Ontario women under 43 will have access to one round of publicly funded in vitro fertilization by the end of this year, says the Liberal government, ending months of speculation about what limits would be placed on the long-awaited campaign pledge.
The extended coverage was announced on Thursday and will be limited to 4,000 cases each year. It will be available to all residents regardless of sexual orientation or family status. The province is adding $50-million annually to the $20-million now spent on reproductive services to pay for the program. The age limit follows the recommendation of a report from an expert panel that the government received earlier this year and released on Thursday.
The announcement – made by Health Minister Eric Hoskins at an indoor playground in Toronto surrounded by babies and toddlers born with the help of IVF – provided some level of assurance to those who have been waiting 18 months for the Liberals to make good on their promise. But some questions are still unanswered.
The minister said he is confident the coverage will begin by December, but no funding agreements have been reached with the 18 fertility clinics that offer IVF and charge thousands of dollars for the service.
Brokering that deal could be a challenge. Thursday's announcement came on the same day the Ontario government imposed the second of two across-the-board fee cuts this year on doctors and as it faces a very public battle with physicians over compensation.
"As soon as those agreements are signed with fertility clinics, we will be able to press 'go,'" the Health Minister said, adding that a working group will determine "precisely how these funds can best be utilized."
The move means Ontario will soon be the only jurisdiction in the country to cover IVF under a provincial health plan. Quebec is preparing to scale back its generous program because of rising costs and replace it with a tax credit.
The funding is for one round, but the province is using a broad definition of that term, saying the coverage will apply to one egg retrieval, which could result in multiple embryos. It will extend to the one-at-a-time transfer of all viable embryos, a provision designed to reduce risky – and costly – multiple births.
The reduction of multiple births is frequently cited as a benefit of funding IVF, because, when people pay for the costly procedure themselves, more than one embryo is often implanted to increase the chances of success.
The Health Minister, himself a doctor, said reducing multiple births is an import part of the plan, and defended the decision to limit eligibility, saying the cut-off age was based on "scientific evidence and best practices."
Fertility experts and advocates in Ontario and beyond have been watching what the province does because it could be a model for others. The cost for one round of IVF treatment is $8,000 to $15,000. Until now, only women who have blocked fallopian tubes have had the treatment covered in the province.
"This is incredibly significant," said Carolynn Dubé, executive director of the Infertility Awareness Association of Canada, a national patient organization. "We are hoping other provinces will look at their funding models."
Adam Young said the news is a little late for him and his wife, Kim. He estimates they have already spent nearly $70,000 in medical and travel costs for two rounds of IVF. They recently started a second round, deciding they could not wait for government funding. They travel about three hours to Toronto from Huntsville and sleep in a trailer parked on a friend's lot north of the city to save money. "It would have been a big difference for us," he said.
Mr. Young took issue with those who say scarce health-care dollars should not be used for IVF. Maybe it is not life or death, he said, but infertility is a medical condition and trying to have a family is something he and his wife feel driven to do.
Even with Thursday's announcement, the wait for aspiring parents may not be over. Fertility centres already have waiting lists in anticipation of the change, with one Toronto clinic estimating it could take a year or more to address the demand.
In addition to Quebec, Manitoba offers a tax credit for IVF treatments, while New Brunswick offers a one-time grant.