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Funding fertility: the fight to have treatments covered

OHIP would not fund fertility treatments for Ana Ilha and Amir Attaran.

Six months ago, Ana Ilha knew her biological clock was ticking. She just didn't know it was ticking so fast.

But when the Ontario Health Insurance Plan would not cover fertility treatments because of the source of her problems - at 37, her eggs were running out abnormally fast, a condition called a low ovarian reserve - she decided to take action.

She and her husband, University of Ottawa professor Amir Attaran, filed a complaint with the Human Rights Tribunal of Ontario on Monday. They argue OHIP's policy is discriminatory, since it covers in vitro fertilization only in limited circumstances.

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"It's a medical condition like any other," Ms. Ilha said. "Couples like us should not have to suffer financially in addition to suffering emotionally."

Their case is part of a debate in Canada's two largest provinces, and it could soon spread across the country.

In Quebec, high-profile TV personality Julie Snyder, the wife of Quebecor CEO Pierre-Karl Péladeau, urged the province to cover IVF treatments. She made a documentary about infertility and put pressure on politicians.

In April, Premier Jean Charest's government announced that it will fund three IVF cycles for couples, making Quebec the only province to do so.

Seang Lin Tan, a fertility expert at the McGill University Health Centre in Montreal, said one in eight Canadian couples struggles with infertility.

"What's frustrating, is that people who would be good candidates are routinely told they have to dig into their pockets," Prof. Attaran said. "I'm fortunate, law professors get paid decently. But that's not true for everyone."

After a year of trying to conceive, the couple paid $6,300 for one IVF treatment at an Ottawa fertility clinic. A further $6,500 in drugs was covered by private insurance.

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A spokesperson for Ontario Health Minister David Caplan said he would not comment on the case.

OHIP paid for IVF in the past, but in a cost-cutting measure in 1994, Ontario withdrew funding except for women whose fallopian tubes are blocked. That applies to about 25 per cent of infertile patients, said Jeff Nisker, a professor of obstetrics, gynecology and oncology at the University of Western Ontario.

"Canadians should not be denied having children for the sin of being socio-economically disadvantaged," Dr. Nisker said. "Almost all other developed countries have funded fertility treatments. It's embarrassing."

Limiting publicly financed procedures by implanting only one embryo at a time would save money, he said. People who pay out of pocket are more likely to take fertility drugs, or have two or three embryos implanted at a time. The resulting multiple pregnancies are more likely to produce expensive premature births and complications.

The fight for IVF coverage has been waged, and won, before. In 2006, Warrant Officer Terry Buffett told the Canadian Human Rights Tribunal that the Canadian Forces discriminated against him by refusing to finance IVF treatments for his wife. The couple's infertility was a result of medical issues on WO Buffett's part. The tribunal ordered the Forces to pay $7,500 in compensation, and to amend the coverage policy.

But there are other precedents. In 1998, the Nova Scotia Supreme Court ruled that since IVF is not a medically necessary procedure, it should not be publicly funded.

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Ms. Snyder acknowledges that her celebrity in Quebec helped her cause.

Ms. Ilha said she hopes her efforts will yield results as well.

"This is about the public interest," she said. She and her husband have asked for $16,300 in damages. "But if the government decides that it is going to change its policy, I'm happy to drop it."

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