Lana de Bastiani moved back home to Yellowknife, NWT to start a family 16 years after she left.
“I love living here. I want to raise a family here, just like I was raised here,” said de Bastiani, 33, who met her partner after returning to the Northwest Territories.
After the couple tried for almost three years to get pregnant, de Bastiani was referred to a specialist who diagnosed her with endometriosis, a disease where tissue similar to the lining of the uterus grows outside that organ and builds up in the body. Endometriosis affects 50 per cent of women experiencing infertility, according to The Society of Obstetrician and Gynaecologists of Canada.
In the hope of having a child, de Bastiani and her partner decided to undergo in vitro fertilization (IVF), an expensive and time-consuming fertility treatment where eggs are fertilized by sperm in a lab and the resulting embryo is surgically transferred into the uterus. Each IVF treatment cycle takes six to eight weeks, and costs between $10,000 and $20,000. It is not uncommon for women to go through multiple cycles.
Prior to starting IVF, de Bastiani had a specialized ultrasound, the cost of which was covered by the Northwest Territories, including flights, accommodations and the intake appointment at the fertility clinic.
But the Northwest Territories, like a number of other provinces and territories, has no fertility specialists and offers no coverage for IVF treatment or travel to receive that treatment.
Thus, the couple will have to pay out of pocket for IVF. Their situation is one shared by many couples across Canada, particularly those living in remote or rural communities.
“When I was at my clinic a couple of weeks ago, I saw they had posters about how people can take out healthcare loans,” said de Bastiani, who calculates that she and her partner will spend between $35,000 and $40,000 on their IVF treatment and travel costs.
“We’re fortunate we can afford it, but we’re draining our savings accounts to do so.”
‘Huge barrier’
Health care is managed by each province or territory, so fertility coverage varies by jurisdiction.
Alberta, British Columbia, Saskatchewan, Northwest Territories, Nunavut and Yukon offer no public funding for IVF treatment. Others cover a portion of the treatment, according to Laura Spencer, a fertility coach for individuals and couples.
New Brunswick gives eligible people a one-time grant of $5,000. Newfoundland and Labrador give $5,000 to residents who must travel to another province to access IVF, for a maximum of three cycles. PEI provides between $5,000 and $10,000 annually, based on family income, for a maximum of three years.
Nova Scotia and Manitoba offer a refundable tax credit equal to 40 per cent of the cost of fertility care provided by a medical practitioner or fertility treatment clinic within their respective provinces.
Ontario covers one treatment cycle for individuals under the age of 43, but does not cover fertility drugs, which cost about $5,000 per cycle. Quebec funds one IVF cycle and fertility drugs covered under the public prescription drug insurance plan.
For rural or remote couples, access is a particular challenge because IVF treatment requires regular trips to the fertility clinic for blood work, ultrasounds, checkups and to purchase drugs that are administered orally or through self-administered injections.
In Canada, reproductive treatment clinics are almost exclusively located in major urban centres. Some of these clinics have satellite centres in smaller cities, but those generally do not perform major procedures such as egg retrievals or embryo transfers, according to Spencer.
De Bastiani and her partner will take turns travelling to a clinic in Edmonton for their major procedures. Her partner will travel to deposit sperm, then she’ll travel there to have her eggs removed. Later, de Bastiani will return to have the embryo implanted.
“Access to specialists is [a]… huge barrier,” said Carolynn Dubé, executive director of Fertility Matters Canada, a national charity that advocates for reproductive benefits and education.
In Atlantic Canada, there are two clinics that can provide complete IVF treatment. Residents of Newfoundland and Labrador and PEI must travel to clinics in New Brunswick, Nova Scotia or other parts of Canada to receive treatment.
Women in rural or remote communities may need to use vacation and sick days and disclose to their boss that they are trying to conceive.
“They’re nervous about how it may look to their employer,” said Dubé. “Are they going to be overlooked for a promotion?”
For these couples, it may also mean going through many parts of the treatment alone because both parties cannot afford to take off work or be away from home at the same time.
“Going through IVF just doesn’t feel great — you’re uncomfortable and… can be in a lot of pain. So having to go by yourself and not having support can be challenging,” said Spencer.
Some women are going abroad for treatment to save on costs, she says.
“Because if they are already travelling [for fertility treatment]… they might as well go cheaper,” said Spencer. “They could… go to Barbados or somewhere [else] and they attach a vacation to it.”
Fertility treatment is health care
Fertility experts are pushing governments, both federal and provincial, to cover more reproductive health costs and establish a framework to make coverage more equitable across Canada.
“Fertility treatment is health care,” said Dubé.
“We live in a province with a universal health care act that isn’t actually taking into consideration fertility treatment for the medical condition that one in six Canadians have,” said Dubé, who lives in Moncton.
Dubé is advocating for Ottawa to work with the provinces and territories to develop programs to address accessibility that are tailored to the needs of each jurisdiction.
De Bastiani is advocating alongside Fertility Matters Canada for the Northwest Territories to add a travel grant for those seeking fertility treatments. She points out that the Northwest Territories already pays for residents to receive other specialized medical procedures. Procedures done within the Northwest Territories, like vasectomies, are covered and the NWT pays for residents to travel to receive them.
Julie Green, former health minister of the Northwest Territories, said in 2022 the region could not afford to fund fertility treatments for residents.
“Falling pregnant is not a medically necessary intervention provided by our healthcare system, and we have no plans to change that,” said Green.
But publicly funding fertility treatments will increase accessibility, said Dubé. IVF treatments jumped five-fold in Quebec between 2010 and 2015 after they became publicly funded, according to a 2019 study.
And better accessibility to fertility treatments means more babies, which means a growing population, says Dr. Diane Francoeur, CEO at the Society of Obstetricians and Gynaecologists of Canada.
“If we want to have Canadians that are going to pay for pension plans and health-care costs when everyone gets old, we need to have babies,” said Francoeur.
“I don’t believe the government should be a bailout for everything, but if we’re trying to grow our population, it’s just really disheartening how little support there is and how much of a challenge it is,” said de Bastiani.
Correction: A prior version of this article incorrectly said that Lana de Bastiani moved to NWT with her partner. The article has also been updated to clarify some of the details of IVF funding and access in Atlantic Canada, and to indicate that Julie Green is a former health minister.
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