Dear Ate Anna,

We came to Canada about a year ago. My husband and I have been trying to start a family for a while. But every month we are disappointed. I am wondering if I am the “cause” of this problem. We are thinking about seeing a specialist doctor. If I see a fertility specialist, does Manitoba Health cover it or do I need to pay out of my pocket? What about IVF treatment?

Rose-Marie

Dear Rose-Marie,

You are not alone. Wanting to have children but having difficulty getting pregnant can be very stressful - both physically and emotionally. Every month, you are filled with hope, but when the period comes you are disappointed. It can seem like you are on an emotional “roller-coaster ride”.

Rose-Marie, in your letter you didn’t mention your age or how long you and your husband have been trying to get pregnant. According to the medical definition, “infertility” is the inability to become pregnant after 12 months of regular, unprotected intercourse. If you’re in your early 30’s or younger, it is recommended to try to get pregnant for at least one year before seeing a doctor. If you are over 35 years old, see a doctor after six months of trying. However, if you have a history of irregular periods or painful periods, repeated miscarriages, pelvic inflammatory disease, or other women’s health concerns consider seeing a doctor to discuss your difficulties in getting pregnant.

Not all fertility problems are caused by the woman. In fact, about 30%-40% of infertility problems are due to male factors while female factors account for about 40% - 50% of cases of infertility. It is estimated that about 10% - 30% of infertility is attributed to both male and female factors, or there is no explanation for it.

Some common reasons for female infertility are: hormone and ovulation disorders, blocked fallopian tubes, endometriosis (the tissue that normally lines the uterus grows outside the uterine cavity). Some common reasons for male infertility are: sperm disorders (absence of sperm or low sperm count, poor motility, abnormal form and shape of sperm), blocked male duct system, varicocele (varicose vein around the testes that may prevent normal cooling of the testicles, leading to reduced sperm count and motility) or hormonal disorders.

Rose-Marie, as you can see, infertility is not only your “problem”; it could be your husband’s or it could be an issue for both of you. Therefore, it is important for you and your husband to see the doctor/specialist together. You can discuss your concerns, and appropriate testing and treatment can be recommended.

For residents of Manitoba, an appointment with a doctor or specialist is covered by Manitoba Health. That means you don’t need to pay the doctor for the appointment. However, most specialists (except a paediatrician - specialist in the care of babies) need a referral from your family doctor before accepting you as a patient. If you don’t have a family doctor yet, call the Family Doctor Connection Hotline at 786- 7111.

After consulting with the family doctor, you and/or your husband may be referred to a specialist - an obstetrician/gynaecologist (OB/GYN, specialist in female reproductive system), urologist (specialist in urinary tract and male reproductive system), or a fertility specialist. A fertility specialist is an obstetrician/gynaecologist who has completed additional training in advanced assisted reproductive therapies. There is usually a waiting period for seeing a specialist.

To determine the cause of your difficulties in conceiving, you and your husband may need to have some tests and examinations. Manitoba Health covers all tests and examinations that are necessary to determine the reason for infertility, as well as surgery to correct the cause of infertility.

After assessing your condition, your doctor/specialist will discuss treatment options with you. Some couples are able to get pregnant after corrective surgery if that addresses the cause of the problem. Some couples may need assisted reproductive technologies to help them become pregnant. Many of these fertility related medical procedures, such as IVF (in vitro fertilization) or artificial insemination, are not covered by Manitoba Health. The cost of treatment can be very expensive. For example: the cost of one course of in vitro fertilization ranges from $8000 – $10,000 and the success rate is not guaranteed. Also, Manitoba Health does not cover many fertility medications. If you have a private medical insurance plan, it may partially cover the cost of some drugs or medical procedures. Check with your private insurer.

Rose-Marie, before you agree to any medical fertility treatments or procedures, ask questions and make sure you understand what is involved - including the cost. For more information about the medical coverage or cost of a treatment, talk to your doctor/specialist or call the Manitoba Health Services Commission at 786-7101 or visit www.gov.mb.ca/health/mhsip/index.html

Take care,
Ate Anna

Ate Anna welcomes your question and comments. Please write to: Ate Anna, 2^nd floor, 555 Broadway, Winnipeg, MB.R3C OW4 or email: annal@serc.mb.ca