Infertility is on the rise in Canada, as various studies referenced in the March 2012 issue of Human Reproductionindicate. In 2009/10, 16% of heterosexual couples in which the woman is age 18 to 44 are experiencing infertility—nearly double the 1992 figure (8.5%).
While rising rates of infertility among older women may not be surprising, the studies show that infertility rates are also climbing for younger women. In 1984, about 5% of couples with a female partner age 18 to 29 were infertile. By 2009/10, the prevalence for the same age group ranged from 7% to 13.7%.
The struggle to have children can lead to strained relationships, depression, anxiety and financial hardship. For employers, that can translate into reduced job performance and productivity, as well as increased absenteeism and costs.
And with more and more younger employees dealing with fertility issues, the impact on organizations is growing.
This impact would be less significant if more group benefits plans covered infertility treatments, some argue.
“I don’t understand why infertility treatments aren’t covered by most employer benefits plans,” says Lindy Forte, founder and managing director of VALCORE Consulting, a firm specializing in health economics. “Benefits plans were designed to provide therapies for medical conditions, and infertility is a medical condition.”
The World Health Organization and the Canadian Royal Commission on New Reproductive Technologies both state that infertility is a recognized medical condition, a view shared by the governments of Quebec and Manitoba.
Quebec became the first North American jurisdiction to offer full funding for in vitro fertilization (IVF) treatments in 2010, while Manitoba introduced a 40% tax credit for fertility treatment costs in 2010. But others in Canada haven’t followed suit.
“It’s really about the costs involved,” explains Forte. “Yet benefits providers don’t bat an eye at paying millions for statins to control high cholesterol—even though high cholesterol is usually caused by poor lifestyle choices, not an underlying medical condition. They’ll also [cover] oral contraceptives to prevent pregnancy.”
Lack of coverage for infertility treatments can be life-altering for many people.
“It has the same effect as hearing that your insurance provider is not going to cover your cancer treatments,” says 35-year-old Deirdre Crampton, an associate producer with a video production company in Toronto. “Infertility is a medical issue that has a profound effect on people’s quality of life and future. [Yet] there’s this view that infertility treatments are not necessary.”
Conception…at a cost
While infertility is an equal-opportunity condition that affects both men and women, women face not only the additional risk factor of age but also the more invasive medical treatments.
“They endure humiliating, time-consuming, often painful medical procedures while trying to maintain a busy professional life,” says Jan Silverman, a fertility program specialist with the Infertility Support and Education Program at Women’s College Hospital in Toronto. “They schedule appointments around their professional commitments and don’t tell anyone what they’re really going through—because this is not only an intensely personal issue but something other people don’t understand.”
Crampton echoes this sentiment. “You’re always running late and often have to take time off,” she acknowledges. “In the last year, I’ve been absent a lot due to severe side effects and complications from treatment. You make excuses and don’t tell the complete truth, and co-workers don’t believe you’re unwell when you’re flat on your back. It’s not fun.”
Infertility is a medical issue that has a profound effect on people’s quality of life and future.
While many individuals respond to simple interventions, others, like Crampton, face years of problems—and a financial burden that can be, in Crampton’s words, “scary expensive.” She’s endured various courses of medications and two rounds of IVF. While her husband’s benefits plan has picked up most of the medication costs—which, she says, is “very helpful”—the couple is still footing the bill for IVF treatments, at a cost of between $10,000 and $12,000 per cycle.
“That’s not unusual,” says Silverman. “I know of couples who have spent hundreds of thousands of dollars exploring every avenue in their pursuit to have a child. These are ordinary working people who take out second mortgages, max out their lines of credit and forgo vacations and luxuries, all to have what their friends and co-workers have: children.”
However, there are employers that do cover infertility treatments. Accenture Canada—a global management consulting, technology services and outsourcing company with more than 4,000 employees in Canada—has paid for fertility treatments, including IVF, since 1999. These benefits include a lifetime limit of $15,000 to cover drugs needed for treatment.
“Our aim is to make sure our employees have healthy and productive lives,” says Nicholas Greschner, director of HR, Canada, with Accenture. “We really want our people to know that we’re here for them during a stressful time, whatever the cause of that stress. We can at least alleviate some of the financial stresses associated with infertility treatments with this benefit.”
According to Forte, that’s also a good business strategy. “An individual who has struggled with infertility is so grateful and indebted to an employer that has helped achieve the couple’s dream of having a child, and that positive feeling extends to co-workers. It’s a great attraction and retention tool. Employers demonstrate that they really care about people’s well-being.”
For Accenture, infertility treatments are just one part of its cafeteria-style benefits plan, in which employees can select the benefits they need at that particular time in their lives.
“Certainly, benefits are an important factor in retention,” says Greschner. “Together with our provider, we continually analyze market trends and look [at] what our competitors are doing so we can readjust our offerings, stay competitive and offer employees a variety of benefits.”
But some experts feel that provincial governments should be picking up the costs of fertility treatments. Beverley Hanck, executive director of the Infertility Awareness Association of Canada, says the province of Quebec saves about $150 million annually by funding fertility treatments that discourage multiple births and instead aim for single births. For example, in most IVF treatments, one or more embryos is inserted with the hope that one or two will implant themselves, and hormone treatments often lead to multiple egg production, resulting in twins, triplets, quads and more.
“What premature babies cost the medical system is horrific,” she says. “And many of them have lifelong health issues, such as cerebral palsy. For Quebec, it’s a win-win situation: [the province] is saving money and bolstering the falling birth rate, because the aim is for single, healthy babies.”
But Silverman understands why doctors and patients may be inclined to go for more than one baby. “It’s expensive, so people are often ecstatic to get two or three for the price of one,” she says. “But they don’t realize the risks—and often, heartaches—of carrying multiples.”
While other provinces are looking at the issue, it may be several years before they offer full funding for infertility treatments, if they do at all. (Ontario currently offers three rounds of treatment funding, but only for women who have both Fallopian tubes blocked. Manitoba offers couples a 40% refund up to $8,000, while New Brunswick has promised a 50% rebate, up to $5,000 a year, for those who need treatment.) In the meantime, companies can make a real difference in their employees’ lives by covering these treatments in their group benefits plans.
“All any infertile couple wants is a normal life,” says Crampton. “We just want what most other people want: a family.”
Moira Potter | May 01, 2012