Medically assisted reproduction program

The medically assisted reproduction program is available since November 15, 2021.

On March 6, 2024, changes were made to the assisted reproduction program. These changes allow the integration of more services insured by the Régie de l'assurance maladie du Québec for eligible persons, under certain conditions. The services made sure under certain conditions are:

• Surrogate pregnancy  (page in French only) involving a surrogate mother
• Preimplantation genetic testing, also known as preimplantation genetic diagnosis, for a person or couple at high risk of conceiving a child with a serious, severely debilitating, or fatal disease for which there is no known cure

Medically assisted reproduction (MAR) provides a medical solution for people unable to conceive a child.

The program is based on and subject to the highest standards of practice in consideration of the government’s ability to pay. It applies modern, financially sustainable criteria based on today’s couples and families and limiting both the obstetric risk to women receiving treatment and the neonatal risk for the children conceived.

Fertility project may be made by:

• Female–male couples
• Female–female couples
• Male-male couples
• Single women
• Single men

The program is intended for people who:

• are insured by the public health insurance plan,
• have infertility problems or are unable to conceive on their own (single people, female–female couples or male-male couples) or have a high risk of conceiving a child with a serious hereditary disease, according to certain eligibility criteria,
• have not undergone voluntary sterilization, neither their partner (such as vasectomy or tubal ligation),
• are age 18 or over when treatment begins,
• and who have not received identical insured services since program inception (except in the case of insemination after a live birth).

For women, the maximum age to receive MAR treatment is:

• 41 years less a day to begin treatment. See the temporary reimbursement program to find out the exceptions to this criterion;
• 42 years less a day for embryo transfer

If you are planning to have a child and are a carrier of a serious hereditary disease, talk to a physician at an assisted-reproduction centre. Since every situation is unique, your doctor will be able to verify whether you qualify for the program's insured services.

For intended parents

Single people or spouses using surrogate pregnancy  (in French only) must meet the same eligibility criteria as single people or spouses using the MAR program.

If the intended parents are not eligible for insured services, their project with surrogate pregnancy will not be eligible. No services can be made sure for the surrogate mother.

If the intended parents are eligible for insured services, but the surrogate mother is not (e.g., she does not have a valid health insurance card), the surrogate mother will not be covered:

• The intended parents remain eligible for the insured services they themselves will receive (e.g, egg collection, sperm collection)
• Services issued to the surrogate mother will have to be paid in full, since they will not be insured by RAMQ. However, certain expenses may be eligible for a tax credit .

For the surrogate mother

The surrogate mother must be a person who:

• is insured under the public health insurance plan,
• is 21 years of age or older and must meet the maximum age criteria for the treatment to be received,
• has not undergone voluntary surgical sterilization (tubal ligation) or tubal reanastomosis.

If you received MAR treatments covered by the public health insurance plan before November 15, 2021, you can once again benefit from covered services, provided you meet the eligibility criteria.

At the start of the program, if you are undergoing in vitro fertilization (IVF) treatment, you have the following options:

• Continue to pay the costs associated with treatments already underway or
• Start a reproductive project within the framework of the program

If you have already begun receiving IVF treatments, the program can cover the remaining treatments you could receive. For example, someone who started ovarian stimulation before November 15, 2021, using IVF medication, is eligible for transitional measures. They can decide to complete their treatment outside of the program and keep their insured IVF for later. Or they can decide to switch to the new program and receive insured services for the remaining treatments (one egg retrieval and the embryo transfers).

If a person already has frozen embryos, they can start a complete new IVF cycle with the new program or transfer their frozen embryos if they meet the eligibility requirements. In the latter case, they will no longer have access to any further IVF services for life.

Talk to your attending physician for further details.

People who want to receive insured MAR services must first verify their eligibility. After a fertility exam at an assisted reproduction centre (ARC), your physician will check with RAMQ (Régie de l’assurance maladie du Québec) whether you are eligible for insured services.

You can still receive MAR if you do not meet the eligibility criteria (for example, if you are age 42 or over), but you will have to pay the cost in full yourself, as services will not be covered by RAMQ. Certain expenses however may be eligible for infertility treatment tax credits .

In the case of an in vitro fertilization (IVF) project, services are guaranteed for a single IVF cycle, for life.

A single IVF cycle may include:

• Up to two ovarian stimulations as per medical indications
• One egg retrieval
• standard IVF services (sperm retrieval and washing or surgical aspiration and micro injection of sperm [ICIS], as well as assisted hatching)
• One straw of donor sperm from distributors approved by Health Canada
• A single surgical sperm cell collection
• The embryonic biopsy and the preimplantation genetic testing under certain eligibility conditions
• Freezing and storage of supernumerary embryos for one year
• The transfer of each embryo (fresh or frozen) from the IVF cycle

The non-IVF services guaranteed are:

• Oral or injectable non-IVF ovarian stimulation
• Up to six donor inseminations per live birth
• Up to six straws of sperm from a donor bank from distributors approved by Health Canada (one straw at a time for one insemination)

Medications are covered under the public prescription drug insurance plan.

Freezing of gametes for fertility preservation is covered to age 25 or 5 years for people age 21 and over. The service is available to people before undergoing gonadotoxic treatment or ablation of the ovaries or testicles. Gonadotoxic treatments are treatments toxic to the ovaries or testicles. They may be cancer treatments or involve medications that can cause permanent infertility.

Treatments covered as fertility preservation services include:

• Up to two ovarian stimulations as per medical indications
• One ;egg retrieval
• Standard IVF services
• One surgical sperm cell collection
• Freezing and storage of a sperm sample, ovocytes or embryos

An IVF cycle is considered to have begun once the patient has started taking medication for ovarian stimulation, either orally or by injection.

MAR services guaranteed are also available to projects involving surrogate pregnancy. All services issued by the surrogate mother are considered to be those of the intended parents, even if the surrogate mother withdraws from the project or chooses to keep the child. No reimbursement can be made to the surrogate mother for the MAR services issued, for the sole reason that she chooses to keep the child or that the project has not been completed.

The surrogate mother may use the insured MAR services for herself at a later date, should the need arise and provided she meets the eligibility criteria.

For more information on surrogate pregnancy, go to the page Grossesse pour autrui réalisée au Québec (mère porteuse)  (in French only).

For preimplantation genetic testing, the services offered to eligible people are:

• All services guaranteed by the MAR program, including an in vitro fertilization cycle or artificial insemination with a third-party contractor
• Embryo biopsy
• Preimplantation genetic testing on all embryos resulting from the guaranteed IVF cycle

If you are planning to have a child and are a carrier of a serious hereditary disease, talk to a physician at an assisted-reproduction centre. They will be able to discuss treatment options appropriate to your situation.

People who are eligible receive insured services on presentation of their RAMQ card at an assisted reproduction centre licensed in Québec. Only services listed in the Insured Services section are covered.

Some of the services not included in the program may therefore be at the patient’s expense. For example, storage fees for frozen embryos and the cost of purchasing eggs from banks must be paid by patients after the first year. Your attending physician can inform you about fees before you begin treatment.

The assisted reproduction centre (ARC) where the insemination and IVF took place will reimburse eligible individuals for sperm straws purchased since November 15, 2021, as part of an insured service, up to a maximum of $850 to cover the purchase price and $100 for delivery.

People who do not meet the eligibility criteria or who exceed the service coverage limits must pay for the services they receive.