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Why Fertility Treatment Usage Is Exploding in Canada · The Missing Middle Podcast

• 0:00
  SPEAKER_01: It sometimes feels like everyone I know is struggling to start a family.
• 0:04
  SPEAKER_01: I'm just past the age where all my friends were getting married, and I kind of expected everyone to have kids by now, but for many that hasn't happened yet.
• 0:11
  SPEAKER_01: And for the ones where it has, it feels like most have needed fertility treatments to get pregnant, including me.
• 0:18
  SPEAKER_01: Now, my mom tells me this is something new.
• 0:20
  SPEAKER_01: She says in her generation, sure some people struggled, but it was way less common.
• 0:25
  SPEAKER_01: Most people just tried to have a kid or didn't try to have a kid and they just had one.
• 0:29
  SPEAKER_01: And it made me want to start looking into it.
• 0:31
  SPEAKER_01: And that made me realize that starting a family looks very different now than it did a generation or two ago.
• 0:37
  SPEAKER_01: Demographics, hosted by Mike Moffat and Kara Stern.
• 0:42
  SPEAKER_01: People are spending more years in school, building careers, paying off student debt, and taking longer and longer to afford a home before having kids.
• 0:50
  SPEAKER_01: So by the time many people feel they're ready, they're older, and that can come with a whole new set of challenges and costs.
• 0:58
  SPEAKER_00: And those costs aren't trivial.
• 1:00
  SPEAKER_00: Globally, in vitro fertilization or IVF, is a$40 billion a year, that's Canadian dollars, a year industry, with those costs being split between families, insurance companies, and governments.
• 1:13
  SPEAKER_00: And speaking of governments, last April, the government of Ontario announced a$250 million investment in expanding access to IVF across the province.
• 1:23
  SPEAKER_00: So the societal shift of families having children later in life has economic consequences.
• 1:28
  SPEAKER_01: We want to talk about it because one of the goals of this podcast is to explore how life in Canada has changed across generations.
• 1:35
  SPEAKER_01: So we often focus on housing or jobs, but even something as fundamental as having a baby seems to be getting more complicated than it was 50 years ago.
• 1:43
  SPEAKER_01: So the inevitable question it led me to think about was do more people need fertility treatments than ever before?
• 1:50
  SPEAKER_01: Or is it simply that more people have access to treatments?
• 1:53
  SPEAKER_00: So we went and pulled the national numbers.
• 1:55
  SPEAKER_00: And it turns out it's not just a Kara and her friends problem.
• 1:59
  SPEAKER_00: Fertility treatment usage is way up in Canada.
• 2:02
  SPEAKER_00: IVF births in Ontario went from 1.7% of all live births in 2014 up to a full 3% in 2023.
• 2:11
  SPEAKER_00: And that's according to the Canadian Assisted Reproductive Technologies Register, which tracks all of the fertility clinics in Canada.
• 2:19
  SPEAKER_00: And of course, Ontario is not all of Canada, but it's actually where most of the country's fertility clinics are.
• 2:24
  SPEAKER_01: When I read those numbers, my first thought was that jump could just mean the science is getting better.
• 2:29
  SPEAKER_01: Like maybe the same number of people are using IVF, but the clinics have gotten way more successful at turning those cycles into actual babies.
• 2:36
  SPEAKER_01: But it turns out that's not true.
• 2:37
  SPEAKER_01: Success rates per cycle have actually stayed relatively flat over the last decade, roughly 37% per cycle, though other factors have changed.
• 2:46
  SPEAKER_01: And part of that's because we're fighting a war against biology.
• 2:49
  SPEAKER_01: So as technology gets better, the average patient age is goes up, and that keeps success rates relatively stable.
• 2:56
  SPEAKER_01: The real growth is in the sheer volume of people walking through the clinic doors.
• 2:59
  SPEAKER_01: And I will want to point out here that like IVF is only one of the forms of fertility treatments you can get, but it is where we get the best numbers.
• 3:06
  SPEAKER_01: So that's why we're talking a lot about it in this episode.
• 3:08
  SPEAKER_00: So if you look at the raw patient numbers from the registry, that surge is undeniable.
• 3:13
  SPEAKER_00: In the 2023 data alone, Canadian clinics reported over 28,000 patients doing IVF.
• 3:20
  SPEAKER_00: Now, 2005 was the first year that the Canadian Assisted Reproductive Technologies Register was able to collect data from all fertility clinics in Canada.
• 3:30
  SPEAKER_00: And there were about 25 at the time.
• 3:32
  SPEAKER_00: And back then there were about 11,000 cycles.
• 3:35
  SPEAKER_00: And a cycle means a single full round of IVF treatment from the start of hormone medications through to egg retrieval or embryo transfer.
• 3:44
  SPEAKER_00: So interestingly, from like 2013 until the pandemic, the numbers are relatively stable.
• 3:49
  SPEAKER_00: It was about 17,000 or so.
• 3:51
  SPEAKER_01: And obviously, there was a drop during the pandemic because so many clinics had to produce their services because of pandemic regulations and restrictions.
• 3:59
  SPEAKER_01: So I'm not surprised that there was a big jump afterwards to over 20,000 with people trying to catch up on the lost time.
• 4:05
  SPEAKER_01: But it actually has stayed and grown since then.
• 4:08
  SPEAKER_01: I did wonder why so much of the data that I was finding was so Toronto-centric.
• 4:12
  SPEAKER_01: And I know we feel like we're the center of the universe, but I also know I know it's not true.
• 4:16
  SPEAKER_01: But it turns out that of the 36 clinics that operated last year in Canada, half of them are in the greater golden horseshoe.
• 4:23
  SPEAKER_01: So within 90 minutes or so of Toronto, depending on traffic, of course, there were only two serving all of the Maritimes until this year when a new one opened in Newfoundland.
• 4:32
  SPEAKER_00: Yeah, so there's a real geographic lottery here.
• 4:34
  SPEAKER_00: And it actually goes beyond, you know, where the clinics are located because there's a range of services that are covered, and that range of services differs from province to province.
• 4:44
  SPEAKER_00: So in Ontario, for example, you get one funded IVF cycle.
• 4:48
  SPEAKER_00: British Columbia just launched their program last year, and it has variable funding depending on household income.
• 4:54
  SPEAKER_00: You know, out in Saskatchewan, you recently had a tax credit that was introduced.
• 4:58
  SPEAKER_00: Uh, in Alberta, you don't get anything.
• 5:00
  SPEAKER_00: So they recently launched a plan to cover fertility treatments, but only for cancer patients.
• 5:06
  SPEAKER_00: So, you know, there's a real kind of uneven playing field.
• 5:09
  SPEAKER_00: Quebec actually has the most support, which might not be surprising given that they're more generous on parental leave and childcare, and they cover a full cycle as well as medication and embryo storage for up to a year.
• 5:22
  SPEAKER_01: So let's actually dig into the why.
• 5:24
  SPEAKER_01: This is really an extension of everything we've said on this podcast about people starting families later than they used to.
• 5:30
  SPEAKER_01: The age numbers alone tell a lot of the story.
• 5:33
  SPEAKER_01: The average age of a mom at the time of her baby's birth was 31.8 in Canada, based on StatsCan's latest data.
• 5:40
  SPEAKER_01: And no province is below 30, and BC was almost at 33.
• 5:44
  SPEAKER_01: And if we kind of zoom in and look at just the moms at the age of their firstborn's birth, the average age was just over 30 years old.
• 5:52
  SPEAKER_01: It's higher in BC and Ontario.
• 5:54
  SPEAKER_01: And I suspect if you look even closer, we'll find it's even higher in cities than in more rural regions.
• 5:59
  SPEAKER_01: And it does matter here specifically because you can delay a lot of things in life, like starting your first job or buying your first house, but you can't delay biology.
• 6:08
  SPEAKER_01: Fertility drops off meaningfully after 35.
• 6:11
  SPEAKER_01: So when you push the average age that far back compared to like what people did historically, of course, you're going to get more people who need help conceiving.
• 6:18
  SPEAKER_00: Yeah.
• 6:18
  SPEAKER_00: And that changes like who actually goes to the clinics.
• 6:21
  SPEAKER_00: Because if you walked into a Canadian fertility clinic 30 years ago, the average patient was around 31 years old.
• 6:28
  SPEAKER_00: Today, the average age of someone starting an IVF cycle has climbed past 35 and a half, it's going up to 36.
• 6:35
  SPEAKER_00: And people 35 and older, you know, now make up 60% of all the cycles in the country.
• 6:40
  SPEAKER_01: I sometimes hear people talk about celebrities who have kids well into their 40s.
• 6:44
  SPEAKER_01: And that's kind of seen as sometimes proof that you can take control of your own timeline.
• 6:49
  SPEAKER_01: You don't need to rush to have kids under 40.
• 6:51
  SPEAKER_01: But I really want people to understand that's not something you should count on.
• 6:55
  SPEAKER_01: Science and lots of money was almost certainly used for most of them, whether or not they talk about it.
• 7:00
  SPEAKER_01: Probably with eggs they froze when they were younger for those that had the money early enough and they maybe knew that they had extreme career ambition.
• 7:07
  SPEAKER_01: And on top of that, like they now have access to the best treatments money can buy.
• 7:11
  SPEAKER_01: The biological clift after 35 or 40 is still the same it's always been, even though treatments can help a little bit, but it makes it a long, expensive, emotional, stressful situation.
• 7:22
  SPEAKER_01: And it often doesn't even work.
• 7:23
  SPEAKER_00: Yeah.
• 7:24
  SPEAKER_00: And even when it does, you know, if we're having kids later and then they're having kids later, you know, I kind of think like I might not have grandkids until I'm about 80, right?
• 7:33
  SPEAKER_00: So the experience I, you know, I'm probably going to have as a grandparent is gonna be different from past generations.
• 7:40
  SPEAKER_00: So all of these milestones getting pushed back, it makes a real difference.
• 7:44
  SPEAKER_01: It's not just an age story, though.
• 7:46
  SPEAKER_01: Clinics are seeing more patients in their 20s and early 30s.
• 7:49
  SPEAKER_01: So that they're not people who are waiting too long necessarily, but they're still struggling.
• 7:53
  SPEAKER_01: We're still seeing a huge rise in diagnoses that complicate conceiving, and clinicians don't really understand why yet.
• 7:59
  SPEAKER_01: But researchers are looking at things like environmental factors and metabolic health.
• 8:04
  SPEAKER_01: The silver lining is that younger patients usually have better egg quality.
• 8:07
  SPEAKER_01: So their success rates per cycle are higher, but it still makes the cost of having a kid incredibly high, even before you actually have a baby, which is when a lot of people think the expense should start.
• 8:16
  SPEAKER_01: And that's not including like the impact on your career and your life, because you have to show up for regular early morning appointments.
• 8:22
  SPEAKER_01: Maybe you have to miss work for treatment.
• 8:23
  SPEAKER_01: It's like there's it does have a big impact when you're doing treatments, no matter what age you are.
• 8:27
  SPEAKER_00: Yeah, and we should also point out that this isn't just a story about women delaying parenthood, because male factor infertility accounts for roughly a third of all fertility cases today.
• 8:37
  SPEAKER_00: And we're learning more over time that a man's age does play a role in fertility.
• 8:41
  SPEAKER_01: The good news is we've seen big changes in fertility coverage over the past decade, which has made it more accessible to people who could never afford it before.
• 8:49
  SPEAKER_01: Because these cycles aren't cheap.
• 8:51
  SPEAKER_01: A cycle can cost something like$10,000 to$15,000 in Ontario, plus another five to$10,000 on medication, more if you're paying for genetic testing and if you're paying for embryo storage.
• 9:01
  SPEAKER_01: Nowadays, many provinces have a round of procedures covered, or maybe you have a budget you can use funded by the province or a tax credit.
• 9:08
  SPEAKER_01: But like so many other things, if you're not paying with money, you're paying with time.
• 9:13
  SPEAKER_01: Wait lists can be brutal in provinces where it is covered.
• 9:16
  SPEAKER_00: Yeah, absolutely.
• 9:17
  SPEAKER_00: And this kind of shows a whole kind of macro effect of all the changes that have gone on in our society that's kind of delay childbirth.
• 9:25
  SPEAKER_00: It has these kind of impacts on our health insurance systems and so on.
• 9:29
  SPEAKER_00: Because we see right now in Ontario, 30% of patients wait under six months for publicly funded IVF, another 30% wait six months to a year, and 10% wait longer than 18 months.
• 9:41
  SPEAKER_00: So some of these wait lists can get pretty long.
• 9:43
  SPEAKER_01: And that's a big problem.
• 9:44
  SPEAKER_01: It's not just the annoyance and inconvenience of not being able to get started when you want to, because with fertility, time is such a big part of the story.
• 9:51
  SPEAKER_01: An 18-month wait for someone already in their late 30s can be the difference between a viable cycle and permanent infertility.
• 9:57
  SPEAKER_00: Yeah, and I can tell you as a 49-year-old, your uh 30s go pretty quickly.
• 10:01
  SPEAKER_00: So that 18 months really makes a difference.
• 10:04
  SPEAKER_01: And each clinic has their own wait list too in Ontario.
• 10:06
  SPEAKER_01: So, like I know someone who came to Toronto from Ottawa for their treatment because you know they looked at the one fertility clinic in Ottawa and the wait times were so long.
• 10:14
  SPEAKER_01: And then they looked at Toronto and they found that you know what, they're actually shorter there.
• 10:18
  SPEAKER_01: But that obviously expands the cost because they have to, you know, pay for the travel, pay for their time off work, or maybe work remotely if they're lucky.
• 10:25
  SPEAKER_01: But even so, like there's a lot that comes with it.
• 10:27
  SPEAKER_00: Yeah.
• 10:27
  SPEAKER_00: So when we talk about the expense of this, it's easy to kind of overfocus on just the immediate financial costs of you know what shows up on a bill.
• 10:36
  SPEAKER_00: But that time off, the travel time and so on, you know, this gets incredibly expensive, not just for the people undergoing it, but you know, if you're spending all your time driving between Ottawa and Toronto, you know, that's time you're you're not at work or doing something else.
• 10:53
  SPEAKER_00: So it kind of affects all of us.
• 10:55
  unknown: Yeah.
• 10:55
  SPEAKER_01: And it's not like you go in for the day and you do your treatment.
• 10:58
  SPEAKER_01: That's it.
• 10:58
  SPEAKER_01: Like it's a process that takes many weeks.
• 11:00
  SPEAKER_01: So even once you're at the top of the wait list, there can still be a lot of waiting.
• 11:03
  SPEAKER_01: In fact, I always describe fertility treatment as basically being a lot of waiting and then go, go, go.
• 11:08
  SPEAKER_01: But most of it's actually just waiting.
• 11:10
  SPEAKER_01: There's a benefits plan angle too to the increased numbers, which I found quite interesting because claims for fertility medications through workplaces, they rose 21% over the last five years, according to ManuLife.
• 11:22
  SPEAKER_01: But fewer than 1% of workplace plans actually cover the treatment itself, which is the most expensive part, especially if you're somewhere in this country that doesn't have any funded cycles, or maybe if you've used up your provincial coverage and it didn't work.
• 11:34
  SPEAKER_01: But also there's an increase in both the workplace benefits coverage in terms of the dollars available, but also who's been able to access it.
• 11:41
  SPEAKER_01: So over time, we've seen the net widen for people wanting fertility treatments who maybe don't have a medical need, but maybe want to become a single parent or they're a same-sex couple, or maybe they need egg or sperm donations to make it work.
• 11:52
  SPEAKER_00: Yeah, and I could only expect that this is going to grow over time just because those pressures that have led to increased IVF usage don't seem to be going away.
• 12:01
  SPEAKER_01: ManuLife in their data that they released based on their claims data found a 13.5% increase in the number of women between 25 and 34 with fertility-related claims, and a 24% increase for women between the ages of 35 and 44.
• 12:17
  SPEAKER_01: So, to recap, the number of people accessing fertility treatments has in fact increased dramatically over the past couple of decades.
• 12:25
  SPEAKER_01: It's happening because of the intersection of people intentionally starting families later in life, an expanding definition of who gets to build a family, and provinces slowly opening the funding taps to make these incredibly expensive procedures accessible to the masses, as well as people in their 20s and early 30s needing these treatments more than they used to.
• 12:44
  SPEAKER_01: As the demand explodes, our healthcare infrastructure is struggling to keep up.
• 12:48
  SPEAKER_01: Between the geographic lottery of where you live, the gaps in corporate insurance, and the biological reality that time waits for no one, I suspect fertility treatments are going to continue increasing in Canada for the foreseeable future.
• 13:01
  SPEAKER_00: Yeah, I think you're right.
• 13:02
  SPEAKER_00: I think we are going to get this kind of policy response where, you know, provinces are going to increase access, you know, try and deal with uh the expense, uh, wait list issues, that kind of thing.
• 13:14
  SPEAKER_00: But I also think policymakers need to take this back a step and look at the more macro issues around, you know, why is it that young people are having to wait until their late 30s to have a kid?
• 13:26
  SPEAKER_00: You know, I really do see a lot of this being a housing issue, uh, a jobs issue of, you know, people starting their careers later, you know, the expectations around having people be in higher education longer and and and so on.
• 13:43
  SPEAKER_00: So I do think policymakers need to look at this in a very kind of narrow sense of okay, what do we do with IVF policy?
• 13:50
  SPEAKER_00: But they should also take a step back and ask, okay, well, why is it that so many people are having kids later in life?
• 13:58
  SPEAKER_00: What are the barriers preventing them from having children earlier and address those barriers as well?
• 14:04
  SPEAKER_01: Thank you so much for watching and listening.
• 14:06
  SPEAKER_01: Our producer is Meredith Martin and our editor is Sean Foreman.
• 14:11
  SPEAKER_00: If you have any thoughts or questions about my favorite Nirvana album, please send us an email to missing middle podcast at gmail.com.
• 14:18
  SPEAKER_01: And we'll see you next time.