# 2015-067 - In Vitro Fertilization, Spectrum of Care (CF SoC)

Case Summary

F&R Date: 2015–09–21

The grievor sought approval for a testicular sperm aspiration (TESA) procedure recommended by a civilian physician to increase the likelihood of success of the In Vitro Fertilization (IVF) treatment he and his spouse were undergoing. Two Canadian Armed Forces (CAF) physicians supported the request, noting that the procedure was covered by the Quebec provincial healthcare plan where the grievor resided, but the request was not approved. The grievor proceeded with the TESA procedure at his own expense and submitted a request for reimbursement, but the request was denied.

The Initial Authority, the Surgeon General, stated that while the Spectrum of Care included intra-cytoplasmic sperm injection (ICSI) in specific cases, TESA was not one of the approved ICSI procedures. Furthermore, the grievor's circumstances did not meet the requirements for ICSI. The IA added that the CAF's fertility treatment benefits are reasonable when compared to similar benefits received by most Canadians and determined that the grievor had been treated fairly.

The Committee noted that the treatments were recognized in jurisprudence, referencing and drawing a parallel to a 2006 Canadian Human Rights Tribunal decision. The Committee found that the grievor should not be disentitled to provincially funded health services because he is in uniform and recommended that he be reimbursed for the cost of the TESA procedure.

The Committee also reiterated its previous systemic recommendation that the Spectrum of Care be expanded to cover a broader range of fertility treatments than it currently does.

CDS Decision Summary

CDS Decision Date: 2015–12–04

The FA did not agree with the Committee's recommendation that the TESA procedure be considered as an exception and that the grievor be reimbursed for that procedure. The FA did not agree with the Committee's previous systemic recommendation that the SoC be expanded to cover a broader range of fertility treatments than it currently does. Although the Committee's research showed that CAF members posted to Quebec and in possession of a legitimate Carte Soleil may use it, and despite confirmation from the Staff in the CAF's Directorate of Medical Policy to that effect, the FA felt it is neither legal nor practical from a CAF health management prospective to do so.