Infertility Treatment in Atlantic Canada

By: Kate Lively, BScN, RDMS
Winter 2004

Atlantic Canada is best known for its rugged coastline and rich culture. Inhabited by only 8 % of Canada’s population, the provinces of Nova Scotia, New Brunswick, Prince Edward Island and Newfoundland & Labrador have a total population of slightly less than 2.4 million people. Providing accessible, comprehensible healthcare in this setting is a challenge, particularly for highly specialized areas such as assisted reproduction. Assisted reproduction is currently available at three centers in the Atlantic Provinces. The Conceptia Clinic in Moncton, New Brunswick; Fertility Services with the St. John’s Healthcare Corporation, Newfoundland; and the Atlantic Assisted Reproductive Therapies in Halifax, Nova Scotia. These clinics are able to provide a broad range of fertility treatments.

The Conceptia clinic is adjoined to the Georges L. Dumont Hospital in Moncton, New Brunswick. This facility, a division of the Beausejour Medical Research Institute, has been in operation since 2000. Currently, the Conceptia clinic offers the following services: Evaluation and treatment of female and male infertility; Controlled Ovarian Hyperstimulation; Intrauterine Insemination; Therapeutic Donor Insemination; In Vitro Fertilization (IVF); Embryo Freezing; Intracytoplasmic Sperm Injection (ICSI), and; Egg Donation.

Fertility Services with the St. John’s Healthcare Corporation is part of the Women’s Health Program at this facility. Although advanced fertility treatments such as In Vitro Fertilization are not part of the program this clinic satellites with a number of clinic’s across Canada to provide access to these treatments for couples in the St. John’s area. Services available through St. John’s include:

Evaluation and treatment of female and male infertility; Controlled Ovarian Hyperstimulation; Intrauterine Insemination; Tubal Reversals; Therapeutic Donor Insemination, and; Satellite services for advanced treatments.

The Atlantic Assisted Reproductive Therapies (AART) unit is the largest of the three clinics in Atlantic Canada. Located at the IWK Health Centre in Halifax, Nova Scotia, this clinic has been providing advanced fertility treatments since the early 1980’s. Initially established by the Department of Obstetrics and Gynaecology at Dalhousie University this clinic has undergone change and expansion over the past twenty years to improve fertility treatment options for couples. For many years, this unit was known as the Reproductive Endocrine Centre, which was located at the former Grace Maternity Hospital. In 1999, the program expanded to provide a number of new services and has now been renamed the “Atlantic Assisted Reproductive Therapies” unit, or AART. The following services are currently offered through the AART unit:

Evaluation and treatment of female and male infertility; In Vitro Maturation (IVM); Embryo Freezing; Intracytoplasmic Sperm Injection (ICSI); Sperm Cryopreservation, and; Tubal Reversals. The delivery of advanced reproductive services to couples living outside the Halifax area has been a topic of awareness for staff providing care at the AART unit. Creative approaches are utilized. The use of “Telehealth” via video conferencing, allows a couple to have a consultation with a specialist at the AART unit and remain in their hometown. Information videos, written material, public information sessions, city maps, lists of accommodations and web sites are all used to enhance care delivery.

In an effort to assist patients who live outside Nova Scotia, specific outreach centres have been established. Currently there are outreach centres in Fredericton, Saint John and Moncton, New Brunswick; Charlottetown, Prince Edward Island; and Gander and St. John’s, Newfoundland. The couple’s own local gynaecologist can perform or arrange many of the necessary tests required during or prior to treatments. Results are then sent to the specialists at the AART unit for interpretation and determination of when it is necessary for the couple to come to Halifax for treatment. This arrangement can save couples travel time, inconvenience, money and may help decrease the stressfulness of a treatment cycle.

Consultation with a reproductive endocrine specialist begins with a written referral from a couple’s family doctor, gynaecologist, or urologist. A typical wait time for an initial appointment with a specialist in Halifax is 2 to 3 months. Once evaluation and diagnosis of the infertility condition has been completed, appropriate options for treatment are explained to the couple by the specialist. Collaborative approaches between the couple and their care providers, assists them in deciding the treatment option that best meets their needs. There are currently no waitlists for treatments such as: In Vitro Fertilization (IVF), In Vitro Maturation (IVM), Frozen Embryo Transfer (FET), Therapeutic Donor Insemination (TDI) and Controlled Ovarian Hyperstimulation (COH). Once preliminary testing is completed and couples understand how to administer medications for their appropriate treatment protocol, they can start their cycle.

During advanced treatment cycles such as IVF, IVM or COH, couples may be monitored via bloodwork and ultrasounds at the AART unit or through an outreach centre. The test results are reviewed by an AART specialist and directions for care are relayed via telephone to the couple and, if applicable, the outreach centre. This can significantly shorten the amount of time required for the couple to be physically in Halifax. Currently procedures such as retrieval of eggs and transfer of embryo are done in Halifax at the AART unit.

Following a treatment cycle of IVF or IVM a chart review is completed. During review, physicians, embryologists and nurses discuss the response and outcome of the treatment. Recommendations for repeat attempts, if desired, are made. This information is made available to couples via a telephone conversation or at a clinic appointment. Emotional support before, during and following treatment is available from a variety of sources. A referral can be made to a psychologist, social worker or psychiatrist who is sensitive to infertility issues. Doctors and nurses who work in the clinic are also available by telephone or appointment to discuss emotional reactions and coping mechanisms. Support groups sponsored by IAAC are now available in Fredericton and St. John’s, New Brunswick and Halifax, Nova Scotia.

The financial cost of infertility treatment is substantial for most couples. Prices are subject to change as the cost of medical supplies and other goods increase. Treatment costs do not include the cost of drugs. Couples with a drug plan may have some or all of their drugs covered, depending on their plan. Treatment costs at AART currently are:

Initial Consultation – no charge

Registration Fee – no charge

In Vitro Fertilization – $4,200.00

In Vitro Maturation – $3,350.00

Therapeutic Donor Insemination – $ 325.00

Intrauterine Insemination (IUI) – $ 144.75

IUI with Therapeutic Donor – $ 375.00

Frozen Embryo Transfer – $ 400.00

Embryo Freezing – $ 250.00

Semen Cryopreservation – $ 350.00

Intracytoplasmic Sperm Injection – $1000.00

Assisted Hatching – $ 500.00

The future for couples seeking fertility treatment in Atlantic Canada is positive. Success rates of advanced treatments are comparable to other areas in Canada. There is no longer a need for couples requiring procedures such as intracytoplasmic sperm injection (ICSI) to travel outside of Atlantic Canada. A program for egg donation is currently under review at the AART unit and is available through Conceptia Clinic in Moncton. Outreach centers continue to gain expertise, with the hope that eventually a mobile unit will travel to these centres to treat couples requiring egg retrieval and embryo transfer. Accessible and comprehensible treatment for infertility is available for Atlantic Canadians, perhaps closer to home than expected. For more information visit www.aart.ca or www.conceptia.ca.

ABOUT THE AUTHOR: Kate Lively is a registered nurse working at the Atlantic Assisted Reproductive Therapies centre. She has over twenty years experience working with maternal and women's health. She has a BScN from Dalhousie University, she is a Registered Diagnostic Medical Sonographer in OBS/GYN and she is currently completing a Masters in Nursing with a Reproductive Endocrine focus from Flinders University in Australia. Kate lives with her husband and two children about 45 minutes outside of Halifax.