# 2015-096 - In Vitro Fertilization

In Vitro Fertilization

Case Summary

F&R Date: 2015–07–22

The grievor and her husband, both military members, required in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatments for the husband's infertility. Their request for funding of the treatments was denied by staff of the Director Medical Policy because of the method of testing used to identify the cause of the husband's infertility. The grievor contended that the Spectrum of Care (SoC) did not provide comparable medical coverage to Quebec's provincial coverage or to that of the RCMP. She requested that the SoC be retroactively amended to match the IVF/ICSI coverage provided in Quebec and to the RCMP, and that she be compensated for her assisted procreation treatments, as well as her husband's.

The Commander Canadian Forces Health Services, acting as the Initial Authority (IA), denied the grievance. The IA stated that the grievor's request for funding of ICSI would not be considered because IVF and ICSI are two separate and different treatments based on gender. The IA noted that the SoC provides funding for IVF (for a maximum of three cycles) only if the infertility is the result of a bilateral fallopian tube blockage. He stated that there was no indication this was the grievor's case, and found that she did not meet the conditions for funding of IVF under the SoC. With respect to comparable coverage, the IA stated that since the decision, in 2010, of the province of Quebec to expand funding for infertility, IVF had been discussed three times by the SoC and no changes to the policy were implemented. He also noted that as of April 2013, all RCMP members are covered by their provincial health care plan for all non-work related health issues. He stated that the Canadian Armed Forces (CAF), while sensitive to the toll that infertility can take on couples, must exercise due diligence in the expenditure of public funds.

The Committee noted that Queen's Regulations and Orders for the Canadian Forces article 7.01 allows an individual CAF member to submit a grievance, while article 7.08(3) provides that a grievance may not be submitted jointly with other CAF member. The Committee found that these regulations prohibit the grievor from submitting a grievance concerning her husband's entitlement to ICSI, as this treatment pertains only to him.

The Committee reviewed the SoC policy concerning funding of IVF and confirmed that it is only provided if the infertility is the result of bilateral fallopian tube obstruction. The Committee found that the grievor did not meet the conditions for IVF funding.

The issue of comparable health care coverage was previously analyzed by the Committee in another grievance. At that time, the Committee found that the decision of the SoC representatives to retain the status quo for IVF/ICSI funding, despite the fact that the province of Quebec and the RCMP were funding up to three cycles regardless of the cause for the infertility, failed to meet the CAF's commitment of comparability and was unreasonable in the circumstances. The Committee noted that the Chief of the Defence Staff (CDS) disagreed with its findings and recommendations. His view was that comparable health care did not mean that the CAF must provide identical care to that provided to other Canadian citizens. The CDS also noted that the CAF is not bound by provincial regulations/legislation or other federal department policies. The Committee stated that it is currently reviewing another grievance which deals with a CAF member who resides in Quebec and requested funding for IVF/ICSI, and will deal with this systemic issue in that file.

The Committee recommended that the grievance be denied.

FA Decision Summary

The CDS agreed with the Committee's recommendation that the grievance be denied. The CDS also agreed with the Committee's finding that the grievor did not meet the conditions for IVF treatment.

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