# 2021-010 Medical and Dental Care, In vitro fertilization

Case summary

F&R Date: 2021-03-25

The grievor and her spouse had a consultation with a fertility clinic at their own expense. The grievor then underwent in vitro fertilization (IVF) and paid for the associated fees. Her claim for reimbursement for both the consultation and IVF were denied. She contended that without being referred to a specialist to determine whether she had blocked fallopian tubes, it was impossible for her to meet the criteria set out for reimbursement of IVF in the Spectrum of Care (SoC). She requested reimbursement of medical costs associated with IVF.

The Commander Canadian Forces Health Services, acting as the Initial Authority (IA) determined that, in accordance with the SoC in effect at the time of the grievor's IVF treatment, she was not entitled to reimbursement for IVF. He stated this was because there was no evidence the grievor suffered from bilateral fallopian tube obstruction, the criteria required for IVF funding. However, the IA found, and directed, that the grievor be reimbursed for the consultation fee with the fertility clinic.

The Committee concluded that the grievor was not eligible for reimbursement of IVF costs in accordance with the SoC in place at the time, given she did not have a diagnosis of bilateral fallopian tube obstruction. However, the Committee found that the grievor should have been referred by the Canadian Armed Forces to a specialist for a consultation to determine whether she suffered from blocked fallopian tubes. The Committee noted that this could have led to the grievor being entitled to reimbursement of IVF treatment. The Committee recommended that the grievor be reimbursed for any further consultation costs. The Committee also recommended that IVF not be reimbursed as this would be contrary to the policy.