Would-be parents who turn to in vitro fertilization to conceive children will find inconsistent oversight of fertility clinics across the country with some facilities free to set their own policies about how to do business.
The relative autonomy of the clinics was highlighted recently when the Regional Fertility Program in Calgary refused to help a woman become impregnated with sperm from a donor who did not share her skin colour.
The clinic said this week that its ban on blending races during in vitro fertilization (IVF) was changed more than a year ago, suggesting the woman had been misinformed by one of its doctors. But Alberta does not directly regulate the clinics, nor do other provinces except Quebec.
With Ontario promising to fund in vitro fertilization, and Alberta giving thought to paying the cost of the procedure, governments and fertility experts are asking whether more regulation is needed.
"I think that people who are seeking this kind of treatment are very vulnerable. They suffer from infertility and they are desperate to get a child and they are going to take all sorts of risks," said Colleen Flood, the Canada research chair in health law and policy at the University of Toronto.
Dr. Flood said any clinic that refused to mix races during the in vitro process could become the subject of a complaint to the provincial College of Physicians and Surgeons, which licenses doctors to practise medicine. Although doctors have been able to refuse to dispense birth control on the grounds of religious conscience, "it would be difficult to claim, I think, that your conscience requires that you can't mix the races," she said.
But other policies, clinical practices and even the effectiveness of the treatments are not being adequately assessed at many of Canada's private, for-profit in vitro clinics, Dr. Flood said.
Since the Supreme Court gutted the federal Assisted Human Reproduction Act in 2010 and declared that regulation of the clinics was the jurisdiction of the provinces, there has been a patchwork of oversight.
Quebec has a law with fines of thousands of dollars for those who break the rules. Other provinces, including Ontario, which is home to half of the 43 clinics listed on the website of the Canadian Fertility and Andrology Society, do not.
In some provinces, including British Columbia and Alberta, the colleges of physicians accredit IVF facilities. They look at things such as sterilization procedures and the competence of medical staff.
But Karen Eby of the Alberta college says: "We don't typically set standards on clinical care. We just don't get into [that] level of detail. The things we are looking at would be 'do you have a surgical checklist, do you have safe exits, are your staff appropriately trained, do they get annual reviews …"
Colleges of physicians in some other provinces don't go that far.
Ed Schollenberg, the registrar for the College of Physicians and Surgeons of New Brunswick, which has one of the clinics, said his organization accredits doctors but not individual facilities. So there are no on-site inspections.
A handful of the IVF clinics have been approved by Accreditation Canada, which sets standards and does site visits to ensure they are being met. But accreditation is mostly voluntary outside of publicly funded facilities in Quebec and Manitoba.
"We have this odd approach in Canada: If it's publicly funded, then it's all systems go on the regulations frontier," Dr. Flood said. But for privately funded clinics, "it's pretty much caveat emptor, whether we are talking about IVF services or cosmetic surgery or anything. It's pretty astonishing, actually."