Fertility funding fosters diverse group of parents
When Sarah Sabihuddin and her husband first started to try for a family back in 2012 — about a year after tying the knot — they never imagined that they’d have any difficulties. But when months went by with no positive results, the Oakville, Ont.based couple spoke with their family doctor, who referred them to a fertility specialist in early 2013.
After many rounds of invasive tests, the couple was given the frustrating diagnosis of “unexplained infertility.”
Over the next couple of years, Sabihuddin and her husband did four rounds of intrauterine insemination (or IUI) without success. Each time the cost was about $1,000.
Between the start of their fertility challenges and 2015, they had managed to save the money for one round of in vitro-fertilization (IVF) — which costs between $10,000 and $20,000. The cycle failed and none of the embryos were viable.
“We were left with nothing and had exhausted our financial options,” Sabihuddin says. “At our debrief appointment six weeks later, we had the intention of letting our clinic and doctors know that this was the end of our road.”
However, they learned at that appointment that the Ontario government was planning to fund IVF beginning in 2016, and that the clinic had started a wait-list in anticipation of the announcement. Sabihuddin and her partner decided to add their names.
A little more than a year after it launched, Ontario’s first IVF program is just coming out of its infancy. It’s taken until now for the program to get its stride after some wobbly first steps, but the result is a new, more diverse cohort of parents bringing babies home from the hospital. When the program came into effect at the beginning of 2016, any woman with a valid OHIP card under the age of 43 in Ontario could qualify, explains Dr. Tom Hannam, reproductive endocrinologist and owner of the Hannam Fertility Clinic.
But that doesn’t mean every couple that wanted to access publicly funded IVF could do so immediately. Rather than making the system unlimited — a move that led to the province of Quebec having to shut down its funded IVF program — the government made 5,200 publicly funded IVF cycles available that year, as well as 27,000 cycles of IUI. Spots were allocated to clinics based on size and geographical spread, and the cost was $70 million.
“Each clinic had to try to figure out their own fair system,” Hannam says.
That meant choosing between setting up a lottery, a first-comefirst-serve wait-list or some other system that either prioritizes based on medical need, or gives first dibs to couples who are about to age out of the system.
Hannam said those early weeks of 2016 were “totally destructive to the morale of our team” as they fielded hundreds of calls and emails, but even more so for all the would-be parents hoping to access a funded IVF cycle. “We had far too many people than I had numbers of spots.”
While most of the clinics have wait-lists of a year or more, the chaotic early days of the system are behind Ontario’s fertility specialists, who can now reflect on the program’s success making IVF available to people who couldn’t previously dream of affording the procedure.
“I met a woman last week. They’re fairly new Canadians, here for four years,” Hannam says. “She works at Tim Hortons and he’s going to school right now. They’re in their 30s and there’s male factor infertility, so their only way of getting pregnant is through IVF. This would never have had a chance without this funding opportunity.”
“When you see them have that baby it’s amazing,” says Dr. Clifford Librach, founder of Create Fertility Clinic, noting the more diverse socio-economic mix in his clinic since the program started.
However, Librach does point out that there are some places where the program could be made more equitable. His clinic sees a lot of cases where there’s a third party involved — an egg donor or surrogate. For a woman seeking IVF, “they made the cut-off age 43 even though the eggs might be younger,” Librach says.
These parents-in-waiting don’t have the same access to the funding as say, same-sex male partners in their mid- to late-40s who use surrogates who are in their 30s.
A spokesperson for the Ministry of Health said this is because “the effect of age on male fertility is not as pronounced and occurs much later.”
The experts who participated in the advisory process for infertility services recommended that patients in groups with a success rate of less than 10 per cent of having a live birth should not be funded, the spokesperson said in an email.
The fact that women in their 40s often use donor eggs from much younger women was not addressed in the ministry’s response to questions from the Star.
Funding remains at $70 million for the program in 2017, but more of the funds will be allocated to IVF — enough for 5,800 cycles.
Given the high stakes of having just one shot to make IVF work, the program has also highlighted the need for an informed and proactive approach among patients.
At A.L.I.V.E. Holistic Health Clinic, Mary Wong, a traditional Chinese medical practitioner with a specialty in fertility, sees many patients who weren’t aware at the start of their funded cycle that there are measures they can take to make the most of that single chance to create embryos. A 2015 study found that acupuncture — covered by many employee health benefit plans — improves the success rate of IVF by 13 per cent. It does this in part by doubling blood flow to the reproductive organs, Wong says. “It’s very important to maximize oxygen and nutrients to signal the growth of a healthy egg.”
To increase her odds, Sabihuddin did massage for relaxation and exercise for overall health, acupuncture before and after her embryo transfers.
And in her household there is happy news at last. In February, the couple brought home their baby girl, Safira Marie Jehani Sabihuddin. “Her first name means ‘a woman on a journey’ or ‘a female traveller,’ ” says her mom.
“Without this program we would not be able to welcome this little one into the world. In a time of competing government priorities, I am so happy that the decision was made to help create and support families like ours,” Sabihuddin says. “Some say it takes a village to raise a child, but in our case it has taken a village to conceive this child, and for that we are so very blessed and appreciative.” Brandie Weikle is a parenting expert and the host of The New Family Podcast and editor of thenewfamily.com.