November 29, 2022 | LGBTQIA+

Medically Assisted Reproduction

In 2010, Quebec’s public healthcare regime (“RAMQ”) began offering one of the most generous coverages in Canada for medically assisted reproduction.  RAMQ covered three fresh in vitro fertilization (“IVF”) cycles as well as all frozen embryo transfers arising from the funded fresh cycles. This was a big deal, as IVF is a critical way for many families to be able to have children and can present significant financial barriers when it is not publicly funded, costing upwards of $ 6,000 to $ 8,000 per cycle. However, in November 2015, Bill 20 was passed and with it all public IVF funding in Quebec was withdrawn with the sole exception of fertility preservation for patients with cancer.

The exciting news is that as of November 15, 2021, the medically assisted reproduction program has been reintroduced under RAMQ which includes coverage of IVF and IUI (intrauterine insemination, a less invasive but typically less effective method of medically assisted reproduction). Medically assisted reproduction offers fertility treatments to assist individuals and couples become parents who either cannot conceive on their own or who have difficulty conceiving without assistance. This might include, for example, a heterosexual couple struggling with infertility, a queer couple made up of two cisgender women, a single woman who wants to become a mother on her own, or a queer couple made up of a cisgender woman and a trans woman where the trans woman has sperm frozen from before her transition.

The Act respecting clinical and research activities relating to assisted procreation ensures that the fertility treatment services offered are ethical and safe. In order to receive medically assisted reproduction treatments, you must be eligible for the Quebec health insurance plan (RAMQ).

If you are interested in receiving fertility treatments under this Act, the first step is to undergo a fertility exam. The exam can be done by your family doctor, a gynecologist, or at a center for assisted reproduction. A fertility exam will determine if a diagnosis of infertility is justified and to help a physician determine its cause. The results may show that you are having trouble conceiving for reasons other than infertility.

Depending on the cause, you and your physician will determine the best treatment for your situation. The treatments available include simulation or induction of ovulation, intrauterine insemination, or in vitro fertilization.

The program has a limited scope and is available to female-male couples, female-female couples, and single women. It is not available to those who have undergone voluntary sterilization such as tubal litigation or vasectomy. Patients must be above 18 when the treatment begins, and the maximum age for patients is 41 years less a day to start treatment and 42 years less a day for embryo transfer. If you meet the eligibility criteria but received fertility treatment before November 15, 2021, it may be covered for you as well. If you have already frozen embryos, you can also start a new IVF cycle under the program.

If you are ineligible for medically assisted reproduction services, you cannot obtain RAMQ coverage. However, you may be entitled to a tax credit for the treatment of infertility. See this website for more information: https://www.revenuquebec.ca/en/citizens/tax-credits/tax-credit-for-the-treatment-of-infertility/

The insured services include a single in vitro fertilization cycle, which may include:

  • One egg retrieval
  • Up to two ovarian simulations
  • Sperm retrieval
  • One straw of donor sperm (must be approved by Health Canada)
  • Freezing of embryos for one year
  • The transfer of each embryo

Additional treatments offered include oral or injectable ovarian simulation, up to six donor inseminations per live birth, and up to six straws of donor sperm. Other fertility-project services include medications that are covered by the prescription drug insurance plan.

Even if the reimplementation of public health coverage of assisted reproduction services does not impact your family, it is important for equity in our society. Those with fertility issues often have to spend significant sums of money to achieve what others can obtain naturally, which can lead to taking out loans just to grow their families. Moreover, LGBTQ+ Canadians have lower average annual incomes than non-LGBTQ+ Canadians and are more likely to need assisted reproduction treatments in order to have children.

Furthermore, publicly funded fertility treatments reduce the likelihood of multiple births through IVF, which increase risks to both mothers and babies. By covering the costs of IVF through RAMQ, the provincial government controls the terms of the treatment, which includes only transferring one embryo at a time other than in exceptional situations. By reducing the risk of multiple babies per IVF cycle, we reduce the health risks to mothers and babies which significantly lowers healthcare costs. NICU stays are fewer and shorter for IVF babies and mothers using IVF need less hospital care, benefiting the healthcare system as a whole.

Most importantly, this highly anticipated program helps more individuals and couples become parents, is a step towards reducing unjust barriers, and while not a perfect program, we are grateful that it has been re-established.

For more information, check out the following links:

https://www.ramq.gouv.qc.ca/en/news/2021-11-15/changes-coverage-medically-assisted-procreation-services

https://www.quebec.ca/en/family-and-support-for-individuals/pregnancy-and-parenthood/medically-assisted-reproduction/mar-program

https://www.quebec.ca/en/family-and-support-for-individuals/pregnancy-and-parenthood/medically-assisted-reproduction/description-of-services/how-to-receive-mar-services

https://www.cbc.ca/news/canada/montreal/in-vitro-fertilization-funded-public-1.6244008

https://montreal.ctvnews.ca/quebec-to-bring-back-publicly-covered-ivf-as-of-nov-15-1.5659943