The Impact of the Ontario Fertility Program on Duplicate Fertility Consultations

Abstract

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.

Infertility treatment and postpartum mental illness: a population-based cohort study

“…In our cohort, individuals who underwent IVF were socially advantaged and resided in high-income neighbourhoods, and were thus able to afford the cost of IVF therapy. 16 , 17 In vitro fertilization necessitates closer medical follow-up and, in some cases, more intense screening for readiness for pregnancy, including both physical and mental health fitness. 14 Therefore, after adjustment for maternal age and social determinants of health, there may exist an underlying predisposition toward adverse postpartum mental health — mostly mood and anxiety disorders, identified in the outpatient setting — among recipients of IVF.…”

“…During this period, consulting with a physician about infertility issues and monitoring of noninvasive infertility treatment were covered under the province’s universal health insurance plan; however, use of in vitro fertilization (IVF) was largely self-paid. 16 , 17 …”

Queering reproductive access: reproductive justice in assisted reproductive technologies

“…Yet it is unknown who the program is targeting because there is no publicly available sociodemographic and distribution of funding data. In creating OFP, The Ministry of Health and Long-Term care did not provide any guidelines or principles of prioritization for fertility clinics to distribute resources [ 61 ]. This has resulted in non-standardized waitlists with varying mechanisms of prioritization and a two-tiered system where those who could afford to pay can be put on the waitlist and still opt for privately funded IVF [ 61 , 62 ].…”

“…In creating OFP, The Ministry of Health and Long-Term care did not provide any guidelines or principles of prioritization for fertility clinics to distribute resources [ 61 ]. This has resulted in non-standardized waitlists with varying mechanisms of prioritization and a two-tiered system where those who could afford to pay can be put on the waitlist and still opt for privately funded IVF [ 61 , 62 ]. The majority of fertility clinics in Ontario are privatized with no overarching provincial legislation or standardization to govern the practice or fees associated [ 5 ].…”