Same-sex couple's fertility treatments stalled as private clinic holds out for more government funding

The women look at each other with reassuring smiles before they launch into their story.

Their dream is to become parents, and to have a child of their own.

But while they knew that as a same-sex couple, that journey would come with challenges, they never expected to be caught up in a conflict between the government and the private fertility clinic where Sarah is to be artificially inseminated.

"I feel helpless. I feel I don't have any solutions." said Sarah. (CBC has agreed to use pseudonyms for Sarah and her partner Maria, because they worry revealing their true identities could affect their chances of having a baby with the clinic's help.)

"We come from two great families. We both have siblings. We have friends who are lesbian couples that have had kids," said Sarah. "I think it's just the greatest gift of life, and having that almost ripped away from me is horrifying."

She and Maria, who have been together for years, did their research before starting the process to be inseminated at Clinique Ovo. They said the clinic had a good success rate, and they had read positive reviews online before starting the process.

But in November, after the CAQ government's 2020 legislation on assisted procreation came into effect, most private fertility clinics put in-vitro fertilization (IVF) and artificial insemination treatment on hold in a dispute over the fees Quebec's health insurance board (RAMQ) was prepared to pay for these services.

The clinics succeeded in negotiating an increase in the fee RAMQ pays for a round of IVF treatment, from $3,900 to $6,600, and resumed offering IVF.

However, RAMQ held the line on what it was prepared to pay for costs associated with artificial, or intrauterine, insemination (IUI), which can run to about $800 per cycle.

Under the new law, RAMQ will pay for up to six rounds of IUI treatment. The current rates covered per cycle are:

• Artificial insemination for $85.

• Stimulation by oral agents plus artificial insemination for $190.

• Ovarian stimulation by gonadotropins (hormone to facilitate pregnancy) followed by insemination for $235.

At least two clinics — Clinique Ovo and Procrea Fertility's clinic in Gatineau — didn't resume offering IUI, as they argued the cost of providing a round of treatment is higher than what RAMQ is prepared to pay.

Consequently, some patients have been left in limbo: Sarah and her partner already spent thousands of dollars on tests at the clinic and were set to begin their first round of intrauiterine insemination when Clinique Ovo suspended those treatments.

"We ended up in this situation where we were held hostages, where we couldn't proceed," said Maria. "This created a lot of psychological strain."

"I don't think a lot of people talk about that or understand that. But emotionally and psychologically, this has been really difficult for both of us."

Maria said they could change clinics, but that is difficult after having already invested so much money in the process at Clinique Ovo.

'Disproportionately affects' lesbians, says LGBT+ advocate

Mona Greenbaum, executive director of the Montreal-based LGBT+ Family Coalition, says her group has been fielding many calls from lesbian couples since private clinics put services on hold. She said the conflict over fees is causing many people undue stress.

"Why hasn't the government negotiated this with the clinics before the law came into effect?" asked Greenbaum.

"The clinics are using patients as negotiation tools."

"The LGBTQ community is in the middle. We're being hurt, by the lack of action by the government — and lack of empathy on the side of the clinics," said Greenbaum.

The couple says they're holding tight.

They don't want to start all over, especially because the suspension of IUI services by some private clinics has created long waits in the public sector.

"Why don't they resume service and then retroactively charge the government for the discrepancies for all the inseminations to find a solution?" Sarah asks.

Clinic, Health Ministry blame one another

The clinic says under RAMQ rules, it's not possible to charge patients the true cost of its service and wait to be reimbursed by RAMQ later.

In a statement, a spokesperson for Clinique Ovo said the clinic had hoped the issue of IUI fees would be resolved at the same time as the private sector came to an agreement over the fees for IVF treatments.

"At present, the Quebec government unilaterally made the decision to impose a below-market fee for these treatments and force clinics to operate at a low cost," said Chloé Plenet, who speaks for Clinique Ovo and The Fertility Partners, the company that owns the clinic.

Discussions between Quebec's federation of medical specialists (FMSQ), the group representing obstetricians and gynecologists (AOGQ) and the government are underway in the search for a solution, said the clinic.

"We urge the government to immediately open negotiations due to the urgency of the situation and quickly work towards a lasting solution for the sake of patients," said Plenet in the statement.

Marjorie Larouche, a spokesperson for the Ministry of Health, said the ministry is disappointed that some clinics have suspended their IUI service, despite the strides the government has taken in making assisted procreation more accessible.

"It is important to mention that the choice to offer the services or not to offer the services insured by this program belongs to each private clinic," she said in a statement.

None of this helps Sarah and Maria right now, as they wait for a break in the impasse.

"There have been many, many sad nights and tears and trying to raise ourselves up again," said Maria, "in order to continue with our dream of having a family."