Government Funding for Fertility in Ontario

In Ontario, the journey towards parenthood through fertility treatments is complex, with financial and logistical challenges playing significant roles. A common question we always get is: Is IVF covered by OHIP?

The Ontario Health Insurance Plan (OHIP) provides some coverage for fertility treatments, including In Vitro Fertilization (IVF) and Intrauterine Insemination (IUI), as well as options for fertility preservation. Significant backlogs at clinics across the province further create challenges for aspiring parents. This article aims to detail the specific aspects of what the government of Ontario covers, highlighting the limitations such as non-covered medications, the restriction to a single IVF cycle, additional tests not included, and potential wait times. This information is crucial for individuals and couples to understand the full picture of accessing fertility care in Ontario.

Scroll to the bottom for the October 2024 update based on the recent announcement by the province.

Ontario Fertility Program

The government of Ontario offers support for eligible individuals and couples facing fertility issues through the Ontario Fertility Program. First launched in December 2015, this initiative is part of Ontario’s effort to make fertility treatments more accessible and affordable to its residents.

Coverage Details

Ontario’s fertility coverage is different than other provinces. Through this program, Ontario covers:

The cost of one IVF cycle per patient, per lifetime, including the transfer (one at a time) of all viable embryos retrieved from that one IVF cycle.
The cost of IUIs (no limit to the number of treatments)
The cost of artificial insemination (no limit to the number of treatments).
The cost of fertility preservation is covered once per lifetime — however, this applies only to patients facing a medical condition (such as cancer treatment) that may cause infertility. Elective egg or sperm freezing is not funded under this program.

There are a few exceptions, such as:

Patients that qualify can receive one funded IVF cycle separate from a funded fertility preservation cycle.
Patients can receive an additional funded cycle of IVF if they have acted or are acting as a surrogate.

Cycle monitoring during your funded treatment — including physician/nurse assessments, certain blood and urine tests, and certain ultrasounds — is covered through the Ontario Fertility Program, not directly through OHIP. At participating OFP clinics, there is no cost to you for these services. Optional tests are not covered (e.g. AMH test or sperm DNA fragmentation).

The cost of any fertility medications required for your treatments, which can run up to $5,000 for IVF cycles (the exact amount varies depending on the protocols) and $1,000 for IUI cycles, is not covered by the program.

Additionally, any genetic testing or storage fees are not covered.

Eligibility

Applicants to the Ontario Fertility Program must reside in Ontario and have a valid OHIP card.

In addition, the following requirements must be met:

Under the age of 43 for IVF.
You must have a medical reason for pursuing fertility preservation (freezing sperm or egg samples).

This program is offered at eligible fertility clinics in Ontario across the province (search our directory to find a participating clinic).

How to Apply

You must get in touch with a participating clinic directly to apply for funded fertility treatments.

Determining your eligibility: Ensure you meet the eligibility criteria for the Ontario Fertility Program. Generally, this includes having a valid OHIP card and meeting specific criteria (e.g., being under the age of 43 for a funded IVF).
Select a Fertility Clinic: Choose a fertility clinic in Ontario that participates in the Ontario Fertility Program.
Initial Consultation: Schedule an initial consultation with the clinic. During this visit, the doctor and clinic will discuss your options and the possibility of accessing the funded IVF cycle. Make sure to ask about the wait list.
Program Enrollment: If you are deemed eligible, your fertility clinic will assist you with enrolling in the Ontario Fertility Program for a funded IVF cycle. The clinic is ultimately responsible for handling most of the administration, as they report directly to the Ministry of Health.

One downside is that those waiting for an Ontario funded fertility program can be waiting for a long time. Waitlist are long, but vary clinic to clinic.

Conclusion

While OHIP provides support for fertility treatments, it is evident that patients frequently have to pay additional out-of-pocket costs including expensive fertility drugs. There are difficulties when it comes to coverage limitations, such as those for additional testing and medications, as well as the cap on IVF cycles and different wait times. Although a solid support system is in place, managing these treatments necessitates careful planning because of time and money-related uncertainties. This overview underscores the need for individuals seeking fertility treatments to be informed about both the available support and the inherent limitations, facilitating better preparedness for the road ahead.

October 2024 Update

Ontario’s fertility program is set to improve significantly through two key changes aimed at making fertility care more affordable and accessible:

Tax Credit: Starting January 2025, Ontario introduced the Ontario Fertility Treatment Tax Credit, covering up to 25% of eligible fertility expenses, up to $5,000 annually (on up to $20,000 in eligible expenses). The tax credit reduces financial barriers for families accessing fertility treatments.
Increased Access to OFP: Ontario is investing $150 million over two years to expand the Ontario Fertility Program (OFP), aiming to nearly triple the number of families receiving funded IVF cycles. This increased funding will allow more clinics to participate, which should reduce wait times and expand treatment options.

Sources

FAQ

Is IVF covered by OHIP?

One of the most common questions we receive, the answer is Yes. In Ontario, the government funds up to one IVF cycle per patient per lifetime for all forms of infertility, including single individuals and same-sex couples. The only requirement is that you are under the age of 43. A medical reason is not required for IVF — it is only required for funded fertility preservation (e.g. egg or sperm freezing due to a medical condition such as cancer).

Is IUI covered by OHIP?

Yes! An unlimited number of IUIs per patient are covered through the Ontario Fertility Program at participating clinics. At OFP-participating clinics, the IUI procedure itself is no-cost — however, medications remain out-of-pocket. At private clinics, you can expect to pay $500–$1,500 per cycle (significantly lower than IVF).

What is the wait time for a funded IVF cycle?

If you are looking for an OHIP-funded IVF cycle, you can expect to wait up to a year (or more). Many clinics across the province face large backlog of patients with a limited amount of funding available. It's best to contact a clinic (or more than one) and get on a waitlist if you're interested.

What is the cost of IVF in Ontario?

The cost of IVF varies from clinic from clinic. For a private payer, you can expect to spend at least $12,000-$15,000 and this can go as high as $25,000+. We see "at least" because this varies from person to person depending on the medications and depending on the other services required or paid for (e.g. ICSI, PGT-Testing).