycle of in vitro fertilization.
Eighteen months later, couples in Ontario struggling with infertility are still waiting to find out when and how that financial help will be delivered, knowing that every month that passes reduces their odds of becoming parents.
An expert panel, assembled after the Liberals were returned to power with a majority, has finished its report, but the government has yet to say when it will make public its plans, which are expected to be in place by the end of the year. In the meantime, couples are weighing the odds, with some deciding to spend tens of thousands on IVF rather than risk a delay. Others are taking their chances, trusting that the government will make good on its commitment before it's too late for them.
Fertility experts and advocates outside Ontario also are watching, hoping that whatever measures are introduced might serve as a model for other provinces at a time when Quebec – the only jurisdiction in Canada that offers upfront payments to cover IVF – is preparing to dramatically scale back its generous program.
"People are putting their lives on hold," said Carolynn Dubé, executive director of the Infertility Awareness Association of Canada, a national patient organization that has been getting many calls.
Ms. Dubé said her hope is that the long delay means Ontario will deliver a well-thought-out program – one that her group can point to as an example for other jurisdictions and that avoids the rising costs that forced Quebec to rethink its IVF coverage.
That won't be easy. At a time when Ontario faces an $8.5-billion deficit and is looking to other parts of the health-care system for savings, it has promised to open up its wallet to fund a treatment that can cost on average between $8,000 and $15,000. It must find a way to do it that keeps those costs in check, such as setting age limits and creating rules about what will be covered.
For Carolyn Hewitt, 36, the government delay was too much. After waiting a year, she and her husband used their own money to pay for a round of IVF treatments this spring, hoping their son, born in 2013 with the help of IVF, might have a sibling.
"Who knows what they will cover," Ms. Hewitt says of the Ontario plan. "We could have waited and then found out we were excluded because we have a child."
It was an expensive decision. Even with employer drug coverage, she estimates they will be out of pocket about $16,000, but feels she is lucky because she has the financial resources to even consider this option.
Sandra Alsaffawi-David, a member of Ontario's expert panel, has chosen another path. She is waiting to take advantage of provincial funding after taking out a loan to pay for her first round of IVF, saying she trusts the province not to renege on its pledge.
Ms. Alsaffawi-David, part of a group that has been lobbying for years to have IVF covered by provincial health care, praises the Liberals for their commitment, but is already talking about expanding coverage beyond the one cycle promised by the government, calling it "a great place to start."
At the same time, she says it makes sense to place some limits on eligibility, to avoid having to roll back benefits as Quebec is doing.
The case for funding in Quebec included the expectation that it would reduce costly, and risky, multiple births. Given the high cost of the treatment, often more than one embryo is implanted to increase the odds of success. Quebec rules require only one embryo be used. The rate of multiple births fell, but not enough to compensate for the cost of IVF treatments.
Now Quebec, which extended coverage to all women, has proposed legislation that would replace up-front coverage with tax credits based on income. The new bill would exclude women older than 42 from coverage, though the province has backed down from plans to prevent older women from funding IVF out of their own pocket.
Manitoba offers a tax credit for IVF treatments and New Brunswick offers a one-time grant.
Whatever rules Ontario creates, doctors can expect to see a surge in demand, says Dr. Neal Mahutte, medical director of the Montreal Fertility Centre and president of the Canadian Fertility and Andrology Society.
After Quebec introduced funding, the number of new IVF cycles jumped to more than 8,000 in 2012, from 1,900 in 2009, he said. The prospect of that funding ending now has couples rushing to get IVF treatments – choosing, for instance, to try for a second child more quickly – before government money dries up, he said.
In Ontario, increasing demand means wait lists at fertility clinics are swelling. Dr. Tom Hannam estimates it will take more than a year to get through those in line for IVF at his Toronto clinic when the province begins to pay for some portion of it.
"You can imagine the choices people make around this. It can be awful," Dr. Hannam said. "This waiting thing has been quite difficult."