IVF Coverage and Single-Embryo Transfer: Evolving Policy Changes in Quebec and Ontario

IVF Coverage and Single-Embryo Transfer: Evolving Policy Changes in Quebec and Ontario

In public policy discussions of in vitro fertilization (IVF), the potential for multiple pregnancies (i.e. pregnancies with twins, triplets, or more babies) continues to stir up controversy. In some cases, multiple pregnancies can cause physical, mental, and financial strain for intended parents and their families, and can present medical risk to both the mother and the babies. These are risks the Canadian government seeks to minimize through its universal health plans and, in some provinces, through public policy.

In 2010, Quebec became the first province in Canada to fund in vitro fertilization through universal healthcare. Public policy in Quebec mandates the use of single-embryo transfer (SET) in the IVF process. Single-embryo transfer involves harvesting multiple eggs for fertilization, but only transferring one embryo per IVF cycle; the remaining embryos are kept frozen for potential future use.

Prior to Quebec’s decision to fund IVF, couples could opt to transfer multiple embryos at once—but at their own cost. Once full coverage was available through universal health insurance, however, SET became much more popular in Quebec and was used in 32 percent of IVF cycles in 2011, jumping from 2 percent in 2009. According to Dr. Bradley J. Van Voorhis, director of the IVF Program at the University of Iowa Carver College of Medicine, this increase in SET cycles confirms that these cycles are more likely to occur and will ultimately reduce birth rates of multiples. When public policy first started mandating the use of SET during in vitro cycles, the rate of multiple births dropped from 30 percent to 7.9 percent.

Why Implant Multiple Embryos?

10-20 percent of the population in Western Europe and North America currently experiences infertility, which has led to a rise in the number of intended parents seeking fertility treatments, such as IVF. In 2002, Canada’s crude birth rate—that is, the number of live births occurring among the population of a given geographical area— dropped to an all-time low of 10.5 live births for every 1,000 population.

In provinces where IVF is not covered by universal health insurance, the cost of one cycle is approximately $10,000, and the results are not guaranteed. Thus, intended parents may seek out additional assurances of success, including the transfer of multiple embryos with each IVF cycle.

In Ontario, debate is underway to determine whether this province’s universal health coverage will include the costs of IVF. Some officials are promising coverage of IVF at the beginning of 2015. According to CBC News in Ontario, Health Minister Deb Matthews estimates that Ontario will spend $50 million annually, covering 4,000 or more people, once the program is fully implemented. Today, however, this policy change is still under debate.

If you have experience with IVF—single-embryo transfer or multiple embryo transfer—we’d love to hear from you. Which route did you choose and why? What are your thoughts on public policy changes under consideration in Ontario?

The Cost of IVF in Canada

The Cost of IVF in Canada

What Is In Vitro Fertilization?

In Vitro Fertilization (IVF) is a medical procedure where a woman’s eggs are removed from her ovaries and fertilized in a lab with sperm from her partner or selected donor. The embryos created from the fertilization are returned to her uterus, or the uterus of a surrogate mother, in hopes of creating a pregnancy. As a woman’s age increases, the live birth rate from IVF decreases.

A 35 year-old woman can expect a live birth rate of approximately 30% to 35%. If a woman’s partner or sperm donor suffers from infertility issues such as low sperm motility or movement, then intracytoplasmic sperm injection (ICSI) may be necessary. ICSI is a delicate procedure requiring the lab technician to inject a single sperm into the egg, and is performed at an additional cost.

How Much Does In Vitro Fertilization Cost?

The cost of IVF varies across Canada. The chart below outlines the per-treatment cost ranges for IVF alone and when sperm injection (ICSI) is required.

Geography Costs– IVF Cycle Cost IVF + ICSI Medication
Western Canada $4,000 – $8,000 $5,400 – $9,500 $2,000 – $7,000
Ontario $4,500 – $7,000 $6,000 – $8,150
Quebec $5,500 $7,000 – $8,000
Maritimes $5,400 – $5,925 $6,900 – $7,425

Additional costs may include fees for initial consultations and/or registration with the fertility clinic, other recommended services and procedures such as assisted embryo hatching, legal fees for egg, sperm or embryo donor contracts and surrogacy contracts, and other miscellaneous expenses such as travel costs and lodging.

Alternative Funding Sources

You may also be eligible for provincial and federal tax credits when claiming your non-reimbursed medical expenses on your Canadian income tax return. How much of a credit you will receive is dependent on your income.

Some fertility treatment clinics offer financing options to help pay for the cost of treatments. Your employer health benefits may also offer coverage on drug prescriptions and select procedures.

Debate #1 – How Many Embryos To Transfer?

Many intended parents opt to have multiple embryos transferred at one time in order of one at a time in order to increase the chance of pregnancy and decrease the cost associated with multiple IVF cycles. Due to the risks associated with multiple births, more clinics are now providing more thorough information sessions to prospective parents and some clinics are insisting on single embryo transfers. Depending on your circumstances and conditions, some of your treatment may be covered by provincial health care. For example, in Ontario, OHIP will pay for three cycles of IVF (but not the medications) for women under the age of 40 with bilateral blocked fallopian tubes that has not resulted from a sterilization procedure. In Quebec, three rounds of IVF treatment for couples are funded only if one embryo is transferred at a time. Check with your provincial health ministry to see if any costs are covered before you begin your treatments.

Debate #2 – Should Government Cover The Cost Of IVF?

UK regulators have recently proposed changes to IVF coverage that would include women up to the age of 42 (previous limit was up to the age of 39), same-sex couples and those suffering from terminal illness. These changes have sparked conversation around the world and recently re-ignited the debate in Canada regarding whether the government should also cover women up to the age of 42, same-sex couples and those suffering from terminal illnesses.

Pregnancies created from the transfer of multiple embryos are 17 times more likely to result in a pre-term birth, are more likely to require a caesarean birth, and the infants are more likely to need expensive care at birth and throughout their lives. Quebec instituted the one-embryo-at-a-time policy to help reduce the risks, thereby reducing the costs associated with multiple transfers. Supporters of broader IVF coverage advocate the cost savings and/or health benefits to the government, the intended parents as well as the surrogate mother. A study by Dr. Keith Barrington and colleagues from the University of Montreal has reported that Quebec has experienced a decrease in twins from 27% to 5% in the first 6 months of government funding.

What do you think? Should the government expand IVF coverage in Canada? Let us know your thoughts.

Study: Older Moms Using Donor Eggs

Study: Older Moms Using Donor Eggs

Study Tracks Older Moms Using Donor Eggs: An American Journal of Perinatology article, coauthored by Dr. Mark Sauer of Columbia University, showed that older moms who conceive using donor eggs are not at increased risk of complications compared to younger moms who have similarly used IVF.

Ottawa Citizen Article