KARMA Blog – How does the Ontario Fertility Program Work?

By Sonja Swanson

 In December 2015, the Ontario Ministry of Health began the Ontario Fertility Program (OFP). This covers some of the costs associated with fertility treatments to help Ontarians grow their families. There are some eligibility criteria and some aspects of care that are not covered.

 

IUI Funding

The patient must have a valid OHIP card and there is no limit on the number of IUI cycles that can be done per patient in their lifetime. There is not an age limit for someone wanting to do IUI.

The Funding covers all monitoring (ultrasounds, blood work, doctor/nurse visits) during the IUI cycle and one IUI insemination procedure. However, there is an additional cost for processing the sperm sample and any medication costs are to be paid by the patient.

The IUI funding covers use of partner or donor sperm for IUI. If using frozen donor or partner sperm, the purchase cost or cryopreservation and annual storage fees are not included in the funding program.

 

IVF Funding

The Funding is billed to the person receiving the embryo transfer with the goal of establishing a pregnancy (the Primary Patient); this could be the intended parent (IP) or a surrogate. The Primary Patient must be less than 43 years old at the start of the cycle and have a valid OHIP card. There is one (1) funded cycle per lifetime as a Primary Patient. If the Primary Patient is a surrogate, at least one IP must also have a valid OHIP card and have not received a funded cycle previously.

The Funding covers all monitoring (ultrasounds, blood work, doctor/nurse visits) during the IVF cycle and standard embryology services to inseminate, culture, and cryopreserve the embryos. Fees that are not part of the funding include: annual storage, medication, PGT biopsy (KARMA) and PGT testing (CooperGenomics), and purchase of donor gametes (sperm or eggs).

Any funded cycles must follow the Embryo Transfer Policy, which means in most cases, patients are only allowed to have one embryo transferred at a time.

Milestone 1 involves the creation of embryos (and a possible fresh embryo transfer) in the following ways:

  • Primary Patient undergoes oocyte retrieval

  • Secondary patient (egg donor) undergoes oocyte retrieval

  • Primary Patient uses a previously frozen batch of their own oocytes

  • Primary Patient uses a single batch of frozen donor oocytes

Milestone 2 covers all the subsequent transfer of cryopreserved embryos:

  • Any/all frozen embryos from the Milestone 1 procedure

  • Embryos previously created during a self-pay IVF cycle

  • A single batch of donated frozen embryos

Once the funded IVF cycle is started, there are multiple end-points that indicates completion of the cycle:

  • Two attempts at cycle monitoring were conducted and no retrieval occurred

  • An oocyte retrieval was performed and no viable oocytes were found

  • A retrieval occurred, viable oocytes were found, but no viable embryos developed

  • All oocytes/embryos were thawed and no viable candidates for transfer developed (if using a previous batch of oocytes/embryos)

  • All viable fresh and frozen embryos generated by the funded cycle have been used for transfer (a pregnancy may or may not occur)

  • Primary Patient concludes care in writing (stating they no longer want to continue)

This means that if your IVF cycle “fails” and no oocytes are found, no embryos are viable, or no pregnancy occurs following transfers, that is still considered the funded cycle. At KARMA we do our very best to create embryos that are of good quality and are able to be transferred, but unfortunately, that cannot be guaranteed.

 

If you have any questions or concerns whether your cycle is eligible to be funded, please speak to the nursing team or the clinic manager (sonja.swanson@karmaobgyn.com).

The OFP has helped many families at KARMA and throughout Ontario to grow their families and is a great opportunity for those who may struggle to afford fertility care on their own!