Objectives: The Ontario Fertility Program (OFP) funds 5,000 annual in vitro fertilization (IVF) cycles. We hypothesized that after introduction of the OFP, there would be an increase in duplicate infertility consultations by patients attempting to increase chances at obtaining publicly funded IVF through enlisting at multiple fertility clinics. Methods: This retrospective observational study included women eligible for healthcare services in Ontario from 2014 to 2016 and compared infertility consultations pre-and post-initiation of the OFP. Results: Post-OFP, the average number of consultations per patient and the proportion of patients with more than one consult increased (1.04 vs. 1.05, p = 0.015 and 3.8% vs. 4.2%, p = 0.027, respectively). Total consultations for infertility increased from 24,565 to 27,714 post-OFP. The OFP had the largest impact in the Greater Toronto Area (GTA). Conclusion:The OFP resulted in a statistically significant increase in duplicate consultations, although unlikely to be of clinical relevance. The disproportionate impact seen in the GTA highlights the inequitable access to fertility care in Ontario. RésuméObjectif : Le Programme de procréation assistée de l'Ontario (PAO) permet de financer, chaque année, 5000 cycles de FIV. Notre hypothèse est qu' afin d' accroître les chances d' obtenir une FIV financée par les deniers publics, il y aurait un accroissement des demandes d' un second avis pour les consultations en infertilité suite à la mise en oeuvre du PAO, ce qui augmenterait les coûts pour le système de santé publique. Méthode : Cette étude observationnelle rétrospective porte sur des femmes admissibles aux services de santé ontariens entre 2014 et 2016 et compare le nombre de consultations en infertilité avant et après la mise en oeuvre du PAO. Résultats : Après la mise en oeuvre du PAO, le nombre moyen de demandes de règlement pour les patientes qui ont obtenu plus d' une consultation s' est accru (1,04 contre 1,05; p=0,015 et 3,8% contre 4,2%; p=0,027, respectivement). Le nombre total de consultations en infertilité est passé de 24 565 à 27 714 après la mise en oeuvre du PAO. L'impact le plus important du PAO touche la Région du Grand Toronto (RGT). Conclusion : La mise en place du PAO a donné lieu à un faible, quoique statistiquement significatif, accroissement des demandes d' un second avis en consultation. La disproportion observée dans la RGT met en évidence l'iniquité d' accès aux services de fertilité en Ontario.
Objective: On December 21, 2015, Ontario began funding one cycle of IVF for each resident with a uterus under the age of 43, but with a program cap that is insufficient to meet the annual demand. Our objective was to determine how fertility patients believe that the limited number of funded IVF cycles should be distributed.Methods: A survey was distributed to patients attending a university affiliated hospital-based fertility clinic in downtown Toronto, including its associated peripheral satellite clinics. Results:From August 2016 to March 2017, 271 patients responded to the survey, of whom 90.3% were in favour of public funding for IVF. The majority of participants favoured allocating IVF cycles to maximize patients' access to IVF in Ontario rather than targeting funded IVF cycles so as to maximize live births (62.7% vs. 32.8%). Most participants wanted all clinics to adopt the same approach for distributing funded IVF cycles compared to the current system in which each clinic chooses its own criteria for allocation (84.5% vs. 8.5%). Participants favoured distributing IVF by way of a scoring system that took individual patient factors into account. However, the factors that each respondent considered important varied materially. Conclusion:Patients overwhelmingly supported public funding for IVF, desired a consistent policy for distribution of limited funded IVF cycles at all clinics, and preferred a method that took individual patient factors into consideration when determining patient priority for funded IVF but there were heterogenous opinions on which factors should be included.
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