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Is TESE covered by OHIP?


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#1 Cotton

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Posted 11 November 2019 - 08:31 AM

My clinic is trying to charge us $450 for "Tesa/Pesa" as a part of our funded cycle but it seems it is covered by OHIP. What is going on here? Where is an official document I can print out and hand to them? Or am I somehow mistaken? Thanks in advance

 

....

 

Men who require services in support of fertility treatment (e.g. surgical sperm retrieval) will be eligible for funded services as part of one funded IVF cycle.

 

https://news.ontario...y-services.html



#2 CrisBelieve

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Posted 11 November 2019 - 09:54 AM

Hi Cotton.

You are indeed correct. When I was cycling, the charge was $850 for the TESA. But when I did my funded cycle, we didn't pay anything.

More details on our infertility journey in 'About Me' page

 

Me: 40, DH: 43

TTC for many years - severe male factor - Obstructive Azoospermia

 

Our 7th cycle brought us the miracles we were looking for.  Our twin girls were born in 2017!  heart.gif heart.gif

 

Trying for baby #3

 

Fresh transfer in Feb 2019 = BFN

FET - June 2019

June 25 - transferred one day 6 grade 2 expanded blast

June 29 - POAS...very very faint line!  

July 4 - beta @ 9dpt = 95, beta @ 11dpt = 311, beta @ 13dpt = 646

July 25 - viability scan @ exactly 7 weeks - one baby with heartbeat of 147!  So very thankful.

August 8 - 9 week ultrasound - baby moving around with heartbeat of 170!

August 30 - 12 week NT scan - all looks well with the babe, heartbeat of 155

October 24 - anatomy scan...everything looks great and we are having a babyboy.gif !  So happy!

 


#3 DorothyandToto

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Posted 11 November 2019 - 10:59 AM

I just looked at my clinics price list for the funded retrievals. It says ICSI with PESA/TESA sperm is funded. It does indicate that ICSI with microTESE sperm is not funded and costs $800. Im not sure what the difference is? I would think your clinic would have to provide you with a full price list for all procedures funded vs nonfunded....but I dont know where and official funded procedure list for the province is.

#4 Cotton

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Posted 11 November 2019 - 01:30 PM

The reasoning of the woman I spoke to was "If we're trying to charge you for it, it must not be covered!", which doesn't seem like a good enough reason to part with $450.

 

We refused to pay for it on the day of the egg retrieval because I read on this forum it is covered and someone was supposed to get back to us but they never did. It only came up again when I purchased progesterone and the nurse/assistant? checked if we had an account balance.

 

So I guess I will be calling service Ontario tomorrow.



#5 DorothyandToto

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Posted 12 November 2019 - 09:11 PM

Did you get a proper answer as to what is covered?

Found this interesting link about all the different sperm retrieval options:

https://www.hopkinsm...eval-procedures

#6 Cotton

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Posted 13 November 2019 - 02:40 PM

The man I spoke with at Service Ontario relayed an email address, said it can take 1-2wks for a response

 

fertilityprogram@ontario.ca



#7 Cotton

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Posted 15 November 2019 - 09:16 AM

Under the Ontario Fertility Program (OFP), eligible patients are entitled to receive one funded In vitro fertilization (IVF) cycle per lifetime. The one funded IVF cycle under the OFP includes up to two attempts at cycle monitoring, one egg retrieval procedure, one sperm retrieval procedure, one round of embryology services to fertilize the eggs and culture the embryos, and the transfer of all viable embryos resulting from the start of the cycle (including the thawing and culture process for each transfer).

 

Under the OFP, eligibility for a funded IVF cycle is always determined based on the patient who will undergo the embryo transfer (the patient who is trying to get pregnant). This patient must meet all of the following criteria:

 

•         Hold a valid Ontario health card; and

•         Be under age 43 years old (i.e., maximum age of 42 years old); and

•         Have not yet received one funded IVF cycle per lifetime through the OFP

 

Other people participating in the cycle (such as sperm donors) also have to meet the eligibility requirement of having a valid Ontario health card to receive funded services.

 

If in the opinion of the treating physician, your husband requires a therapeutic medical surgical procedure such as Testicular Epididymal Sperm Aspiration (TESA) or Percutaneous Epididymal Sperm Aspiration (PESA) to retrieve a sperm sample, then this would be covered under the OFP provided that your husband has a valid Ontario health card. Please note that more advanced diagnostic and therapeutic microsurgical techniques such as TESE (Testicular Sperm Extraction), Microscopic or Microdissection TESE, etc. are not covered.

 

The OFP only covers one sperm retrieval procedure per funded IVF cycle, and if no viable sample is retrieved then the cycle will end or else you will have to pay for additional sperm retrieval attempts or use an alternative sperm source.

 

If your fertility clinic requires clarification or confirmation that TESA or PESA is funded under the OFP they can contact us directly for assistance.  

 

If you are concerned with the information that was provided to you by your fertility clinic, the OFP can contact your fertility clinic on your behalf to address your concerns. In order to do so, please provide your health card number as well as explicit permission to contact the clinic and share your personal health information. This consent can be sent to fertilityprogram@ontario.ca

 

We hope this information is helpful.

 

Sincerely,

 

The OFP Team


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