Assisted procreation

Assisted procreation is a medical solution for couples who are having difficulty conceiving a child, for example due to infertility or a genetic disease that could be inherited by the child.

Demand for assisted procreation treatments has increased in recent years, and all evidence suggests that it will continue to increase, a trend encouraged by new social realities.

The decision to have children later in life when female fertility has begun to decline, recognition of non-traditional families such as single and same-sex parents, new technology that makes infertility treatable in more and more cases, discussion of assisted procreation services in the media, and increased success rates are some of the factors that explain the growth in demand for these services.

The choice of which assisted procreation treatment to apply depends on the cause of the infertility. The most appropriate treatment for each person or couple is determined through discussion with the attending physician, based on the cause of the procreation difficulty and its clinical features.

These treatments are :

• Ovarian stimulation
• Artificial insemination
• In vitro fertilization (IVF)
• Embryo transfer
• Preimplantation genetic diagnosis

All women of childbearing age—including homosexual women—can have access to services for assisted procreation.

All costs related to medical procedures and medication for ovarian stimulation, artificial insemination. and three cycles of in vitro fertilization shall be defrayed by the public plan. More specifically, this means the services required for:

• Retrieval of ova and ovarian tissue
• In vitro fertilization
• Preimplantation genetic diagnosis
• Transfer of a fresh or frozen embryo
• Sperm extraction via medical procedure

The plan will cover three stimulated cycles of in vitro fertilization, which produces several ova and embryos, and one-by-one implantation of each embryo for as many times as there are embryos. On the other hand, the plan will cover up to six cycles for natural or modified natural cycles, which generally produce a single embryo.

The public plan will not pay for services for in vitro fertilization beyond three stimulated cycles or six natural cycles.

The medication used for the purpose of assisted procreation are covered by the Public Prescription Drug Insurance Plan in accordance with the normal provisions. Individuals with access to a private plan  are covered by their private insurer. The Régie de l’assurance maladie du Québec (RAMQ) assumes the cost of drugs for individuals covered by the public drug-insurance plan .

No retroactive reimbursement shall be paid out for assisted procreation services or medication that have already been received.

For more informations, consult the Frequently Asked Questions section

Step 1

The attending physician will establish the diagnosis of infertility and attempt to identify the causes. They will basically assess the couple or the woman and propose certain measures to promote fertility.

The attending physician will refer patients to secondary care, if required, for a more comprehensive work-up or to receive appropriate treatment.

Step 2

The gynecologist at a regional center designated for assisted procreation can pursue the assessment and initiate treatment, such as ovarian stimulation, intrauterine insemination, and ultrasound monitoring (folliculogram).

Regional centers will be set up first in Québec, Estrie, Mauricie–Centre-du-Quebec, and Saguenay–Lac St-Jean, followed then in Abitibi-Témiscamingue, Outaouais, and Bas-St-Laurent.

Step 3

When required, the gynecologist may refer patients to a tertiary-care center for in vitro fertilization. As a result, patients would then be followed up by the regional center for ovarian stimulation and follicle monitoring up until the day of ovum puncture.

Tertiary-care services will be available, in english and in french, at the McGill University Health Centre (Royal Victoria Hospital). The tertiary-care services will also be available in four private clinics: OVO (Montréal), Procréa (Montréal and Québec), and Montreal Fertility Centre.

In vitro fertilization services will be available at the Centre hospitalier universitaire de Montréal starting in 2011.

The government wants to reduce the number of multiple pregnancies from in vitro fertilization from 30% to 5%. Multiple pregnancies are, among other things, a source of premature births, entailing their own complications and sequela, some of which are permanent.

The approach fosters best practices:

• Modified natural cycle (The cycle generally produces a single embryo.)
• Implantation of one embryo at a time
• The physician may, under exceptional conditions, transfer a maximum of 2 embryos if the woman is 36 years of age or younger, and a maximum of 3 embryos if the woman is 37 years of age or older.

Although the plan must ensure fair access to all Québec couples, at the outset, only Montréal and Québec will have centers offering in vitro fertilization services.

There will be a transition phase for couples who have already been assessed and are awaiting in vitro fertilization. The physicians, as is the case in all other fields, will determine patient priority.

Patients will not be able to jump to the head of the line by paying for services out of pocket. Eventually, a predetermined number of in vitro fertilizations will be made available on a pro rata basis according to the populations in the province's various regions.