Public funding for IVF and subsequent testing helps ensure that everybody has equitable and fair access to reproductive care, regardless of their family and personal health backgrounds (source – BC FAMILY DOCTORS)

When you carry a BRCA gene mutation, everyday life decisions often become a lot more complicated. The decision to have children, specifically, is one of those intricate and personal processes that requires extra consideration.

In day-to-day discussions about pregnancy and parenthood, we are faced with many questions. Do I seek out assistan ce in conception (i.e., In vitro fertilization)? How would I like to handle childbirth? Is breastfeeding important to me vs. formula feeding? These are weighty topics of discussion faced by all parents. Some may choose to forgo any medical assistance out of personal preference, while others may find that it makes the difference for their journey of becoming a parent. When genetic diseases like Hereditary Breast and Ovarian Cancer syndrome (HBOC) come into the picture, the question of medical involvement becomes even more pertinent.

How do we handle it when a BRCA gene mutation becomes part of the picture in fertility decision-making?

For many women, conception and childbirth aren't always straightforward. This can stem from various factors, including age, lifestyle, reproductive disorders, infertility, gynecological status (i.e., endometriosis), partner fertility, genetic disorders, and health status. For women who have tested positive for a genetic change (like BRCA), they may also be apprehensive about pregnancy due to the risk of passing on mutated genes to their children. This concern is not without basis, as BRCA+ individuals have a 50% chance of passing on the mutation to their children.

What is IVF?

Note: It’s important to mention here that many women who carry a change in their BRCA gene (or whose partner does) consciously choose natural conception from their menu of fertility options. While this article does not go into great depth on that topic, we would like to emphasize that it is a legitimate and common choice (Chan et al., 2016). Fertility planning is fundamentally personal, and no woman should have to face it alone. If you are feeling overwhelmed by fertility decision-making and require support in this area, we suggest reaching out to InspireHealth Supportive Cancer Care, and speaking with one of their highly trained counsellors, who will be more than happy to talk it through with you.

For women who decide it is important to them to prevent inheritance of the BRCA gene to the next generation, In-vitro fertilization (IV F) is an option.

IVF is an involved fertility treatment that has become increasingly common in the last 40 years. IVF assists with the fertilization that occurs when eggs and sperm merge to form an embryo, recreating the same natural process of conception in a laboratory setting (hence the in-vitro denomination; Latin for in glass).

The IVF process includes several stages. First, women undergoing IVF first undergo ovarian stimu lation (with the assistance of medications) to increase the number of eggs (or “follicles”) released by the ovaries. Following stimulation, the eggs are then retrieved surgically. Following this, the eggs and the sperm (from a donor or partner) are then mixed or artificially merged, and eventually, an embryo is formed. This embryo is then implanted into the patient, allowing pregnancy to take place. After confirming the patient’s pregnancy through blood testing, the IVF patient’s status and health are monitored until childbirth.

An imperfect medical marvel

IVF is amazing, but it doesn’t come without its risks and obstacles, of course. First of all, IVF can be prohibitively expensive. In BC, a single round of IVF can reach costs of $12,000 to $15,000 CAD out-of-pocket. These IVF costs can now be eligible for coverage, thanks to the Publicly Funded IVF program that was introduced on July 2nd, 2026. Depending on your pre-income tax, Medical Services Plan (MSP) enrollment, and age, you can apply for IVF coverage in BC through the Grace Fertility, Olive Fertility, andPacific Centre f or Reproductive Medicine clinics. This can make IVF much more accessible, with insurance and financial assistance programs adding to the pooled sum of money that can go into paying for IVF.

There can also be health concerns associated with the medical procedures in IVF, such as Ovarian Hyperstimulation Syndrome (OHSS). Moreover, IVF is not a perfect science, and several cycles may be required to produce a healthy pregnancy, making the procedure complex and demanding. IVF specialists are, however, very familiar with managing these risks and managing patient expectations. The procedures are considered very safe and effectiveness rates are increasing.

What is unique about IVF when you have a BRCA mutation?

If the individual undergoing IVF is also looking to determine whether their embryo has inherited genetic mutations (like BRCA1/2), an additional procedure called Preimplantation Genetic Testing for Monogenic disorders (PGT-M) exists.

PGT-M involves first determining which genetic variant is present in the patient and their family. Then, a biopsy is extracted from the embryo after it is cultured in the lab. This sample then undergoes genetic testing to determine if the genetic variant is present.

If the embryo is identified as being unlikely to carry the variant, it can be implanted into the patient, drastically lowering the risk of the child inheriting a mutation. For BRCA+ individuals, PGT-M can be life-changing – it can eliminate an important pregnancy concern and give parents peace of mind that their child will be unlikely to be affected by an inherited health problem.

In a recent study on 64 BRCA-positive patients undergoing IVF found that when using PGT-M, 59% of the embryo implantations resulted in healthy childbirth (Barrett et al., 2023).

Is PGT-M available in British Columbia, and is it covered by our healthcare system?

At this time, PGT-M is not covered by MSP. The cost of PGT-M includes the cost of developing a specific test for your mutation within the embryo, the cost of freezing the embryo, the cost to biopsy the embryos, and individual testing of each embryo. Therefore, the number of embryos tested will determine the total cost. The total process can cost anywhere from $3000 to $7000+ CAD in addition to any other IVF procedure-related costs.

Hope on the horizon

Despite this, the value of PGT-M public coverage has been previously demonstrated, especially in the case of Australia. Since 2021, Australia has offered Medicare rebates to individuals who choose to undergo PGT-M during their IVF procedure. As the financial burden of genetic testing during IVF was alleviated, the yearly IVF cycles that used preimplantation genetic testing increased by 28%. This change in public policy has been supported by several studies , finding that PGT-M can lengthen the lifespan of affected individuals and can be cost-effective for national healthcare spending (Nadgauda et al., 2023). Australia’s choice to make PGT-M accessible for all patients seeking IVF has gained acclaim from experts and policymakers alike (Adamnson et al., 2025).

The case for PGT-M coverage in Canada

In the case of British Columbia, and Canada in general, the benefit of provincial and/or national coverage for PGT-M in the case of BRCA and other genetic disorders is evident. A study modelling PGT-M coverage in the Canadian healthcare system found that policy change would be highly cost-effective (for >90% of BRCA-specific cases), potentially decreasing the national costs for managing BRCA-associated diseases drastically and increasing patients lifespans by five or more years on average (Lipton et al., 2020). Similarly, a recent paper looking at the cost-effectiveness of PGT-M in the Canadian healthcare system for BRCA1-positive patients found that the procedure helped increase the number of healthy births while reducing the amount of ovarian cancer cases and associated deaths (Hunkler et al., 2026).

What is the outlook for PGT-M in BC?

Despite the lack of healthcare coverage for PGT-M in BC, the tides are changing. Alongside coverage for IVF treatments, the introduction of BC Cancer’s Free Jewish BRCA Testing Program (which ended on March 30th, 2026) has shown that it is possible to implement large-scale, affordable genetic testing programs for BRCA-affected individuals. Likewise, more innovative genetics projects associated with IVF are being introduced, as in the case of Genome Quebec. This concept of “genomic justice” (Pleasant et al., 2026), or the right of all individuals to access genetic resources and procedures with a low financial barrier, is gaining acceptance in medical and policy circles. For those concerned about increasing costs to public healthcare, Todd Lencz and Shai Carmi put it best:

“Many of the same arguments were made against IVF decades ago; a decade later against genetic screening of embryos for lethal diseases; and more recently against testing embryos for variants that increase breast cancer risk. Despite these arguments, these procedures are now widespread.”

Regardless of whether you choose to undergo PGT-M, IVF, or any medical assistance during your journey of becoming a parent, whatever works for your personal preferences and circumstances will be the best choice.

If you ever find yourself in a tough position and need professional advice on the matter, BC Cancer’s Hereditary Cancer Program and High Risk Clinic offer public access to genetic counselling and risk assessment. Fur thermore, the BRCA Support BC BC-Wide Virtual Support and Education Series (in collaboration with InspireHealth) is a great way to meet other car riers and learn more about others living with BRCA1/2 navigate personal life decisions and health choices.

According to one BRCA carrier, including PGT-M and IVF in her fertility journey ultimately gave her the family she always wanted.

“It is a hard journey, it is physically difficult for the woman and emotionally difficult for the couple,” she mentioned, adding that it is important to be gentle with yourself and not put too many expectations on how you should or shouldn’t feel.

“Our daughter is just our little miracle. She was the only embryo that we were able to create. And we feel so b lessed and overj oyed.”

References

Adamson, G. D., Armstrong, H., Cheong, Y., Damato, E., Fatemi, H., Ferriani, R., Griesinger, G., Ledger, W. L., Pistollato, M., Pellicer, A., Petrova, A., Rombauts, L., Wilsdon, T., & Ziebe, S. (2025). Policy s olutions to improve access to fertility treatment and optimise patient care: consensus from an expert forum. Frontiers in Reproductive Health,7, 1605480. https://doi.org/10.3389/frph.20 25.1605480
Barrett, F., Shaw, J., Besser, A. G., Grifo, J. A., & Blakemore, J. K. (2023). Preimplantation genetic testing for monogenic disorders: clinical experience with BRCA1 and BRCA2 from 2010–2021. Journal of Assisted Reproduction and Genetics, 40(11), 2705–2713. https://doi.org/10.1007/s10815-023-02925-6
Chan, J. L., Johnson, L. N. C., Sammel, M. D., DiGiovanni, L., Voong, C., Domchek, S. M., & Gracia, C. R. (2016). Reproductive Decision‐Making in Women with BRCA1/2 Mutations. Journal of Genetic Counseling, 26(3), 594–603. https://doi.org/10.1007/s10897-016-0035-x
Hunkler, K., Boedeker, D., Bulles, K., Combs, J., & Brown, J. (2026). Preimplantation genetic testing for BReast CAncer gene 1 and risk-reducing surgery is more effective at age 35 than age 40. Fertility and Sterility. https://doi.org/10.1016/j.fertnstert.2026.02.025
Lipton, J. H., Zargar, M., Warner, E., Greenblatt, E. E., Lee, E., Chan, K. K. W., & Wong, W. W. L. (2020). Cost effectiveness of in vitro fertilisation and preimplantation genetic testing to prevent transmission of BRCA1/2 mutations. Human Reproduction, 35(2), 434–445. https://doi.org/10.1093/humrep/dez203
Nadgauda, A., Ganti, T., & Walter, J. R. (2023). Cost-effectiveness analyses of preimplantation genetic testing. Fertility and Sterility, 121(4), 693–702. https://doi.org/10.1016/j.fertnstert.2023.12.022
Pleasant, V., Slocum, B., & Purkiss, A. (2026). Genomic Justice as Reproductive Justice: Universal coverage for preimplantation Genetic Testing for Hereditary breast and Ovarian Cancer syndrome. Technology in Cancer Research & Treatment, 25, 15330338261427326. https://doi.org/10.1177/15330338261427326

Managing Fertility and Family Planning as a BRCA Carrier: What are the options in British Columbia?