Addressing barriers to fertility care

Addressing barriers to fertility care

by Pavan Gill, author on The Conception Diaries Pavan Gill 31 January 2019

Many women have a hard time thinking of fertility treatment as an option for themselves. “It’s way too expensive. I could never afford it.” “How do I see a fertility specialist?” “What does infertility even mean? When should I ask for help?” “I’m new to this country. How do I learn about my options?” If you’ve been asking yourself any of these questions, then this article is for you.

While advancements in fertility treatment have given women from diverse walks of life the chance to start a family, many, unfortunately, continue to face significant road blocks to obtaining fertility care. These barriers are complicated by cultural, socio-economic, and language factors. The purpose of this post is to shed light on some of these barriers and to help make access to fertility care a reality for you.

Recognize that you might need some help to get pregnant

You have stopped taking the birth-control pill. You and your partner having been trying to get pregnant for some time now. In fact, it has been 14 months and still no pregnancy. You wonder whether something is wrong but aren’t sure if it is time to see a doctor.

You are not alone in not knowing when to seek help. Numerous studies have shown that most people do not know a lot about fertility. So, when should you see a doctor? Infertility is defined as not successfully achieving a pregnancy after a reasonable period of unprotected intercourse (12 months for women under the age of 35, and 6 months for women over 35). If you have reached these month limits, then you should definitely follow up with your family doctor. However, some women might need to see a doctor earlier based on their medical history. (For example, if you have a history of irregular periods or recurrent miscarriages, then your doctor should get involved sooner than that.)

Overall, it is never too early to have that initial conversation with your family doctor about your fertility and pregnancy goals. Involve them in the journey from the beginning. Initiate the conversation with your doctor at your next visit. Learn about what factors can make getting pregnant more challenging and how they might be relevant to you.

Getting a referral to a fertility clinic

Accessing a fertility clinic often requires a referral from a family physician, general gynecologist, endocrinologist, or other specialist. Fertility clinics have referral forms on their websites that need to be filled out by the referring doctor. The wait time to see a fertility specialist can range from a couple of weeks to a couple of months. Contact the fertility clinics near you to get a sense of wait times. Work with your family doctor to get the referral sent in a timely manner. Some investigations can be completed by your doctor in advance of your specialist appointment, such as blood tests and ultrasounds. Ask your family doctor about this.

How do you decide which fertility clinic to be referred to? Often, your doctor will be able to provide some suggestions. Pick a clinic that is conveniently located. Typically, fertility clinics require multiple visits, sometimes over many months. Speak to other women who have received care from that fertility clinic to learn about their experiences.

Funding is available for many fertility treatments

Fertility treatments are expensive. The costs of tests, medication, and procedures can quickly add up. The average woman undergoing fertility treatment can spend up to several thousand dollars per treatment cycle. However, options are available to offset many of these costs, including government funding, private insurance coverage, and payment plans.

The Ontario government created the Ontario Fertility Program (OFP) in 2015, which covers the procedural costs of artificial insemination or intrauterine insemination (IUI), as well as one cycle of in-vitro fertilization (IVF). For additional reading about what is and is not covered, check out the province’s page on fertility treatments.

Many fertility clinics also offer financing options to help you manage costs, including monthly payment plans. Finally, not every woman will require the more costly option of IVF in order to achieve a pregnancy. Other more affordable treatments can help you get pregnant. Work with your fertility specialist to personalize your care.

Language interpreters might be available

Nearly half of Toronto’s population was not born in Canada, which means that English is not the first language for many people. However, there are steps you can take to improve communication at your fertility appointment.

Have your referring doctor include your preferred language on the referral form. The fertility clinic might be able to accommodate your language needs through an in-person or over-the-phone interpreter. Ask the clinic prior to your appointment whether information is available in more than one language or whether anyone on the care team speaks your language. Another option, though not ideal, is to bring a family member or close friend who is bilingual to help give explanations at the appointment.

If you do not understand well what the fertility specialist is telling you, let them know. They will do their best to help you understand.

Participate in fertility research

Finally, research is a critical part of advancements in fertility care. Women who currently participate in fertility research do not reflect the diversity of women who need fertility services. There is a gap, and so women from diverse cultural and socio-economic backgrounds need to participate in fertility research, so that advancements can benefits all women. Ask your fertility clinic about research projects it is involved in, and consider participating.

Pavan Gill, guest author on The Conception Diaries Guest author: Pavan Gill, MD, is a third-year resident in the OB/GYN program at the University of Toronto. She is passionate about addressing disparities in fertility care.