You had your best-laid plans and then COVID-19 came along and hammered the entire economy. But you’ve got this – if you have the right information. Join Rob Carrick and Roma Luciw on Stress Test, a podcast guiding you through one of the biggest challenges your finances will ever face.
ROMA: Many people assume getting pregnant is straightforward and free. But for the one in six Canadian couples who experience infertility, the path to having a baby is difficult emotionally, physically and yes, financially. Same sex couples and people trying to get pregnant without a partner are on that same road. And for all these aspiring parents, fertility treatments aren’t cheap.
ROB: For hopeful parents, it’s a massive expense they probably never planned for. Remember, this is a time when people likely have mortgages and maybe student debt. It’s not a time when people have a lot of spare money.
ROMA: Welcome to Stress Test, a personal finance podcast for millennials and gen Z. I’m Roma Luciw, personal finance editor at the Globe and Mail.
ROB: And I’m Rob Carrick, personal finance columnist at the Globe.
ROMA: Today, we’re going to tackle a difficult topic: the high cost of infertility for Canadians who are struggling to conceive. It can be a stressful and lonely journey with a huge price tag and no guarantee of success. But as more people delay having kids, we need to do a better job of talking about infertility like the steps before and during IVF treatments.
ROB: A few provinces cover some infertility costs. Ontario and Quebec pay for one round of IVF for people under 43 and 41. A small but growing number of workplaces are offering fertility benefits, but many people have to foot the entire bill.
ROMA: So how much does it cost for one round of IVF? How many rounds do people have to do? How big is this financial burden? Next up, we’ll hear from an expert about the IVF process and the associated costs. Dr. Tamara Abraham is a reproductive endocrinologist and infertility specialist. She practices at Generation Fertility in Vaughan, Ontario.
Dr. Abraham, what’s the typical situation a patient or a couple is in by the time they come to see you about their infertility troubles?
TAMARA: Yes. So I would say that in general there’s two broad categories of people that come to see us. There are people that need fertility treatment to become pregnant right away. So whether that’s same sex couples or individuals that don’t have a partner that needs things like donor sperm or people that need a surrogate. Those people come to us right away on their fertility journey. But the other group would be heterosexual couples that have been trying to get pregnant on their own for some time now. And generally, the timing of when they come to see us is variable. But the recommendations are usually for women under the age of 35 if they’ve been trying to get pregnant for one year or more without success, coming to see a fertility doctor, or if you’re over the age of 35, if you’ve been trying for six months or more to come see a fertility doctor.
ROMA: What are the first steps when treating infertility?
TAMARA: So initially, for most couples, it’s very rare that we would say someone should do IVF right away. There are circumstances where that is the only way that someone can get pregnant or it might be the most effective treatment. But most commonly, we usually start with other treatments, whether that would be medication to help the women ovulate more than one egg combined with something called intrauterine insemination, where we concentrate the sperm and put it directly into the uterus.
ROMA: And how much does that treatment cost?
TAMARA: So it’s variable depending on whether there’s funding available in the province, but it can cost anywhere from 800 to 1200 dollars.
ROMA: Okay. So the next step is IVF. What exactly is that? What’s the process?
TAMARA: The goal of IVF is to stimulate the ovaries so that we’re stimulating as many eggs as safely possible. We then retrieve those eggs and fertilize them outside the body using sperm, and we create embryos. Those embryos are then transferred back into the uterus, usually one at a time, to achieve pregnancy.
ROMA: And what’s the typical success rate of IVF?
TAMARA: So that’s largely dependent on the person who’s contributing. The eggs, the female, usually female partners egg the age of the female partner. But I would say on average, 40 to 50% success rate with IVF.
ROMA: So IVF is generally the most well-known fertility treatment. When people talk about steps to getting pregnant, it’s also the most expensive. What does a single round of IVF cost?
TAMARA: It’s very variable depending on province and individual coverage. If someone has individual drug coverage, for example. But in general, the cost is somewhere between ten and $20,000 for a single round of IVF. I would say in general, the procedure typically costs around $10,000 and the cost of medication again is variable, but can be anywhere from 2 to $5000. And then if someone wants to do additional add ons or things like genetic testing of the embryos, that can be an additional $5,000.
ROMA: So how many rounds on average does it take before patients either get pregnant or stop trying?
TAMARA: I would say on average, most patients will do about two, maybe three rounds of IVF, but that’s extremely variable.
ROMA: And some patients just don’t do it because they can’t afford it. Have you come across that?
TAMARA: Well, I work in Ontario, so in Ontario we have funded IVF, so every female with a OHIP card is eligible for one funded round of IVF. Now, the cost of the medications, like I said, can still be anywhere from $2000 to $5000. And even that cost can be too much for some individuals. So I have seen some individuals that have not been able to afford IVF treatment.
ROMA: Dr. Abraham, you work in Ontario, but can you touch on what the case is in other parts of the country?
TAMARA: Yeah. So currently Ontario and Quebec are the only two provinces that offer funding for fertility treatments. So all other provinces require payment out of pocket. Oftentimes health insurance to a company or a purchased health plan, like you said, will cover at least the medication costs. More and more, it’s becoming common for companies to also cover some of the fertility treatments. So some companies, like I know some of the banks just implemented this. A lot of the tech companies are starting to implement this. They’re providing some benefits for the treatment itself as well. It’s one of the incentives I think, for getting an employee is that they have really good fertility benefits and we’re starting to see more people in Canada have these benefits available to them, which I would say is more of a new thing.
ROMA: In addition to IVF, some companies are offering egg freezing as a fertility benefit. Is that happening more frequently in Canada?
TAMARA: It is, yes. We’re also seeing a lot of individuals coming to us with, like you said, their workplace offering full benefits for egg freezing cycles.
ROMA: And what’s the price tag for that?
TAMARA: So on average in. Freezing cycles cost somewhere between $6500 to $8000. Again, not including the cost of the medications. Those are always extra.
ROMA: And the egg freezing effort. Tell us a bit about what that entails.
TAMARA: So as women, we are born with all the eggs we ever have, and as we get older, that number naturally declines. Women are kind of more aware of this factor, and they’re aware that if they wait to become pregnant when they’re older, they might not have as high a chance of achieving pregnancy just because of this natural decline in fertility as we age. So egg freezing is kind of giving women a little bit more power over their potential fertility by allowing them to freeze their eggs and potentially have more options if and when they decide to have children in the future. It’s not an insurance policy. We can never guarantee that frozen eggs will lead to a wife and child in the future, but it’s definitely one way of potentially keeping your options open.
ROMA: Dr. Abraham, would your experience accessing treatment be any different if you were doing the government funded route versus paying for it out of pocket?
TAMARA: Yes. So there is a limit to the number of government funded cycles that is available per year, and the government has allocated that funding accordingly. So when you want to access government funding, you’re put on a waitlist and that waitlist can be anywhere from 1 to 3 years depending on the clinic that you’re at.
ROMA: 1 to 3 years, that’s a chunk of time.
TAMARA: It is, especially if time is not on your side.
ROMA: What advice would you have for someone undergoing fertility treatments? Were thinking about doing these treatments to start their family?
TAMARA: I would tell them to be kind to themselves. I think infertility is very challenging and patients are doing everything that they can to help build a family. And so I really encourage them to have self-compassion and understand that they’re doing everything within the confines of their situation to build the family that they want.
ROMA: Dr. Abraham, thanks so much for joining us. After the break, we’ll hear from people who have gone through IVF about the financial and emotional toll.
ROB: Our first guest has spent $200,000 on IVF and counting. She and her husband had their first child through IVF. Now she’s undergoing treatments and hopes they can have another child. Here’s her story.
ANDY: My name is Andy. I am 36 years old and I live in the GTA, Ontario. I am married to my husband of seven years. We have one child who just turned three. We knew we wanted kids our whole lives. I come from a family of two. My husband comes from a family of three and it was just never up for discussion. We started with the government funded rounds.
Yeah, I was just trying to do the math, and I think we spent approximately $12,000 on our first rounds, and that included our travel expenses, that included our medication expenses, that included the storage fees for any embryos that we ended up with. That included genetic testing as well.
We’ve done six rounds of IVF in total. The first round was covered. The additional five rounds were not covered. We’ve probably spent time looking at the math and we’ve probably spent around 200,000 and we may be looking at an additional 100,000. So almost 300,000 total.
We thought trying for our first child was expensive and we’re understanding that the second child is triple that. We paid for what’s called a guaranteed life birth program. So it’s more of a combined package that if you require multiple embryo transfers, it’s all encompassed into an inflated cost. If I could wave my magic wand, I would choose an employer that has an amazing fertility plan. I had a maximum lifetime allotment of 20 $500 for meds, and I ate that up in my very first round. And if my insurance company specifically does not cover fertility medications.
So I hear of a lot of things in the states where you can actually do a la carte picking for your insurance company. I wish we had that option. You know, my husband had 20 $500 also for maximum medical associated costs, and I couldn’t access that as well for tax purposes. I am not able to put in my travel expenses all of the additional costs that you spend $100 a month on ovulation tests and pregnancy tests that nobody talks about food costs. And I can’t put any of that into my taxes either.
We have a fertility social worker who has helped navigate that process a lot better than the physicians have, but that was seeking that out privately, not with our clinic strongly suggesting it on paper. If you look at my husband’s and my gross income, we look like we do very well for ourselves. We look at our peers and we do feel as though we are behind it because we have used all of our additional finances to pay for these treatments.
We have been extremely fortunate that we have family members that we have gotten interest free loans from. Without that, I don’t see how we could have afforded this. What we typically do is we will get an interest free loan from a family member. Use that like our wombs. Pay it back and then move on to an additional round or an additional expense. The other thing is we have had a financial planner this entire time to ensure that this isn’t eating into our retirement savings.
I think that now I will be telling my child they should be getting a screen at a minimum from a fertility specialist in their early twenties to determine if they are number one. What is their egg reserve? What do their hormones look like? Do they have any genetic predisposition that may make it difficult for them to have a child? And with that, I think as a parent, I may want to have extra savings for my child, not just for education, but for fertility for their first home, I think is a financially responsible thing to start doing. It has completely changed our lives. We look at life differently. I have different friends because of this. But having the success of having one child has opened up our lives to know it’s possible and they are so worth it.
ROB: Our next guests also live in Ontario. She’s 39 and he’s 41. We’re not using their names to protect their privacy. They met in their mid-thirties and started trying for a family shortly after. It has not been easy.
GUEST 1: I met my husband when I was 35, but we started trying when I just turned 36.
GUEST 2: We started doing some of the tests, but I think their recommendation at that point was just to keep trying for a little bit longer. And that was when we did get pregnant, wasn’t it?
GUEST 1: Yeah, Yeah. So I mean, and we did happen to get pregnant within the first year. Unfortunately, we found out that that baby had Trisomy 18, which again, we don’t know specifically where that came from. She said that it was basically a fluke and random chance and then at five months that pregnancy ended. So then we tried ourselves again. We got pregnant again, and unfortunately, that resulted in a miscarriage. So at that point, we were like, let’s speak to a fertility special again, specialist again.
GUEST 2: And that’s pretty much from where we’d been on the journey so far. They were pretty quick to say we should probably look at IVF. So, see, there are a few other different fertility treatments, but our recommendation was IVF, because obviously I just eliminated or it would significantly, drastically reduce the chance of genetic issues with an embryo.
GUEST 1: Last year alone, we spent close to $59,000. So once you go through the IVF process and you have embryos and we had three that were genetically tested. Then if you pay for it yourself, you have to pay for the actual embryo transfer, which we didn’t realize at the beginning. But when you’re going through a funded cycle, your embryo transfer is funded as well. But when you pay for it yourself, then every time you do a transfer, you have to pay for that yourself. And that’s $2,250. Part of it was savings. Part of it is the benefits. And then part of it is loans. So yes. Yeah. And then sacrificing other things that we would want to do that we are choosing not to do because we’re paying off our loans. Our new clinic had a system set up where you can do a bundled purchase, so you can either purchase one itself, and this only includes the actual procedure and the first year of storage. So beds are not included in this. The first one is roughly around 13,000. If you do to initially like sorry, as in pay for two. Right from the get go, it’s about 18,000. And then if you pay for three, it’s almost 24,000. So we decided to pay for two just because of what has happened in the past for us with our canceled cycle, we resumed, okay, let’s go with the safer route and and pay for two up front. It was almost 24,000 because we also added a separate incubator. So they gave you all your options and basically said, do you have a separate incubator? You don’t need to, they won’t need to keep opening and closing it, and you may have a higher chance of having a successful blastocyst or embryo. So we’re like, yeah, of course, to throw that in, you know, we’re paying and that’s that. That was $850, right? So we’re like, okay, throw that in. But it is really stressful because you don’t want to be in a situation where you’re like, Oh, I should have picked that ahead of time due to three. Do we do one, do we do two? And then all these extra tests. And it doesn’t stop with just IVF because once you start doing the embryo transfers, there’s all these other tests that you could do as well. It is a very stressful situation and you do feel like it. Kind of just like people trying to squeeze money out of you. But then at the same time, it’s just a charged topic and we want this one goal. So we’re like, okay, do you would rather go on vacation or have this one goal? And it’s always been this goal was reprioritizing it. And we were fortunate enough at the time that when we were doing it, my work paid a lifetime max of $8000 on meds. They increased it to 15,000 this year. So we have money to use for our funded IVF cycle for people that don’t have any benefits. All of this is coming out of my pocket. Yeah. So I can’t imagine the stress. And the reason why we didn’t wait for the funded IVF cycle is because the timeline to get approval is 12 to 14 to 16 months and some clinics are three years. It really just depends on the clinic. So we’ve been on the waitlist since March of last year, so we’ve already hit the one year mark of waiting. They told us it should be roughly around 14 months and because of the diminished area, ovarian reserves status time is of the essence. So we didn’t have the flexibility of waiting another year because who knows what my account would have been a year from now.
GUEST: 2: Yeah, basically by paying you’re able to jump the queue. You just, they’ll just treat you straight away. I mean, we were just in the fortunate position where I think for most things we were able to say, yes, we’ll do it. I don’t really know how that would have felt if we were like, No, we can’t, you know. And you think, well, could that be the reason why this doesn’t work? You know, you spend all this money and then it’s the loss that you sort of like, you are almost trapped into you have to spend it, in a way.
GUEST 1: It’s heavily hormonal. You’re injecting so many drugs into your body and they tell you, like the more calm you are, the better the processes. But then you’re so stressed because you have so many visits. I think at some point there are between three and five visits a week. Not to mention daily injections, especially if it’s not going well. You’re anticipating like what’s the size of my ankle next time? And then, you know, you’re not necessarily supposed to vigorously exercise that. You’re supposed to like, maintain a fairly healthy diet. And there’s all these components to it that affect your lifestyle. If you would have had a glass of wine to distress, you can’t do that anymore because it is like you in the back of your head. You’re like, it affects the quality of my egg. So there and then you’re on, I don’t know, hundreds of supplements because you’re trying to maximize the situation, which also costs hundreds of dollars a month. So there’s just yeah, a lot of stress coming your way in so many different ways.
ROB: Next is Amanda, a 37 year old based in Ontario? She spent her twenties and early thirties, focused on her career when she and her husband were ready to have kids. She chose not to wait for the government funded round to get started with IVF. She paid with savings and her line of credit.
AMANDA: We knew we wanted to just get going and we had the ability to, so we decided to go out of pocket. And so our cost for IVF itself, so the process of it and just paying for the actual, I guess human resource and clinic resources was $11,527. I went through the meds that I paid for and we do have some private insurance, but even with that, they don’t cover IVF at all. The medications were partially covered, but even then it looks like it was just over $3,000 be paid on medications and embryo freezing was $925. And now we’re paying $600 a year as well to keep them frozen right now. We genetically tested our embryos. So for up to four embryos we had four at the time. So I’ve done six cycles. So I didn’t do the final tally because I was terrified. But if I was to do a quick count here and let’s say 26,000 with the meds for the cycles close to $30,000, and not everyone’s going to have that. But that’s been our story for so long in my life. And it was really just about career, career, career and making sure that I had the money to get myself through school. And I want to be very clear on this, especially in case my parents listen to this. My parents were a huge support in making that happen, and I didn’t have to worry about that too much. But it was really just focusing on that. And I wasn’t thinking about the other aspects of life because at the end of the day, yeah, I don’t know that anyone could have told me to start saving for this then. But then again, actually no one ever tried. So maybe there was an opportunity to say, maybe it is. You can have it all and you should try it all. You can’t necessarily have everything at once. So maybe figuring out how you’re going to prioritize things and how you’re going to set yourself up to do the other things when you’re ready to do the other things. Bottom line is, I would say have the conversation earlier than you think you’re going to need it and think about what your values are and what you want, regardless if there’s a partner there or not. Because you need to make a decision for yourself because this is going to be on the person with the uterus ultimately more than anyone else. So just to think about it early and then later on, when it comes to the financial piece, the thing I would say is either be good with a budget or have a partner good with the budget and keeping track of these things because my partner, my husband is amazing and has been kind of keeping us on track the entire time. And every time I did get nervous about cost, he was there to say we’re going to be okay. And he had the data to back it up. And so knowing that has been really helpful as well. Yeah, I’m in a positive headspace and I’m trying to be optimistic and going forward with things. And I think I guess that’s the only thing. It’s like this is a great conversation to have. I just want to highlight that, like we need to decide what we value as a society and need to support people in achieving that. So what I mean is if we’re concerned about declining pregnancy rates or things like that, maybe one cycle of IVF is not enough to be covered and maybe we need to support our population more in doing these things and also question why the human resource cost of it is covered, but the medication cost isn’t covered or things like that. So because I think that’s the one thing I would say is no matter how much it costs, there’s going to be hidden costs that you’re not going to be able to account for. And that’s, you know, we haven’t even talked about, you know, once things start not going well, whether you’re going to be doing trying acupuncture or seeing a nutritionist or trying to do all of those things to decide if that’s going to maybe give you the boost you need. Right. So I think we just need to decide if this is something that’s becoming a concern and a priority, how we can maybe publicly support that more.
ROB: These conversations tell us a lot about the potential cost of having a baby. As millennials and Gen Z delay parenthood to build their careers, save for a house and pay off debts. We can expect more people will need IVF. Roma, what are your takeaways?
ROMA: 1) If you know you want kids, start planning for this as early as you can.
2) When looking at the health plan of a potential employer, don’t forget to ask about fertility benefits.
3) If you’re considering IVF. Think about where that chunk of money will come from. There’s no perfect answer here, but it should be on your radar.
Thank you for listening to Stress Test. This show was produced by Kyle Fulton and Emily Jackson. Our executive producer is Kiran Rana. Thanks to our guests for sharing their stories.
ROB: You can find Stress Tests wherever you listen to podcasts. If you like this episode, please give us a five star rating on Apple Podcasts and share it with your friends.
ROMA: Next up on Stress Test, we talk buying used. From small items like baby onesies, two large products like a dining room table. People are saving cash, buying second hand. It’s a tried and true strategy that’s having a bit of a renaissance given today’s economy.