Report calls for IVF, better financial support for N.L. fertility services

A long-awaited review of Newfoundland and Labrador's fertility services recommends clinics start offering IVF and fertility preservation within the province, as well as more financial support for people seeking treatments.

St. John's-based market research firm Thinkwell Research + Strategy was tapped in the fall of 2023 by the provincial government to conduct a review of current fertility services and provide recommendations for improvements.

According to an access-to-information request filed by CBC News, the heavily redacted 199-page final report, tabled in September 2024, highlighted ways to improve services as well as existing problems.

While the report, which had 96 pages removed, did not go into detail about the specifics of the recommendations, the executive summary appears to call for more resources.

"Key elements of the proposed model of care include making IVF and fertility preservation for persons assigned female at birth available in the province and enhancing financial support for individuals seeking access to fertility care," reads the Thinkwell report.

Newfoundland and Labrador Fertility Services (NLFS) already offers fertility services like intrauterine insemination (IUI) in the province, but not egg preservation.

Patients have to travel to get in-vitro fertilization (IVF) from clinics outside the province.

The access-to-information request response said information could be redacted if it would reveal advice, recommendations or policy options for the province, as well as disclose information that could be financially or economically harmful to its interest.

CBC News has asked Health Minister John Hogan for an interview.

Barriers to services

In 2021, Premier Andrew Furey made an election pledge to set up an IVF clinic in the province, which hasn't happened.

In March 2022, the N.L. government introduced an IVF subsidy, which was retroactive to 2021, that allowed approved patients to claim up to $5,000 per IVF cycle up to three cycles, for a total of $15,000.

The Thinkwell report said that between 2022 and 2023 the province's fertility services total budget was $1,104,630 and that 98 per cent of the $750,000 annual IVF subsidy budget was used.

Thinkwell's research included looking into other jurisdictions' fertility services, literature reviews and surveys, as well as interviews with previous and current NLFS clients, doctors and staff with NLFS and Newfoundland and Labrador Health Services.

In one survey, Thinkwell found that 47 per cent of people who used IVF clinics outside Newfoundland and Labrador said the current fertility services didn't meet their needs, whereas 30 per cent said it worked "moderately well," 15 per cent said it worked "very well" and six per cent said it met their needs "extremely well."

In another survey, Thinkwell found 81 per cent of respondents said they have faced challenges when trying to access fertility services, including long wait times for consultation, testing, diagnoses and treatment.

Respondents also raised concerns about barriers to accessing services because they didn't have a family doctor, as well as problems balancing home and work demands, like not being able to get enough time off from work, missing paid work and a lack of child care.

Beyond expanding care, Thinkwell also found structural problems with how fertility services are managed, like how information isn't shared easily between NLFS, clinics outside the province and specialists or physicians within Newfoundland and Labrador.

"Clients have a difficult time navigating the system and obtaining required information from various sources and channels. They are also uncertain about clinic policies related to waitlists and prioritization for consults and procedures," said the Thinkwell report.

Problems highlighted

Thinkwell also raised issues with how NLFS is organized into "silos," which gets in the way of "integrated decision-making." There is also no single position that oversees its clinic and lab and there are multiple layers of management. The workforce has a limited amount of administrative support, the report found, which gets in the way of carrying out their work.

The current equipment and facilities in Newfoundland and Labrador means the province can only handle five IUI cycles per day, but "demand can exceed this number," the firm wrote. "This is handled through staggering staff shifts and keeping staff late."

"The challenges in service delivery include IVF not being offered at NLFS, limited capacity for initial consultations, delays in blood work processing, and overprovision of IUI cycles. Wait times have been reduced since 2020 and are currently at four or five months."'

The report also raised staffing concerns, pointing out there were times when only a single nurse was available to NLFS clients and that it only has one clinical psychologist.

"The existing lab space is not sufficient to properly place the existing equipment," Thinkwell wrote, adding that "there are equipment requirements that remain unfulfilled within the fertility service."

It added NLFS expenses currently exceed its budget.

Gender inequity

The report also found gender inequity within the services being offered in the province.

"Gender inequity currently exists in service provision, with individuals seeking to preserve sperm having access to fertility preservation services within the province, while no equivalent process is available for those wishing to preserve eggs," it wrote.

The report also cited a lack of information and resources for 2SLGBTQI+ patients around informed care, like non-inclusive language.

"This service inequality is particularly impactful for transgender individuals and oncology patients," it said.

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