Public Funding of IVF
In Canada, public funding for health care, including in vitro fertilization (IVF), is regulated provincially. Ontario was the first province to fund IVF, but since 1993 funding has been restricted to three cycles for infertility patients with double blocked fallopian tubes. Recently there has been a move to expand coverage. In April 2014, Health Minister Deb Matthews announced the provincial government’s decision to "contribute to the costs of one cycle of in vitro fertilization (IVF) per patient for all forms of infertility to help people who cannot conceive children." Alana Cattapan wrote an op-ed for the Toronto Star about the expansion of this coverage, arguing that the aims of the program could be achieved without public funding, and that one cycle would not be sufficient to promote access to care. In October 2015, the Government of Ontario announced that it would be implementing the new funding program, and the program would include restrictions on age (under 43 years) and the number of embryos to be transferred.
Public funding for IVF began in Québec in 2000 when the government implemented a tax credit for up to 25% (or up to $15 000) for eligible fertility treatments. In 2001 this was raised to 30% (or up to $20 000) and again in 2007 to 50% (or up to $20,000). Bill 26 was passed in 2009: as part of a provincial public health insurance program, the Bill included further funding provisions for IVF (and a large proportion of fertility services available in the province) as well as regulations pertaining to access. The stated rationale for this move was to reduce the number of high-risk multiple births (i.e. twins, triplets, etc.) by making eligibility for public funding of IVF conditional on the practice of single embryo transfer. In August 2010, Québec became the first Canadian province to publicly fund open access to IVF for both medical and social infertility. While reports have shown a significant drop in the rate of multiple births since the program was instituted, the costs of the program have been substantially higher than anticipated.
In the Spring of 2013 the Québec Commissioner of Health and Welfare was mandated to produce an opinion on assisted procreation activities in Québec in order to assess the merits of the IVF funding program. The public consultation aimed to address clinical, scientific, ethical, social, legal, organizational and economic issues. Françoise Baylis and Ryan Tonkens submitted a brief concluding that it is neither wise nor fair to use provincial tax dollars to fund IVF [PDF - 139 KB]. In November 2014 the Québec government tabled Bill 20, An Act to enact the Act to promote access to family medicine and specialized medicine services and to amend various legislative provisions relating to assisted procreation. This Bill aimed to drastically reduce Québec's funding for IVF. The province also announced that it would create an advisory body that would, among other things, promote single embryo transfer.
Other provinces have also instituted measures to provide funding for IVF. Since 2009 Manitoba has put in place a 40% infertility tax credit (up to $8000), without built-in regulatory conditions. In July 2014, the Government of New Brunswick implemented a program for one-time grants to fund 50% of certain fertility treatments (up to $5000), also without built-in regulatory conditions.
More on funding IVF in Canada:
Building Families Equitably in Ontario
Carolyn McLeod, Toronto Star, November 1, 2015
Why Ontario’s IVF Funding Structure is Not the Answer
Alana Cattapan. Shared Values, TVO, October 26, 2015
Can Public Funding of IVF be Justified?
Carolyn McLeod and Andrew Botterell, In Due Course—A Canadian Public Affairs blog, 2015.
What’s Missing From Ontario’s IVF Policy
Vanessa Gruben, Ottawa Citizen, October 11, 2015
New Changes to Bill 20: Small Victory for Reproductive Rights and Family Doctors
Lana McCrea, McGill Journal of Law and Health, May 29, 2015
Voluntary Sterilization, Personal Responsibility, and IVF Coverage
Katharine Browne, Impact Ethics, March 17, 2015
Kudos to Quebec IVF Docs for Reducing the # of Multiple Pregnancies
Françoise Baylis, Impact Ethics, December 2, 2014
Will Québec's Cut to IVF Funding Lead to More Multiple Pregnancies?
Françoise Baylis, Healthy Debate, December 8, 2014
Quebec’s Assisted Human Reproduction Program
Pamela White, Impact Ethics, July 15, 2014
Socializing Access to Fertility Treatments in Quebec?
Audrey L’Espérance, Impact Ethics, June 19, 2014
'Everything is on the Table' in IVF review: Barrette
Kevin Dougherty, Montréal Gazette, June 6, 2014
Assisted Procreation Should Not Be Free, Report Says
Angelica Montgomery, CJAD News, June 6, 2014
Summary Advisory on Assisted Reproduction in Québec
Commissaire à la santé et au bien-être, Gouvernement du Québec, June 2014
Public Funding of and Access to In Vitro Fertilization
Togas Tulandi & Lenora King, New England Journal of Medicine, 368:1948-1949, May 16, 2013
Funding One IVF Treatment Is Not The Answer To Infertility
Alana Cattapan, Impact Ethics, April 21, 2014
Is Quebec's IVF Program an 'Open Bar'?
Lysiane Gagnon, Globe and Mail, April 30, 2013
The Ethics of Spending Millions on High Tech Pregnancies: 'Made in Quebec'
Françoise Baylis, Impact Ethics, June 26, 2013
Who's Paying for IVF? [PDF - 163 KB]
Françoise Baylis, The Mark, February 27, 2013
Say No to Public IVF Funding
Françoise Baylis, canada.com, July 13, 2012
Status of Public Funding for In Vitro Fertilization in Canada and Internationally—Environmental Scan
Canadian Agency for Drugs and Technologies in Health, Issue 14 • December 2010
In Vitro Fertilization and Multiple Pregnancies: An Evidence-Based Analysis
Health Quality Ontario. Ontario Health Technology Assessment Series, 6(18), 2006.