# 2016-070 - In Vitro Fertilization, Spectrum of Care (CF SoC)

Case Summary

F&R Date: 2016–06–08

After he received a diagnosis of male factor infertility, the grievor was approved for reimbursement of costs related to the intra-cytoplasmic sperm injection (ICSI) portion of his infertility treatment, which is covered under the CAF spectrum of care (SoC). He argued that he should also be reimbursed for the in vitro fertilization (IVF) for his spouse, as both ICSI and IVF are required in order to conceive. The grievor claimed that CAF SoC should provide a comparable coverage to what provincial programs offer, which is not the case at the moment.

There was no initial authority (IA) decision on this file as the grievor elected to submit his grievance to the final authority.

Based on the research conducted in previous files, the Committee found that the ICSI, a method used to treat male infertility, must involve IVF in order to be considered a complete fertility treatment; therefore, an ICSI treatment must involve two persons. Since the CAF SoC does not consider IVF as part of a complete ICSI treatment, the Committee noted that this was too restrictive and could lead to unfair and unreasonable results.

The Committee examined the decisions rendered by CDS in previous files about infertility treatments and remained of the view that expansion of the CAF SoC, to include a broader range of infertility treatments, was warranted.

The Committee also examined the coverage offered by the provinces for fertility treatments and assessed that the commitment and changes introduced by the Ontario government to increase it's funding of fertility treatments serves to reinforce the Committee's position that the CAF SoC should be expanded. The CAF SoC must be treated as a living document and stay current with the evolution of provincial health policy changes.

The Committee recommended that the grievor be reimbursed for the costs associated with the IVF portion of his ICSI treatment, required as a result of his male factor infertility, up to three cycles.

FA Decision Summary

The FA, the Chief of the Defence Staff, disagreed with the Committee's recommendation that the grievance be upheld and found that the CAF's should not pay for IVF treatment for the grievor's spouse. The FA relied on a Federal Court's decision and found that “fertility drugs/treatment for a non-disabled party is separate and distinct from those of their disabled partners and must be considered as such”. The FA explained that “the SoC, following the majority of provinces, provides IVF only in the case of a female service member who has bilateral Fallopian tube blockage” and noted that the grievor's spouse was “neither a service member nor is it apparent she has this condition”. The FA agreed that IVF was required in the grievor's situation, but found that the CAF are not responsible to pay for the IVF portion of the conception. He explained that the CAF would cover for the ICSI. Disagreeing with the Committee, the FA expressed his “opinion that not only does the CAF have better fertility benefits for its member' s than the majority of other Canadian provinces, the CAF receives a limited amount of financial resources to ensure that all CAF members are medically fit”. The FA replied to the Committee's argument with regards to the RCMP's benefits by noting that “effective 29 June 2012 the RCMP became uninsured persons" under the Canada Health Act and noted that their access to IVF treatments is now regulated by provincial health care policy.