Cayley Benjamin, of Vancouver, shown in this handout image, is thrilled that British Columbia will finally be joining seven other provinces by funding in vitro fertilization but says the province should pay costs up front to people struggling to save thousands of dollars for the treatment.

Image Credit: THE CANADIAN PRESS/HO-Sarah Davids Photography **MANDATORY CREDIT**

VANCOUVER - British Columbia is joining seven provinces in paying for some of the cost of in vitro fertilization but scant details and long-standing inequities have raised questions about how the plan could benefit patients.

While some applauded the move, expected to begin in April 2025, others in the field were wary of the lack of specifics around what aspects of the treatment would be covered.

Here’s a look at the hopes, concerns and reality of those who receive IVF or advocate for public funding.

FEW DETAILS ARE KNOWN

British Columbia plans to convene an expert clinical group to help create the program and provide $68 million in funding for two years.

Finance Minister Katrine Conroy said last week that "one round of IVF will be available for free" but provided no details.

However, the process of undergoing IVF includes multiple procedures and an array of medical and non-medical costs. Medications alone can run into thousands of dollars and are not included in most programs across the country. Rural patients face added travel expenses for regular visits to clinics in major centres.

IVF involves hormone injections to stimulate production of multiple eggs to boost the chance of pregnancy.The eggs are removed from the ovaries and fertilized with sperm in a lab. One or more of the resulting embryos are transferred to the uterus a few days later and pregnancy is determined by a blood test after about two weeks.

WHICH PROVINCES OFFER COVERAGE?

British Columbia's announcement leaves Alberta, Saskatchewan andthe territories as the only jurisdictions without any IVF funding or plans to provide coverage.

Carolynn Dubé, executive director of Family Matters Canada, said one cycle of IVF costs an average of $20,000. She describedfunding schemes across the country as a "hodgepodge" and urgedBritish Columbia to seek advice from all stakeholders including patients, advocates and clinicians to understand what has worked elsewhere.

"We're asking the provincial governments, the federal government and insurance carriers to all take a piece of the pie," said Dubé, adding it'sparticularly important asbirthrates decline.

Among provinces that do offer coverage, eligible costs vary widely — in some cases only treatment costs are covered while medications and other services must be paid out-of-pocket.Manitoba and Nova Scotia, for example, also offer a tax credit for legal fees for those using donated eggs, embryos or sperm. Patients can submit receipts for up to $20,000 for all the services to recoup $8,000 per year.

In Ontario, coverage is limited to women below the age of 43 and is restricted to one cycle of IVF. It does not include medications.Advocates there want a tax credit for subsequent cycles and travel grants for those who live far from major centres, Dubé said.

Prince Edward Island does not have an IVF clinic but offers up to $10,000 in eligible expenses based on family income fortreatment elsewhere, while Quebec fundsboth treatment and medication.

Michelle Chidley of Fertility Alberta said British Columbia's announcement has bolstered her efforts to push her province to fund IVF.

"I personally believe that access to IVF should not be a privilege for those who can afford it," Chidley said. She launched the group last June after working with a charity to raise money for families needing fertility treatment.

THE WAIT FOR TREATMENT IS LONG

In Ontario, wait lists at publicly funded clinics can last a year and a half, said Dubé, who had three sons after undergoing two cycles of IVF and five embryo transfers.

"And you can be on several wait lists at different clinics. It's wildly stressful. And people age out because they wait so long,"she said of the coverage, introduced in 2015.

Clinical counsellor Holly Yager of Vancouver said the wait for IVF at some clinics, particularly Ontario, has meant some patients travel to British Columbia.

"At one point during the pandemic I remember someone saying it was a two-year wait for the funded treatment in Ontario. Here in B.C., we already have long wait times. So that is a concern for me. I don't know how the clinics are going to manage because they're already very busy."

ONE ROUND IS NOT ENOUGH

Success rates are low for one round of IVF. For every embryo transfer, a little less than 32 per cent of people under 35 give birth per embryo transfer, according to 2021 data from the Canadian Fertility and Andrology Society. That number dips to about 27 per cent for those between 35 and 39 and almost 22 per cent for patients older than 40.

Cayley Benjamin of Vancouver said she and her husband paid $30,000 for one round because of "add-ons" including genetic testing. They delayed their plans to buy a house to pay for the procedure.

"Fortunately for us, I was able to get pregnant following our first round of IVF, and I'm 21 weeks pregnant," said Benjamin, adding she "burst into tears" when she heard British Columbia would start funding some aspect of the procedure.

"I feel such an affinity to others who are on a fertility journey to have children, and I just feel very emotional about it and am really celebrating."

MANY WHO NEED IVF CAN’T PAY UPFRONT

Dubé said IVF would remainout of reach for many people under a provincial funding plan because they still have to pay out of pocket before recouping expenses.

"They think, 'I can't get a line of credit, can't remortgage my house and my parents can't give me the money so I can't do it'," she said.

Benjamin wants British Columbia to fund the program upfront instead of having people wait for reimbursement.

"For so many people the barrier is actually being able to pay for the services at all. I know a lot of people for whom IVF isn't an option because of finances," said the 38-year-old.

"Imagine going to pay for your medications, and the bill is $2,000," she said of just a single purchase of her medications, which totalled $5,000.

"So few benefits plans cover IVF treatment or medications and there are a lot rules and maximums and limitations around it.

"We didn't have any coverage through our health benefits plan and those costs came out of pocket, which is the case for so many people."

THE OTHER HIDDEN COSTS

A report published last year by the World Health Organization said one in six people is affected by infertility, resulting in significant mental health challenges due to stigma and "catastrophic" costs. It called for better policies and public financing to improve access to treatment.

Women who undergo multiple failed rounds of IVF endure trauma, loss and "disenfranchised grief" that is not talked about but impacts every aspect of their lives, requiring significant investment in mental health services for those struggling to conceive, Yager said.

However, male infertility is an even more underrecognized issue and deserves attention, she added.

Canada's fertility rate fell to its lowest ever in 2022, when it was just 1.33 children per woman, according to a Statistics Canada report released in January.

British Columbiahad a rate of 1.11 children, the lowest in the country.

This report by The Canadian Press was first published Feb. 28, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

Note to readers: This is a corrected story. An earlier version referred to Alberta Fertility. In fact, it's called Fertility Alberta.

News from © The Canadian Press, 2024