Posted in #OHIP4IVF, Canada, Community, disaster, family, government, Life, money, Parenting, politics, Toronto

Ontario Provincial Election Primer 2018. Undecided? Read This!


On June 7th, 2018, Ontarians will get an opportunity to vote in an election which will shape the way our province runs for the next 4-years.

The decision we make, has to be made based on what is best for the collective whole, what is best for us, and what is best for the next generation of Ontario Taxpayers, and not based on what people will say about us, our Province, our Premier or our Prime Minister.

The task is a tough one, but let’s try to shed some light on the platforms and what to expect for the next 4-years, and see if that helps you decide who gets your vote.

In 2014, the Ontario Liberal Government made these promises;

Personal taxes

Liberal 2014 pledge was to “Raise taxes on top 2% of Ontario earners”

In order to see how they did, I pulled the Ontario tax rates from the Canadian Tax Returns from 2010-2018.

Ontario tax rates

2018: 5.05% on income of $42,960 or less, 9.15% on $42,963-$64,077, 11.16% on $64,077-$70,000,  12.16% on $70,000-$220,000 and 13.16% on income over $220,000.

2017: $42,201 or less @5.05%, $42,201-$84,404 @ 9.15%, $84,404-$150,000 @ 11.16%, $150,000-$220,000 @ 12.16%, over $220,000 @ 13.16%

2016: $41,536 or less @ 5.05%, $41,536-$83,075 @ 9.15%, $83,075-$150,000 @ 11.16%, $150,000-$220,000 @ 12.16%, Over $220,000 @ 13.16%.

2015: Less than $40,922 @ 5.05%, $40,922-$81,847 @ 9.15%, $81,847-$150,000 @ 11.16%, $150,000-$220,000 @ 12.16%, and income more than $220,000 @ 13.16%

2014: $40,120 or less @ 5.05%, $40,120-$80,342 @ 9.15%, $80,242-$150,000 @ 11.16%, $150,000-$240,000 @ 12.16%, More than $220,000 @ 13.16%

2013: $39,723 or less @5.05%, $39,723-$79,448 @ 9.15%, $79,448-$509,000 @11.16%, over $509,000 @13.16%

2012: $39,020 or less @ 5.05%, $39,020 – $78,043 @ 9.15%, $78,043-$500,000 @ 11.16%, More than $500,000 @ 12.16%.

2011: $37,774 or less @ 5.05%, $37,774-$75,550 @ 9.15%, More than $75,550 @ 11.16%.

2010: $37,106 or less @ 5.05%, $37,106-$74,214 @ 9.15%, More than $74,214 @ 11.16%

 

As you can see, the tax brackets move year over year, and there have been additional tax brackets added. Here is how much Ontarians earned, according to Statistics Canada census.

According to Statistics Canada

Individuals by total income level, by province and territory (Ontario)
  2011 2012 2013 2014 2015
number of persons
Total, all income groups 9,741,870 9,743,420 9,867,280 10,083,520 10,157,280
Under $5,000 872,840 799,690 805,190 855,500 764,990
$5,000 and over 8,869,030 8,943,730 9,062,090 9,228,020 9,392,290
$10,000 and over 8,155,630 8,245,590 8,375,390 8,562,450 8,748,520
$15,000 and over 7,219,670 7,322,660 7,457,070 7,655,920 7,878,190
$20,000 and over 6,301,960 6,416,620 6,545,820 6,745,310 6,974,390
$25,000 and over 5,530,610 5,645,750 5,772,340 5,959,770 6,184,900
$35,000 and over 4,334,550 4,460,560 4,582,210 4,749,620 4,948,440
$50,000 and over 2,852,030 2,972,470 3,087,320 3,230,610 3,394,390
$75,000 and over 1,404,030 1,487,700 1,574,090 1,668,890 1,771,250
$100,000 and over 658,520 707,620 766,990 819,960 886,190
$150,000 and over 231,310 246,520 265,550 278,330 305,590
$200,000 and over 122,190 128,140 136,290 141,740 157,450
$250,000 and over 78,370 81,210 86,300 88,600 98,750
$
Median total income 30,290 31,310 31,820 32,380 33,840

According to Statistics Canada, in 2015, there were 10,157,280 Ontario Taxpayers.

For the Liberals to increase taxes on the top 2% of them would, mean increasing taxes for approximately, 203,145.6 Ontarians, which would be every Ontarian earning over $200,000 per year.

It looks like that has happened, and I’m sure many would support that, but have a closer look at the numbers, and you will see that in 2013, the top tax rate of 13.16% applied only to Ontarians earning over $500,000, but that was dropped in 2014 to apply to Ontarians who earned over $220,000.

In 2013, if you earned $200,000, your tax rate was 9.16%. In 2014, it was 12.16%, and in 2015, it was 13.16%

That is a 4% increase on the highest income earners!

Wait until later in this post to see what the Liberals did to the “middle class” and how much their taxes increased!

 

Corporate taxes

In 2014, the Liberals promised to;

  • Maintain corporate tax rate at 11.5% for now
  • Increase tax rate on aviation fuel
  • Remove small business tax deduction currently used by large businesses

Fact: Ontario Corporate Tax Rates have a low and a high, and in 2018, the rate was 3.5%-11.5%.

The low end is one of the highest in Canada, while the high end is one of the lowest in Canada.

Under the Liberal government who states that Corporations must pay their fair share, the Ontario General corporate income tax rate was:

14% before July 1, 2010

12% June 30, 2010

11.5% after June 30, 2011.

 

In the most recent budget, the Ontario Liberal government matched the Federal Liberal government and got rid of the Small Business Deduction – which reduced the corporate income tax rate on the first $500,000 of active business income of Canadian‑controlled private corporations (CCPC) earned to 4.5%.

As of January 1, 2018, the lower rate of Ontario corporate income tax decreased from 4.5% to 3.5% and CCPC’s with taxable capital is between $10 million and $15 million are no longer eligible for the preferential corporate income tax rate of 4.5% on the first $500,000 of active business income.

 

Jobs

In 2014, the Ontario Liberals pledged to;

  • Increase minimum wage to $11/hour
  • Spend $2.5 billion over 10-years on a Jobs and Prosperity Fund to attract and keep businesses in the province
  • Spend $38-million in the Youth Employment Fund in 2014-15 until September 2015
  • Simplify and restructure Foreign Credential Recognition Program
  • Spend $25-million in the Aboriginal Economic Development Fund over 3 years to promote aboriginal business
  • Create a regulated crowdfunding system
  • Spend $75-million on a “wine strategy” to encourage exports of Ontario VQA winesAside from really jacking up the minimum wage which resulted in the largest loss of part-time jobs in the history of this province, the government spent a lot of our taxpayer dollars in areas which are difficult to measure the cost to job ratio.

Deficit

In 2014, the Liberals pledged to;

  • Balance the budget by 2017-18

Not even close! Between 2007-08 and 2018-19, Ontario’s debt grew from $157 billion to $325 billion.

One only has to look at this chart from the National Post to see the damage that Liberal Spending has done to the deficit, which we all have to pay back, eventually.

In 1985, the Liberals under David Peterson arrived, marking the defeat of Ontario’s four-decade conservative dynasty.

In 1990, Bob Rae became premier with the NDP forming Ontario’s government for the first time in history and their tenure coincided with the worst recession since the end of WWII, resulting in plunging revenues and growing expenditures in an effort to maintain services and stimulate the economy.

The resulting deficits were as high as $12.4 billion and saw the accumulation of $63.4 billion in net public debt.

By 1995, Ontario’s net public debt had reached $101.9 billion.

The NDP government was replaced in 1995 by Mike Harris’s Conservative government, which began expenditure reduction (cut costs) and restructuring to balance the budget as well as tax reductions to stimulate the economy.

Lower taxes, lower interest rates and a booming U.S. economy together helped Ontario’s economy rebound and government revenues grew, helping close the budgetary gap.

Ontario balanced its budget by 1999 but its net debt still grew to $138.8-billion under Ernie Eves in 2003 from $101.9-billion in 1995.

The defeat of Eves ushered in the Liberals under Dalton McGuinty in 2003 and then Kathleen Wynne in 2013.

This period witnessed the largest debt accumulation in Ontario’s history.

Between 2003 and 2014, Ontario’s net public debt grew to $287.3 billion from $138.8 billion – an increase of $148.5-billion.

The Liberals reduced it once, by $1.1 billion dollars after selling of part of Hydro 1, but that surely cannot be the only way to pay down the debt, can it?  Once all the assets are gone, what would they use?

Ontario has been a province since 1867 but 87% of its net public debt was accumulated in the years since 1990.

*** Interest on this debt is $11 billion a year! ***

 

Health care

In 2014, the Liberals pledged;

  • Increase hourly wage for personal support workers by $1.50 in 2014 and 2015 and $1 in 2016
  • $20-million to improve access to primary care physicians
  • Expand home, community and supported home care for 46,000 more seniors
  • Access to dental services for 70,000 more children in low-income families
  • Create low-income health benefit to provide vision care, drug coverage and mental health services to low-income families
  • Eliminate service waitlists for 21,000 people with developmental disabilities
  • $5-million to Children’s treatment centres
  • Expand and improve hospitals over a 10-year plan
  • Cap or cut hospital parking fees for frequent hospital visits
  • Establish Patient Ombudsman

 

Unfortunately, this Liberal government will be known for failing hospitals, failing patients, and failing to take full care of the lowest income earners.

Instead of free medication for the poorest Ontarians, the Liberals provided free medication for children.

Nursing homes are still over crowded. Hospitals are still over crowded. Doctor’s are leaving the province due to the Liberals poor negotiation / tax increase on them.

Pensions/Seniors

  • The Provincial Pension Plan to provide further retirement savings to the Canada Pension Plan

But thanks to the Federal Liberal government, this did not happen and while the concept was a good idea, the burden of cost for administering this program would fall to the employers, who have already been hit with increased taxes, and in 2014, had no idea what was to come with the sharp rise in the minimum wage.

 

Education

  • Implement full-day kindergarten for 4 and 5 year-olds by September 2014
  • Expand student nutrition program to 340 more schools
  • Integrate 60 minutes of physical activity into the school day
  • 3-year $150-million spent on technology and learning fund for tools such as tablets and cameras and professional development for teachers
  • $10-million to create Experience Ontario – Done – Experience Ontario is a pilot program for a limited number of recent high school graduates who have an interest in attending postsecondary education or apprenticeship training, but are uncertain of their next steps.
  • Keep 30% off tuition grant for post-secondary students – Hidden tax increase because if tuition drops by 30% and teachers / teaching assistants, etc., keep getting pay raises, then who gets to make up the difference… Ontario Taxpayers!
  • Build new post-secondary campuses and create spaces for 15,000 more students – this was announced – to be built in Markham – a joint venture between Seneca College and York University. Ironically, after the York University FINALLY opened, a mere 10-years later than it should have, the government plans to build this campus where there is no underground service… Can you say commuter University part 2.

 

Transportation/Transit

In 2014, the Ontario Liberals pledged to;

  • Invest $15-billion in transit projects in the Greater Toronto and Hamilton Area, including the electrification of GO Express Rail and downtown relief line
  • All-day regional express rail GO service in Waterloo Region
  • Invest $14-billion in transit projects outside GTHA, including $1-billion in Ring of Fire transportation infrastructure
  • Two-way, all-day GO Train service in more communities
  • $2.5-billion for highways including expanding Hwy. 427 and expanding Hwy. 7 to four lanes between Kitchener and Guelph

They didn’t agree to speed up the building of current Toronto projects like the Eglinton LRT, or the proposed Finch LRT, which has been dragging along for 6-years costing commuters and business owners significant amounts of money each and every day. Ultimately, they can propose what they want, but they have to get the job done, and that has not happened, anywhere.  Traffic is getting worse by the day.

 

Consumers

  • Lower auto insurance rates by an average of 15% by August 2015
  • Create Consumer Bill of Rights

This pledge was a giant joke, as Ontarians pay some of the highest insurance rates in the world, while Ontario insurance companies make some of the highest profits in the world.  Additionally, what good is a Bill of Rights without any teeth? 

Family care

  • Pay for one cycle of in vitro fertilization – check. Good one!
  • Increase Ontario Child Benefit to $1,310 & index it to inflation afterward – done. Currently at $1378 per child per year.
  • Call on federal parties to include a national child care program in 2015 election platforms… Err, okay, this has not happened. Maybe they should focus on, I don’t know, Ontario!
  • Increase Ontario Works and Ontario Disability Support Program rates for people with disabilities by 1% in 2014-15

Where was removing the Child Fitness Tax Credit??? Wasn’t mentioned but was removed – essentially a tax increase! Families put kids in programs for health and due to the tax incentive.  The removal of this credit is significant, sadly.

WSIB is killing Ontario businesses due to the costs to administer and it punishes the workers. This needed a major overhaul, but wasn’t touched.

 

Environment/Energy

  • Eliminate debt retirement charge on residential electricity bills
  • Develop program to reduce electricity bills for low-income families
  • Keep Northern Industrial Electricity Rate Program to help businesses reduce energy costs
  • Expand outer boundary of Greenbelt over next six years
  • Promote urban forestry
  • Address algae problems in Great Lakes
  • $30-million over next 10 years to maintain Walkerton Clean Water Centre
  • $30-million over next three years to promote local food
  • $25-million over three years for cycling strategy CycleOn
  • Expand provincial trail network

I’m not even going to touch this disaster portfolio by the Liberals. They spent, spent and then spent more, and they taxed, raised, and increased anything and everything to pay for their out-of-control spending. Gas taxes went up, user fees increased, hydro coasts soared, Liberals went to jail, Liberals went on trial, and everybody had to pay.

 

Political reforms

  • Maintain MPPs’ salary freeze – still $116,500 as it was in 2008. Not even increased in line with inflation. That must suck.
  • Cap public sector and broader public sector executives’ salaries – check
  • Reduce number of government agencies by 30% in 2015

There are currently 28 Ontario Agencies;

Accessibility Directorate of Ontario
Government & Consumer Services
Environment & Climate Change
Citizenship & Immigration
Agriculture, Food and Rural Affairs
Attorney General
Natural Resources & Forestry
Children and Youth Services
Municipal Affairs
Health and Long-Term Care
Treasury Board Secretariat
Tourism, Culture and Sport
Labour
Natural Resources & Forestry
Community Safety and Correctional Services
Education
Finance
Advanced Education and Skills Development
Transportation
Northern Development and Mines
Research, Innovation and Science
Energy
Infrastructure
International Trade
Housing
Children and Youth Services
Francophone Affairs
Community and Social Services

In 2010, I counted 26 of them. I’m sure there must be more, but merging them together doesn’t mean efficiencies were created, it just means fewer web-pages to have to update.

  • Introduce financial accountability officer – done
  • Give municipalities option of ranked ballots as an alternative to first-past-the-post in elections

After a review of the facts, this government has essentially lived up to their spending promises, however, there are 2 areas where I believe they failed miserably;

  1. Spending, and
  2. Taxation.

Increased spending where there is a balanced budget means the government takes in X amount of dollars in tax from Ontarians, and spends X amount of dollars.Unfortunately for all Ontarians, the government took in X amount of dollars from Ontarians, yet spent hundreds of billions of dollars more than they took in.

The effect of this spending means that Ontario has to borrow the money and has to pay interest on this borrowed money.

The amount Ontario has borrowed, or the deficit, currently stands at $325 billion dollars!

Imagine earning $100,000 per year, and borrowing $30 million dollars from the bank?  Then having to borrow more and more each year just to make the minimum payments on the interest to stay out of bankruptcy?  That debt will never be paid off unless you earn significantly more amounts of money, reduce all of your expenses, and if the lender agrees to reduce the interest.

If, however, the bank calls the loan, then you are bankrupt.

The same holds true for provinces.

The long-term effect of this irresponsible spending is that going forward for every X dollars the province brings in as tax dollars, there is an amount, let’s call it Y, which the government MUST pay in interest to the bank on the money they had to borrow. That means in order to balance a budget, they have to get even more money from Ontarians, which means even higher taxes, or they have to cut spending.

But if they cut spending, then they have to cut services, which is what they claim the Conservatives always do, so they don’t cut expenses or raise taxes, they do it in a much sneakier way so that you never know they are doing it.

One way this government has reduced spending and increased taxes, for example, is by getting rid of tax credits or deductions, such as the Child Tax Credit, or the Transit Credit. By not allowing these credits, the government no longer has accept less taxes from Ontarians and they win again because either these Ontarians will get back less taxes (because no deduction).

It’s brilliant.

It’s devious.

It’s immoral.

It’s like reducing the size of a jar but charging the same price. Consumers think they’re getting the same amount for their dollars, but in fact they are getting less and paying the same.

If the government told you back in 2014 that they would spend the province into bankruptcy and increase taxes by 3-4% on every Ontarian earning over $40,000/year while cutting credits and deductions, would you have voted for them?

Funny how that was never discussed…

 

Note: By moving the middle tax bracket, your $70,000 of income in 2014 put you in the 9.15% tax bracket, but in 2018, it puts you in the 12.16% tax bracket. That move increases taxes on the “middle class” without increasing the tax rate.  This was done while both the Liberal governments here in Ontario and Federally have been campaigning against the “rich and wealthy.”

These adjustments, along with the adding of levies, and user fees, and all those other words which mean tax, is just another way to prove that this government is underhanded and untrustworthy.

So instead of posting each parties platform and going through the pros and cons of each government, I decided to save everyone time and pull out what I feel really matters.

Liberals: More spending. Budget not balanced until 2024-2025.  Wave hands, and magically increase taxes on everyone over $50,000.

NDP: Even more spending.  Remove the power for governments to call an end to strikes. Debt and deficit to continue to grow.  Money to come from increasing taxes on the”rich” which we now know to be everyone over $40,000 per year.

Conservative: One or 2 years of deficit, then balanced budget and begin paying down the debt.  Plan to get more money into the governments pockets is not through increasing the tax rate, but by lowering taxes, gas, hydro, and letting Ontarians spend more money because 8% of that HST (consumption tax) belongs to Ontario.

Green: Increase spending for 2-3 years, no balanced budget for 3-4 years, and increased revenue to come from taxing the “rich” taxpayers and corporations.

 

Personally, if you ask, I’d rather tighten my belt buckle now and pay that bit extra in order to see the deficit reduced so that my children are not paying for this in the next 5-10 years.  Unfortunately, because the Liberals typically spend without consideration for where the money to pay for it will come from, it puts the next governing party in a bad light because they have to reduce waste, and cut where the Liberals didn’t want to.  It’s a great strategy to keep getting elected, but as a Taxpayer its annoying and unfair.

Good luck and get out there and vote!  It’s your democratic right!

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Posted in #OHIP4IVF

OMG, We’re infertile? How did that Happen?


Trillium used as the official symbol for the P...
Trillium used as the official symbol for the Province of Ontario. (Photo credit: Wikipedia)

As a member of the Conceivable Dreams blogging team here in Ontario, I pretended for a minute to put myself in an infertile couple’s shoes this family day long-weekend, so I Googled “infertility education in Ontario” and we quite shocked and disappointed by the resources which came up in Infertility education, below.

Notice that while there are many helpful resources on infertility in Ontario, there are none from the Ontario government’s own Ministry of Health.  If the intent of Family Day is to allow families to have a day to spend together then am I wrong to expect the government to also look for ways to help couples become families – through funding of IVF and educating Ontarians about causes of infertility…

Look at what came up in my search before anything from the Ontario government;

The first link belongs to a doctor, Thomas Hannam, and his views on infertility, here.  Do you know how to treat your eggs?  “If you are fortunate, you may already know that you have good quality eggs.  However, if you have reason to doubt the situation, then you may wish to try to “maximize” egg quality. Lifestyle matters: sleep well, quit smoking, and minimize caffeine to one cup of coffee a day.”

As a male, maximizing the quality of a female’s eggs never even occurred to me, however those items Dr. Hannam mentions are common lifestyle choices I think we should all be choosing anyways.  I was just surprised to know they had such an impact and egg quality… Should this not be taught to children in school?

My next hit was an OHIP4IVF post from one of our team members, following that was a link to the expert panel on infertility and adoption.

Then came a link to a London Health Sciences Fertility Ontario site (which is not a government education site, but rather a clinic here in Ontario run by a Doctor who cares about infertility.

After that came a site – not in Ontario – suggesting that infertility be taught in school, and that article can be read here;

I agree with that viewpoint.

Then came another article through the Infertility Awareness Association of Canada and while this site is not currently being updated there are significant resources there.

Still missing is the education platform of the Ontario Government.  Everyone knows that educating people is a less expensive and proactive way to address an issue, rather than waiting 20 or 30 years down the road and having to deal with an epidemic on mass.  Not that this Liberal government is the absolute cause of this problem but they are certainly not helping with the solution by constantly disregarding OHIP funding of IVF treatments for infertile couples who are trying to have children at all ages and in all socio-economic groups.  This government constantly refers to their own education program, however, it must be hidden or by invitation only because I could not find it.

Furthermore, the only Ontario government department with any published opinions on infertility is the Ministry of Child and Youth Services.  At least here they say they are going to on their website; “Infertility is a medical condition that often requires medical treatment. Infertility has wide-reaching consequences for individuals, families and society.”

Simple and too the point.  It continues;

“We believe that all Ontarians should have the opportunity to build a family. Infertility is a medical condition that prevents some Ontarians from doing so. These medical problems often require medical treatment(s) to overcome infertility. Right now in Ontario, one in eight couples is struggling with infertility. One in  six couples has experienced infertility at some point in their lives. Both male and female infertility are on the rise. And many other Ontarians – same-sex and single people and people with illnesses like cancer or HIV – need help to start a family.”

Then the government confirms what many of use feel is a major issue with IVF treatment costs – equal access to everyone;

“Access to assisted reproduction services should be free from any discrimination.  Every year, tens of thousands of Ontarians turn to assisted reproduction and other services like acupuncture and naturopathic medicine to help them conceive. Thousands more never seek help.  People who have experienced fertility problems or who have sought help told us about the barriers they face;

  • It’s difficult to get information: many people didn’t know about the factors that affected their fertility.
  • They are not sure where to go for help. Some facilities and practitioners offering assisted reproduction services are not accredited. Are the treatments safe? Where should they go to get the best care?
  • The procedures are too expensive. Many treatments are beyond the reach of most Ontarians.
  • There isn’t enough emotional support to help them deal with the grief over fertility problems, the stress fertility issues place on relationships or the challenges of treatments.
  • Many people have trouble accessing services because of where they live.
  • For same-sex and single people, and people with HIV, social and legal barriers can keep them from getting the services they need.
  • The fertility needs of young cancer patients are often forgotten by treating cancer specialists.
  • There is still a sense of failure or stigma about infertility that keeps many people silent and in pain.”

While I never would have come to this Ministry for information on infertility, and equality in IVF, I suspect many others would not looking here either.  If this next piece quoted from their website is not a cry to be heard, I don’t know what is;

“Ontario can do better. Ontario must do better. The status quo is not acceptable.  We see a province where all Ontarians have the information they need to protect their fertility, where they are confident that they are receiving safe, high quality care, and where other barriers – such as cost, geography and stigma –  do not keep them from getting the services they need.

To be the best place to create a family, Ontario must act now.

  1. All Ontarians should know how to protect their fertility.
  2. Assisted reproduction services should be safe and meet the highest, evidence-based    standards.
  3. Ontario cannot afford to NOT fund assisted reproduction services.
  4. All Ontarians who could benefit should have access to assisted reproduction services.”

Way to go, Ministry of Youth and Child Services!  Now walk down the hall to the Ministry of Health and give them the link to your website and ask them to get their asses in gear, please.

We already know that knowledge IS power so the more people know about their health, the better they will be able to make informed decisions, not only to improve their health but also to manage their fertility – early enough when there is still time to make changes and see the results of those changes.  We also know that age is one of the most important factors affecting the ability to conceive as couples are waiting until later in life to have children than ever before.

Lifestyle factors such as smoking, alcohol consumption and the use of some recreational drugs also affect fertility as does being at an unhealthy weight and certain medical treatments.

The Ministry discusses the benefits of “Fertility monitoring” which can assist couples to make informed choices about their fertility, including when to start a family and when to seek help with fertility. It can also facilitate timely referrals to fertility specialists.

“To give people the information they need to protect their fertility and make informed decisions, we recommend:

  • All primary care practitioners, including doctors of naturopathy and traditional Chinese medicine, should be encouraged to make fertility education/counselling a routine part of care for all patients beginning in their 20’s – male and female, in a relationship or single (including those who are not trying to start a family), regardless of sexual orientation.
  • All primary care providers, gynecologists and other specialists should give special consideration to age when diagnosing fertility problems in women beginning at age 28 up to age 30, who have been unable to conceive naturally after one year, and include their male partners in assessments.
  • All primary care providers, gynecologists and other specialists should offer fertility testing/ monitoring to women who are age 30 and older who want to start a family, and their male partners, so as to facilitate timely referrals to fertility specialists.
  • All primary care providers, gynecologists and other specialists should consider a referral to an infertility specialist to women age 30 and older who have been unable to conceive naturally after six months.
  • The government should fund and support the development of clinical practice guidelines for fertility education and monitoring, including an algorithm to assist practitioners in assessing their patients for fertility problems.
  • The Ministry of Health and Long-Term Care (MOHLTC) should continue to fund existing tests for ovarian reserve and semen analysis tests, standardize these tests province-wide, and introduce newer tests that are more accurate and easier to use as they become available and are approved.”

Why should Ontario invest in fertility education and monitoring?  Because many Ontarians are unaware how to protect their fertility. The Ontario government estimates that 1 in 8 Ontarians are struggling with infertility, however many suspect the number is closer to 3 in 8.

For most women, fertility begins declining around age 30 – even for women with healthy lifestyles, because:

  • Every woman is born with all of the eggs she is ever going to have. Each month, for every egg that is released and available for fertilization, many eggs mature and most are absorbed into the body. Most women will ovulate about 400 times in their lifetime.
  • Eggs get older as women age, making conception more difficult and increasing the chance for chromosomal abnormalities, which often causes miscarriage.
  • Many women are not aware of how they can be proactive in protecting their reproductive health.

A man’s fertility are affected by many factors most men usually do not even think twice about, including:

  • Age.
  • Cigarette smoking.
  • Heavy use of alcohol.
  • Use of prescription medications
  • Recreational drug use.
  • Anabolic steroid use.
  • Occupational hazards that expose men to toxins or high temperatures.
  • Treatment for cancer.
  • Any injuries to the testicles or health conditions that affect the male reproductive organs, such as varicocele, vasectomy, impotence, birth defects and autoimmune disorders.

The Ministry of Youth and Child Services realizes how important it is for primary care practitioners to discuss the relevant factors for  infertility with their patients, both men and women.  Ontarians should know how to best protect their  fertility, but also be aware that no amount of prevention can reverse age-related fertility decline.

Back to the one Ministry in the Ontario government that gets it;

“More and early fertility education can help Ontarians to make informed decisions about their reproductive health and childbearing decisions.  Also, the sooner that Ontarians are aware they may have a problem with fertility, the sooner they can be referred for treatment.  The goals of a provincial fertility education and monitoring program should be to ensure that;

  • All Ontarians can receive fertility education.
  • When fertility monitoring indicates a possible problem, Ontarians are referred quickly to a specialist.
  • Health care resources are used wisely.”

All this talk about a fertility / infertility education program, complete with education sounds like there has been nothing put in place as of yet, and this is all still at the planning stage, but just how long does it take to put these measures in place?

Typically, the Ontario government, this one at least, likes to push the onus back to the individual / couple even though we just read about how couples are not aware of their fertility, nor are doctors bringing it up.  So does it make sense then for the government to recommend that;

“One of the best ways for Ontarians to learn about any risks that might affect their fertility is to talk to their family doctor, nurse practitioner, naturopathic doctor  or other primary health care provider. Primary care providers can and should play a key role in fertility education and monitoring. Primary care providers see patients  at all ages.   Women in their teens, 20’s and early 30’s are more likely than men to go for regular check-ups. In 2006, 33% of 28 year-old women saw a family doctor for a general assessment  compared to 13% of 28 year-old and 17% of 35 year-old males.  Family doctors should  be supported in incorporating fertility counselling into routine preventive healthcare.”

Right now in Ontario, (in)fertility is discussed and assessed way too late, far often after several years of failed conceiving.  In addition, couples also need to be given enough time to try to conceive naturally instead of overtaxing the system, because after a year of trying to conceive naturally, about 90% of couples will conceive.

Some takeaways for the Ontario government might be;

  • A fertility monitoring program to provide a measurable timetable for younger Ontarians so they can conceive naturally before being referred to a fertility specialist.
  • As the current OHIP fee schedule allows for physicians to bill for fertility counselling under a common counselling code there should be a distinct billing code number in order to track how many Ontarians are receiving fertility counselling.
  • Address the fact that single heterosexual people, lesbian women and gay men are  less likely than heterosexual couples to receive fertility education and monitoring because like the rest of the population – a proportion of these people will have fertility issues.
  • Research, research, research, because the last Ontario government report was dated October 19th, 2006 and called In Vitro Fertilization and Multiple Pregnancies.  A lot can and has happened in 7-years which needs to be addressed.

So now I’ve gone off and performed a targeted search of the Ontario Government website in search of information from the Ministry of Health regarding their education programs on fertility.  Boy, was I disappointed.

Here is what came up;

“Pulications – In Vitro Fertilization (IVF)

Generally, In vitro fertilization (IVF) services consist of:

  1. blood work, ultrasounds and physician procedures (egg retrieval and embryo transfer)
  2. embryology laboratory services.

IVF is not an OHIP insured physician service except in the limited circumstances listed in Regulation 552 under the Health Insurance Act.  It is only insured for the first three treatment cycles where the infertility is due to complete bilateral anatomical fallopian tube blockage that has not resulted from a sterilization procedure. A treatment cycle includes preparation, oocyte retrieval and embryo transfer.

Where IVF is insured (that is, for blocked fallopian tubes), the blood work, ultrasounds and physician procedures are insured in all hospital and non-hospital community based fertility clinics in Ontario.

When insured IVF is provided in hospital (that is, in the Mount Sinai Hospital Reproductive Biology Unit, London Health Sciences Fertility Clinic) or in the Ottawa Fertility Centre, associated embryology services are funded (in addition to the blood work, ultrasounds and physician procedures noted above).  Patients cannot be charged for such services provided in those three facilities.

The ministry does not fund fertility drug costs, intracytoplasmic sperm injection (ICSI) or costs associated with the freezing and storage of sperm, eggs and embryos, regardless of where insured IVF services are provided.

March 2012″

Yeah.

Thanks Ministry of Health.  Maybe they missed the announcement that “The Government of Ontario has made a commitment to make fertility monitoring available to women earlier in life.”  That announcement came from the Ministry of Youth and Child Services.

So instead of being proactive and helping today’s generation understand fertility, fund IVF where needed and make sure going forward all Ontarians are educated on factors impacting fertility – the government remains silent. Instead of speaking to the medical community to ensure they have the knowledge and availability to counsel people on infertility, this government is going to ignore the warning signs and the unhappy infertile couples in Ontario then end up having to pay for it at the end of the day when it is the least use and the most expensive.  It’s just our tax dollars after all.  The government can simply tax us more or just cut or de-list more services, right?

So to conclude, if you are infertile in Ontario, or want to make sure that you remain fertile, do not bother searching through the Ministry of Health’s website, but instead, head over to the Ministry of Youth and Child Services and follow their guidelines and information aimed at all Ontarians and what they should know to protect their fertility;

1. Education – The Government of Ontario should ensure that all primary care practitioners are educated about fertility and related issues including: the impact of age on fertility, male and female infertility, and the important risk factors that affect fertility; the reproductive needs of non-traditional families; and the complementary services available to enhance fertility or treat infertility.

2. All primary care practitioners – including naturopathic doctors and doctors of traditional Chinese medicine – should make fertility education/counselling a routine part of care for all patients, beginning in their 20’s. This includes males and females, those in a relationship or single (including those who are not trying to start a family), regardless of sexual orientation.

3.  The government should ensure that printed and web-based educational materials are developed and made available to primary care practitioners to share with their patients.

4.  Counselling – The government should adjust OHIP fee schedule to allow physicians to identify counselling services that are provided specifically for infertility so that practitioners can make the time for this in their busy practices and the government can understand how many Ontarians are receiving this information.

5.  Fertility Testing/Monitoring – All primary care providers, obstetrician/gynaecologists or fertility specialists should offer fertility testing/monitoring to:

  • Women age 28 and over who have been unable to conceive naturally after one year without using contraception.
  • Women age 30 and older when they want to start a family (to estimate their ovarian reserve and the need for referral).
  • Women age 30 and older who have been unable to conceive naturally after six months.
  • The male partners of women who are undergoing testing.

and anyone who appears to have a fertility problem should receive a timely referral to a fertility specialist (e.g., women under 30 should be referred after 12 months of trying to conceive naturally without success; women aged 30 and older should be referred after six months).

6.  Clinical practice guidelines – Developed for fertility education and monitoring and include:

  • Guidelines for fertility education.
  • The important risk factors for female and male fertility.
  • An algorithm that could help primary care practitioners assess patients’ risk factors for infertility and the appropriate diagnostic tests to use.
  • Criteria for diagnosing infertility in women and men.
  • Single validated methods for measuring each of: the follicle stimulating hormone, antral follicle count and semen analysis tests to be used across the province.
  • The specific test ranges or thresholds to use to make timely appropriate referrals to specialists.”

If Ontario was doing an effective and proper job of educating all Ontario residents about infertility as they say they are doing, then why do we still have couples struggling with infertility? And where is the evidence they are doing what they claim to be doing?   Would there not be statistics showing a decline in infertility rates?  Then no one would need IVF at all, but we can now clearly see that the Ministry that is in the know is not the Ministry making the decisions.

When can we expect to see that education that the Ministry of Youth and Children Services calls for?  Funding it is the first step to make this right, and here on Family Day in the province of Ontario would have been the appropriate time to announce the long-awaited plan on tackling this issue.

It’s not going to happen.

What are they waiting for?

Posted in #OHIP4IVF

Hope for the New Year, 2013. Fiscal and Social Responsibility: #OHIP4IVF


In my opinion, 2012 was a year of awakening for many.  We came to realize that government meets half our needs, people treat each other with indifference and financially “we” are on the verge of bankruptcy.  In 2012 opportunities were lost when we occupied, worked to rule, or went on strike, while corporations accepted massive loans from government and still gave out multi-million dollar bonuses to the executives who cried poor in the first place.

The Ontario Auditor General’s 2012 annual report flagged a number of wasteful programs, including $25 million on a scrapped electronic Diabetes Registry, and $700 million on a little-known Toronto commuter card, known as PRESTO.  There was also the cancellation of the 2 power plants – the actual cost to cancel both plants is at least $640 million and there was an Ornge scandal, just to name a few.

In Ontario, the politicking is getting worse as is our healthcare.  In order to compensate for this waste, the Ontario Liberals have been slowly using our healthcare system to sweep their mismanagement under the rug.  They put in a user fee, the delisted physiotherapy and chiropractic care, they forced doctors to take less money and it’s only going to get worse before it gets better.

We are not working.

It’s you… Not me.

So in 2013, we need to take a stand.  We need to elect officials who care about people and who can keep finances in check.  We need to micro-manage our elected officials and make sure they do as we require and if not, we must boot them out.  We cannot stand by any longer and allow government to waste our tax dollars on over-priced union wages or buying votes to the detriment of Ontario’s hard-working citizens.   We cannot allow our elected officials to cut healthcare in order to balance a budget that they failed to take care of.  We cannot allow our elected officials to treat people the way they have been treating us any longer.

One very important way for elected officials to accomplish both fiscal responsibility and social responsibility (caring for people) is through the immediate funding of In-Vitro Fertilization.   Funding IVF saves us, the taxpayers, considerable amounts of money and funding IVF sends the message that the government cares about couples who are struggling with infertility.

Did you know that the average cost of an IVF treatment is around $10,000.00.  And did you know that many doctors implant more than one fertilized egg in hopes that one of the batch will result in a pregnancy.  And did you know that if there are multiple babies born, usually prematurely, that not only does this pose a health risk for the mother but also for all of the babies and at the end of the day after hospital care and treatments, the bill to the taxpayer can be as high as $1,000,000.00.  That is $1,000,000.00 per pregnancy, folks.  That cost is covered by OHIP which means by you and I.

In Quebec, however, the government funds IVF treatments, which means infertile couples don’t have to mortgage their financial futures to have children AND with one egg implanted, there is no risk for multiple births and a much lower probability of hospitalization by the mother and the baby which can lead to additional illness and a huge toll on OHIP.

Net result of IVF funding… Considerable reductions in the cost burden on us, the taxpayer.

Infertile couples (hopefully) get the opportunity to be parents and there is no elitism as only the rich can afford the massive IVF bill.

It’s fiscally responsible, which I like.

It’s morally responsible, which I like.

It’s socially responsible, which I also like.

It provides a better, safer, opportunity for couples who really want to be parents to be parents.

So why doesn’t the government do it?

No idea.

So let’s send all the parties this holiday card below with a note to get moving on this issue or start clearing out their desks.  Elections are coming and it’s time to take a stand against government stupidity.  If I hear another politician dismiss this issue by saying that they “studied it and at this point it doesn’t make sense”, I’m going to take names and post them at election time so we’ll know who can safeguard our tax dollars and who shouldn’t ever be in that position again.

Here’s hoping for a better 2013 for all infertile couples.

Feel free to tweet your thoughts using the #OHIP4IVF for those of you in Ontario or who wish to show your support.  If you add the tag #onpoli then that hits the Ontario politics feed as well.

You can also follow Conceivable Dreams @OHIP4IVF on Twitter and on Facebook here.

We can make this happen!

Holiday card - IVF

Posted in #OHIP4IVF

Four Ways Men Can Support Their Spouses During In Vitro Fertilization


Intracytoplasmic sperm injection
Intracytoplasmic sperm injection (Photo credit: Wikipedia)

In Vitro Fertilization (IVF) is a medical procedure where a woman’s eggs are removed from her ovaries and fertilized in a lab with sperm from her husband, partner or a selected donor.  The embryos created from the fertilization are returned to her uterus, or the uterus of a surrogate mother, in hopes of creating a pregnancy.  The success rate for this procedure for a woman of 35-years-old is between 30-35% assuming that the eggs are fertilized.  If the sperm provider suffers from infertility issues such as low sperm motility or movement, then intracytoplasmic sperm injection (ICSI) may be necessary.  ICSI is a delicate procedure requiring the lab technician to inject a single sperm into the egg, and is performed at an additional cost.

The cost of IVF varies across Canada, but in Ontario a couple can expect to pay;

Between $4,500 – $7,000 per cycle, $6,000 – $8,150 if ICSI is required and between $2,000 – $7,000 for medication.  Additional costs may include fees for initial consultations and/or registration with the fertility clinic, other recommended services and procedures such as assisted embryo hatching, legal fees for egg, sperm or embryo donor contracts and surrogacy contacts, and other miscellaneous expenses such as travel costs and lodging as needed.

As the model currently exists, IVF is not affordable for everyone.

My good friend Moses and his wife have two wonderful children conceived through IVF.  He described the journey towards becoming a family as stressful, confusing and frustrating at times.  Throughout the process, Moses became a cofacilitator at an infertility support group and he helped encourage men to take an active role in the support group.  He says it’s very important that both members of an infertile couple understand it’s okay to be unsure of what will happen down the road.

Moses also explained that when facing infertility and uncertainty it is very common that both husband and wife feel puzzled.  Getting past the misconception that infertility is primarily a female problem and that separate or together, there should not be any embarrassment that they are unable to conceive.  There is a ton of information available on websites, but the most meaningful information comes through discussions with couples who have experienced, or are experiencing the same issues.

In a previous post, I highlighted how many couples who are unable to conceive first begin to investigate the issue with their doctors and with specialists well before sharing the results with family and friends.  As a result, they endure the frustration of having to answer as to why there do not have children yet, or when they do inform family of their fertility issues, they have to sit through uninformed, yet supportive, comments such as; “it’s going to be all right”, or “relax, and it will all work out”.  Without having time to learn about infertility and IVF those are the most supportive comments many parents and close friends can come up with.

In Moses’ case, he realized there was a plethora of information available online, but having to sort through and decide what was reputable, and applicable to their specific situation was difficult and more specifically, he found that there was very little information available to assist men in dealing with infertility and even less geared towards men surrounding IVF.

Once Moses and his wife found a support group through their hospital, Moses noted what that some couples were very open and engaging, while others preferred to just sit back and listen.  He noted that the men, unless directly engaged, tended to observe more than participate and being the kind of person he is, Moses spoke up during these sessions – asking questions, stating facts and citing sources – which provided a forum for other men in the group to participate more actively.

As a result, Moses was asked to co-facilitate some of these support groups and provide the male perspective in order to assist men in the group to understand what they were feeling and that it was okay to be unsure of what would happen down the road or that their spouses were also puzzled, confused, frustrated, angry, and sad and it was okay if they were too.  I learned that the average number of years that couples are full of stress, blame, resentment and self-doubt is 2.4.

I also learned from Moses that during this period of time in which the woman has to come to grips with the fact that she may not be able to conceive a baby.  The father needs to play a huge part in this life-altering realization beginning with listening and ending with supporting.

Here are the 4 key pillars of support men need to offer during infertility, according to Moses:

1.  Listen – with your eyes and ears.  Don’t wait for your wife to come to you to talk.  Sense when she needs your support, whether it’s just to have you listen or for her to vent at.  You know she’s have a really tough time and it’s the time you need to be hyper aware of her needs.  By failing to step up at this point could cause irreparable damage to the relationship which she may never get over.

2.  Acknowledge that you are not able to sort through this by yourself.  As men, we have this tendency to try to solve problems regardless of whether there is a solution available or if our opinions are needed at that moment.  But there is not a solution available and with infertility being the serious problem that it is – tensions are already high – and our offer of a solution is not helpful.  Instead, we need to seek the help of professionals who deal with infertility and who have first-hand experience with the next steps and we need to speak with them, with others in the same situations and with organizations who are there to assist, in order to make sure that we can learn, educate ourselves and support our wives.

3.  Seek out opportunities to speak with like-minded people.  Briefly touched on in the previous point, you cannot underestimate the importance of speaking with like-minded people who have either gone through this with success or who have not had success as it provides a window into where your mindset could be in six-months, a year, or two-years.  In addition, these couples may have tried something different or picked up a trick or technique which might be beneficial down the road or at the very worst case, these couples may be able to offer up support or hope which can help you down the road as the going gets tough.

4.  Educate yourself – this is huge – give yourself power.  As in every situation, motivated people do their homework and continue to keep up the pace on the current goings-on in every facet of their lives.  In the workplace, they continue to educate themselves because they want to learn more, know more and get a higher degree which can help them get a better position and in life, people who want to stay healthy stay up-to-date on the latest trends and reports.  Researching and learning about infertility, treatments, IVF, risks and rewards helps prepare couples for the decisions they have to make and what their future will look like.

It makes sense that couples who want families so bad that they are willing to give up their bodies and their life savings remain on top of the latest trends in treatment of infertility, drugs, and the side-effects on the woman and the potential babies and on IVF and risks, rewards and expected length of time.

When asked whether or not he felt that each province should cover the cost of IVF treatments in order to reduce the cost to taxpayers of multiple births, Moses adamantly responded that “YES!”  Not only does the funding of IVF reduce the costs to taxpayers but it also helps couples who want children more than anything else in the world not have to lose everything in order to have them.  Having to pay for multiple treatments, without any government intervention, made it perfectly clear to Moses that IVF is not available to everyone and it should be.

In this day and age where society worries about the breakdown in the family unit, it is refreshing to see couples who are trying their hardest to become families knowing the importance of this family unit to them and that their child(ren) would be supported and nurtured through thick and thin.

It makes sense to fund IVF in order to keep premature babies and mommies out of the hospital and keep that costs off the taxpayer.  It also makes sense to help couples who want children more than anything else in the world, try to realize that dream.

Please follow @OHIP4IVF on Twitter or the hashtag #OHIP4IVF to support government funding for IVF.  Help other couples become parents, without the financial burden that comes with infertility.

*I am sharing my story as a member of the Conceivable Dreams blog team, and have been compensated for this post.  Opinions and the words which I have written are all my own.
 
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