The Decibel - Navigating Canada's fertility industry

Episode Date: April 6, 2026

A growing number of Canadians are struggling with fertility, and the business helping people make babies is booming. The global fertility services market was valued at over $21-billion in 2021 and is projected to more than quadruple by 2031. As more hopeful parents turn toward services like in-vitro fertilization – or IVF – and surrogacy to conceive, Globe investigative journalist Kathryn Blaze Baum worries they may not know exactly what they’re signing up for. Today, Blaze Baum shares her first-hand story and reporting into the fertility industry in her new book, In Fertility: The Story of a Miracle and the Big Business Behind It. Kathryn will explain what it’s like to navigate assisted reproductive technology, its high costs financially and emotionally, and what she thinks needs to change about how Canada handles fertility. Questions? Comments? Ideas? Email us at [e-mail] Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

So I have this beige linen box and it's hidden in my closet. It's tucked behind a stack of sweaters because I want to keep it, but I don't want to be forced to look at it all of the time. And inside is this collection of sonogram images, of babies that never made it, that were a dream that didn't get to come Earthside. Catherine Blaisbaum is an investigative journalist with the globe. I would add a sonogram image one at a time to this box, and it kind of became a mausoleum of our losses. And these are sort of the losses along the way in our quest to grow our family. We had four miscarriages,

but then adding image on top of image on top of image was just this very visceral, very physical, tangible way of reminding us of what we had been through, but also what we were striving toward. Catherine is describing her and her husband Dan's difficult journey, trying for their second child. Their daughter, Sydney, was born in 2018, but their efforts to give Sydney a sibling

would take them through years of pain and heartbreak. I'm one of five kids. I grew up in a house full of noise and chaos and love and laughter, and that's just what I always envisioned for our lives. family. And we wanted Sid to have that growing up too. And Dan and I just felt that we had, you know, more love to give, as cliched as that might sound. We just had no idea how hard it would be, how long it would take and how much it would take out of us. It would take their family through Canada's fertility sector, from miscarriages to in vitro fertilization, to surgical

procedures, to surrogacy. Infertility struggles are becoming more common. And the big business of fertility is booming in Canada and around the world. The global fertility services market was valued at over $21 billion U.S. in 2021, and is projected to more than quadruple by 2031. As more people turn toward assisted reproductive technology to conceive, Catherine worries they may not know exactly what they're signing up for. Catherine recently wrote a book called Infertility, the story of a miracle and the big business behind it. And today, she's here to tell us what she learned about the fertility sector firsthand and what she thinks needs to change.

I'm Cheryl Sutherland, and this is The Decibel from The Globe and Mail. Hi, Catherine. Thanks so much for being here today. Thank you so much for having me. I'm really excited to be here. Same. I'm really excited to talk about this really wonderful book that you you wrote. I think it's going to help a lot of people. And I also think that many people listening will have either struggle with infertility or know someone that has struggled with infertility. And something that was striking to me while reading was that you hear about it right in the periphery, but I just had no idea about just how complex the system is and just all of the treatments that

are involved at the time. It just is a very long journey. And I know it's very different for many different people, but like it just, that's what really struck me when I was reading it. Absolutely. And I was also struck when you're kind of going through it at just like the marvel of life. I know how cheesy that sounds. But it's like we learn in school, you know, egg meat sperm makes embryo grows into baby. It's like there are so many other things that have to happen and go right. And it really helps you understand why it doesn't always go right and why we should be in such awe when it does. Absolutely. So you're going to walk us through what it was like for you navigating Canada's fertility sector. But before you do, can you just tell us what we mean. when we say infertility? Sure. So most people think of infertility as the failure to get pregnant after about a year of regular unprotected sex,

which is true. But that is a narrower definition that I think misses a huge swath of people, like including myself, because a broader definition includes people who can conceive, but for one reason or another, are unable to carry a pregnancy to term.

And we know that one in six Canadians struggles with infertility and that the rates are climbing. And there are many causes. It could be a block philopian tube. It could be ovulatory disorders like PCOS or conditions like endometriosis. And many cases, frustratingly, are unexplained. Right. Okay. So you had Cid in 2018. Yes. And then you wanted to give Cid a sibling, right? And that's when your struggles started

happening. You eventually turn to IVF, right, or in vitro fertilization. And this is where eggs are retrieved and then combined with sperm outside of the body, inside of a lab, and then viable embryos are transferred into the body. Lots of science terms here. But I think a lot of people have heard of IVF and how it works. But what did you think before starting it? Like, did you have any misconceptions? There were lots of misconceptions. I went into it thinking that it usually works the first time, which in fact, it does not. It typically doesn't work the first time. Most patients need a couple of cycles to reach a viable pregnancy. I thought a lot of eggs meant a lot of embryos, which meant a lot of genetically normal or good embryos. And I thought that would mean a successful

transfer. And that's sometimes true, but in my case, it wasn't. Or at least it wasn't for many attempts. And I also, like I knew we were fortunate to be living in an urban center like Toronto, that we had access to a clinic. But I had no idea just how lucky we were. Like, I had no idea that some Canadian jurisdictions like PEI and three territories have not a single IVF clinic. And I knew it was pricey, but I didn't know just how expensive it could become. Okay, so you are in an urban center and you did IVF here in Toronto. Can you give us a sense of what the treatment process was like for you, both emotionally and physically? This is the big reason I wanted to write this book because it was so much harder than I expected. And I don't want to scare people. I, you know, I want people to be hopeful.

I want people to be optimistic. I also want people to have a decent sense for what it's actually going to be like. So our fertility journey was years long. There were miscarriages. There was five rounds of egg retrievals, multiple embryo transfers. Several of them resulted in no pregnancy at all. One of them resulted in a miscarriage. There were multiple surgeries.

I had scar tissue in my uterus that impacted my ability to develop a thick, healthy, receptive uterine lining where an embryo could burrow and grow. I will always remember, you know, before my first retrieval being told, you know, you'll be groggy when you come out of the procedure and you can go to work the next day. Maybe some people could, but that was not my experience. I was practically bedridden. I fainted twice. One time I woke up on the bathroom floor with blood everywhere, I needed to get 11 stitches in my face. Oh my goodness. So, you know, if you're listening and you're through it and you're like, wow, that's not what happened to me. Or you're going through it and you're thinking, like, well, I hope this doesn't happen to me. I hope so too. You know, I went into it

really hopeful. I went into it, like excited. You know, like my body hadn't up until this point done what I wanted it to do. And I was excited to tell it what to do through the language of hormones. I felt like I was going to be regaining some control. And that is true. You do regain some control. And then you quickly realize that you don't get to hold on to it for very long, or at least in my case, And that loss of control is really like disorienting, the uncertainty it creates can be very isolating. You don't know how to talk about it. People don't know how to talk to you about it. And like everything becomes a landmine.

Like your calendar becomes a landmine. It's like, can you go to that event or are you going to feel terrible? Or are you going to need to be doing an injection? Do you need to sneak off into the bathroom? It's just, it's very consuming and it can become the white noise of your life. Right. I can imagine that as you went through this, that emotional tool, just gets harder and harder.

Harder and harder. And when the rare thing happens to you, you just feel very vulnerable and you feel like very exposed. And actually fertility treatment is exposing. Like by nature of what you're going through, like you are literally laid out on a table, right? Like, you know, not to be graphic, but like you're lying there, you know, tush to the end of the table, legs, you know, wide open, please. And, you know, there is no time for modesty when you're going through this. And, you know, your body is just there to sort of be seen and harvested in a way. And it's all toward this greater good, right?

Like you are doing this for this goal of a baby. And so it's all worth it. But it can all be hard. Okay. So you talked about your journey a little bit there. Do we have a sense of how successful IVF is? So what we know is that it typically takes more than one treatment round, especially for those. over the age of 35. So the longer you wait to have children and to go through this, you know,

the more meaningful implications it has for your chances at having a successful IVF round or natural pregnancy for that matter. So looking at the national data, the clinical pregnancy rate per transfer for those under age 35 is around 45 percent compared to around 35 percent for those aged 35 and over. So you can see how it goes down. And it just continues to go down from there. And I will also say at the same time that it's not necessarily helpful to know the average success rate for the average patient because that metric is, you know, meaningless to the individual person at hand. And that is something that doctors will tell you, right? Like, you know, they have to take into account your age. They have to take you account. Have you ever had a miscarriage before? You know, do you have any other, you know, conditions that might interfere with fertility? So there's so many factors. On that, when it comes to IVF cycles, this is a medical procedure, right? Is any of it covered in Canada? So no Canadian province or territory fully covers fertility treatment. But some jurisdictions do offer some financial support.

And that's really important because it costs, on average, somewhere around $15,000-ish thousand dollars per IVF cycle. But provinces and territories have generally speaking decided that fertility treatment isn't, quote unquote, medically necessary. And therefore, it is not entirely publicly insured. That being said, there are provinces. like Ontario that offer publicly funded cycles, one per lifetime usually, for patients under typically a certain age in Ontario, I think it's 43. But this does not cover medications, genetic testing, or embryo freezing. And also importantly, I should say that there are months long wait lists for these funded cycles. And that's really counterintuitive in fertility

because time is unfortunately the enemy. And I know that's hard to hear. I also think that important for people to be aware. So you said that some places will fund one cycle, but then you also mentioned that the first cycle is not always successful. That's right. And it is so heartbreaking to think of people out there who, you know, after waiting and waiting and waiting and trying naturally, they finally get a funded cycle and they do it. And for one reason or another, it doesn't work. And for them, you know, that might be the end of the road. What about clinics in Canada? Do we have a sense of success rates when it comes to individual clinics? You would think that this would be something that patients should know, that when you're

picking a clinic to spend $20,000 at, that you should have access to the information that tells you whether Clinic A has higher success rates than Clinic B. But unfortunately, in Canada, that's not the case. And the reason for that goes back to the 2004 Assisted Human Reproduction Act, which is the first piece of comprehensive federal legislation tackling this issue. And the stated aim of that act is to protect those who use or who are born of assisted reproductive technologies. So under this initial act, there was a central federal agency that was responsible for oversight and data collection. Under this regime, clinics were going to be required to publish their success rates.

But in 2010, after a constitutional challenge, the Supreme Court struck down parts of the legislation as unconstitutional, saying it infringed on provincial jurisdiction into health care. So in the end, the oversight agency was dissolved and the responsibility to administer and enforce what remained of that act fell to Health Canada. Over the years, the federal government has strengthened parts of the law, but critics say some aspects are outdated and are not enforced in any meaningful way. We'll be right back. So, Catherine, your fertility doctor eventually recommended that you and Dan, your husband, consider surrogacy. But that's actually commercially banned in Canada. Can you explain how surrogacy exists here? The word you used commercially is very important there because surrogacy is legal in Canada.

What's illegal is paying the surrogate and compensating them for their literal labor, right? So since the Assisted Human Reproduction Act was enacted in 2004, Canada has been operating under an altruistic surrogacy model in which surrogates can only be reimbursed for expenses. They can't be paid a salary. And so that approach is rooted in a philosophy of not wanting to commodify the female body and to guard against the potential for exploiting women who might be financially vulnerable. And so when I'm talking about surrogacy with people, one of the things that they're most surprised by is the fact that you can't pay these people to carry your baby. Like this is hard work. It's like many months of their life. And you can't compensate them.

You know, everybody else is being paid. The doctors, the lawyers, you know, the. drug companies and these surrogates, the ones who are literally giving their bodies to this, I cannot. And so why would anyone do this, right? Yeah, that's a question I have. I mean, I would assume that perhaps there was some sort of pay involved because it is a very long and hard journey for someone's body to go through.

Totally. And what I have come to learn in the reporting and in talking to the surrogates that I interacted with on our journey is that there are several reasons. Chief among them is this genuine desire to want to help a stranger or a loved one or someone in your circle to do this incredibly selfless thing. There's also among some this desire for like a sense of purpose. They're looking for something more. And this is a way to feel like they're giving back. For others, it's about finding a community in the network of surrogates. And some people, believe it or not, really just love being pregnant. I've heard about those people. So how did you find a surrogate? Like what was the process like?

So there are a few ways you can go about finding a surrogate in Canada. The way we did it was through an agency. And an agency has a list of surrogates who could potentially be introduced to intended parents. And, you know, effectively you kind of go on like a bit of like a dating period and you decide if the fit is right. And if it is, you're matched and you can move on to the next stage of the process. So agency wait times are somewhere usually quoted between like six and say 12 months. But in our experience, it was only a couple of months before we matched with a woman named Stacey. The range for these kinds of agencies in the country from my reporting is around $12,000 to $16,000.

It can be a little bit less. It can be more? Okay. So can you help me understand this? Because you just talked about how in Canada we're not supposed to be paying surrogates, right? but then you're paying an agency. So can you explain how agencies are charging to match people? You're right.

So under the act, it's illegal not only to compensate a surrogate, but it's also illegal to pay someone to arrange the services of a surrogate. So that does raise a question about what surrogacy agencies are actually doing and whether their services constitute arranging. Agencies say that what they're doing is offering consulting services and providing assistance to surrogates and intended pay. parents when it comes to managing the reimbursement of expenses, for example. They say they are not matching per se, but rather they are introducing people to each other. And that those people then are the ones who coordinate the actual services and the matching with one another. Okay.

And so we talked about the expenses as well. I think we just should talk a little bit more about when we talk about expenses for surrogates, it can be a range of things, right? Absolutely. And so as we've talked about, working with an agency can run you 15,000. thousand dollars alone. And then there are all the reimbursements for pregnancy-related expenses, the additional groceries for increased caloric intake, maternity clothing, travel to the clinic, especially if they live out of town, lost wages if she has to miss work or go on bed rest.

There are legal fees associated with drawing up a contract. And you pay for not only your own legal fees, but of course you pay for the legal fees associated with the surrogate having representation. There's the cost of psychological screening for both parties, which is a requirement of most clinics. And as well, there's, you know, the cost of medical screening for the surrogate. There's the cost of life insurance for the surrogate, which is usually required under a contract. So there's a lot of expenses. Wow, I didn't know about all that. That's really interesting to know. So you and Dan eventually worked with two women. You mentioned Stacey, but there was another woman involved here as well. So can you tell me about your journey through surrogacy and these two women?

Right. And so you'll remember that I talked about all of our failed transfers. So our first angel, B.C. injured four embryo transfers, and unfortunately none of those took. We didn't even get a chemical pregnancy. Bless her for trying over and over and over again, but we kind of mutually decided that it was time for us to part ways for reasons that no one could explain to us the transfers just weren't working. And so we actually found our second surrogate, Kendra, through Facebook. You know, she was on Facebook. She wasn't working with an agency, and she was just sort of scrolling one day and Dan and I had made a post and we boosted it to particular demographics and I guess it ended up on her computer screen and she saw us and she felt drawn to it and curious. And so we had a lovely

conversation and began our journey together. And so with her, she had one failed embryo transfer in the spring of 2022, but we tried again the next month and to our shock and total joy after so many failed transfers and miscarriages and loss, like we saw a positive pregnancy test and it worked. Oh, my goodness. I mean, first off, how many years were you into this journey when you saw this pregnancy test? By that point, three years. Three years. Yeah. So this was the first time in our IVF journey working with a surrogate that we had a positive test. So we were really hopeful that, you know, when we saw this yes, that maybe it really actually was a yes. What was it like? What was like for you when you found out after such a long time that Kendra was pregnant.

So Dan and I were at a family event and, you know, a text came in and I looked at my phone and it was a picture of a positive pregnancy test. And I was just like, wait, is that for us? Like, is that ours? Like, we haven't seen one of these in so long. And so I grabbed Dan's hand and we ran out of this event and I showed it to him. And it was like this beautiful sunny day in June. And I just remember we both like looked up at the bright blue sky and then looked at each other.

were just like, is this real? And just like collapsed to the ground, like, smiling and hugging and just like pure joy. And we just, we kept saying like, is this real? Like, it just didn't feel real because we'd had so many nose. And then Kendra called us and, you know, reassured us that it was real, that we weren't hallucinating. And so there was a yes. And then things did progress and the pregnancy was going really well. And then three months later, you find out something.

unexpected. Yeah. I wasn't feeling well. So I was nauseous and I was tired. And I remember saying to Dan that if I didn't know better, I would think I was pregnant. It seemed entirely implausible for a multitude of reasons, not least of which the fact that my uterus didn't seem particularly hospitable. And so a couple of days later, after saying that to him, I took a pregnancy test. And before I even put like the cap back on, there were two lines. And it was just like two pink lines. Oh my gosh. And like, again, disbelief. Yeah. So I called Dan into the bathroom and I was like, I handed it to him. And he looks and he goes, what is this? And then I just burst out laughing because I was just, I guess, I guess, I'm not sure. Um, yeah, I was like, I, I guess, like I think I'm pregnant.

And it turned out I was. And so what was going through your mind? Because you have Kendra who is pregnant with your baby and then you find out you're pregnant. And of course, you've gone through this journey and all these losses. Like, what was going through your mind? I mean, if you're somebody who's been through miscarriages, you know that what I'm about to say is very truthful to the experience, which is you no longer trust the positive test. So I was like, oh, you know, wow, that's crazy. I'm pregnant. We weren't trying. Like, how did this happen? But then my brain quickly went to, well, you're going to lose it anyway. But as time went on and we, you know, go to the clinic and we do the ultrasounds and we're doing the blood work, I'm like, oh, like this is happening.

Every week went by and I wasn't having bleeding and I wasn't having cramping and I wasn't having a miscarriage. This pregnancy was progressing. And it was a really wild experience because, you know, obviously neither Kendra nor I expected to be pregnant alongside one another. But here we were, you know, pregnant together. And then in January of 2020, I was, like, lying in bed in the morning and I get this phone call. And I knew there was only one person that was going to be calling me at the crack of dawn. And she was like, my water broke. My water broke. And I remember thinking, like, this is Kendra, of course. Yeah, this is Kendra. And I remember thinking like, no, no, no, it's too soon. It's too soon. And I remember my brain going, how could it be too soon?

This has been four years, right? But it was too soon. So it was 35 weeks, which is kind of towards premature. And she ended up having an emergency C-section. So we made it to the hospital. And I remember we're in the OR together. And I'm like sitting, you know, at her head. And there's a lot of like action around her, you know, preparing for this C-section. And I'm just like, oh, my God, is this about to happen? And I could just feel like inside my body. But it was like I was like a shaken can of soda. And I was like about to explode. And that is exactly what happened. It took a few beats for like our baby boy, Oliver to cry. He came out, the cord was wrapped around his neck and he was like four pounds, 10 ounces. And he needed some interventions at first to help him breathe. So it was very scary.

But when I heard his cry, like it was just this catharsis, this like release of four years of like torture and heartbreak and hope after hope after hope. So you have Oliver. So I have Oliver. And then a few months later, you welcome another baby. So I have Oliver and I'm sitting with him in the NICU and I feel his baby brother kicking him inside me, kicking his little toes. I'm like, oh, they're already roughhousing. So, yeah, just a few months later, my water breaks and I end up in the hospital and his cord was wrapped around his neck too. So I have an emergency C-section under general anesthesia and I wake up and my boy is here.

My second boy is here. And I just remember thinking like, I opened my eyes because I was so groggy. I opened my eyes and I saw him and I was just like, okay, he's here. Like, everybody's here. It's over. Like, we can just be people who go through just the usual stuff in life. And I just remember being so relieved and so grateful. And by he, who is here? That's Ben, Benjamin. Yep. And he came home on Mother's Day. And it was just such a whirlwind because because I'd had a C-section, I actually couldn't like, after that, you're, not supposed to pick up things that are heavier than, say, 10 pounds or so. But I had a four-month-old at home, and he was over 10 pounds. So I was in this, like, bizarre situation where I had this four-month-old and a newborn, and I can't pick up my four-month-old because of the C-section from the newborn. It was a really crazy experience that I can only describe as existing in two time zones, like concurrently. Big picture, Catherine. After what you went through

navigating this world. What do you think needs to change about Canada's fertility sector? I think first of all, we need to do a better job of educating people going into it about what to expect. I think it would be helpful if people had their, you know, certain hormone levels tested at a younger age and maybe over the course of a few years to see how it's tracking, just to get ahead of potential issues. So many things go undiagnosed for so long as well. I think we need more stringent consumer protections, especially with the rise of what are called add-on treatments. These are treatments that are not part of sort of the core of IVF. They are additional things that you can do to, you know, better your chances of a successful

pregnancy. But some of them are based in science and some of them less so. Many of them are debated. And so you can end up spending thousands of dollars on these add-on treatments. And these are things like pre-implantation genetic testing to see if the embryo is genetically and chromosomally balanced. It can be embryo glue. there are lots of ways for you to spend money

and when you are desperate, you will do any of them. We spent $25,000 on add-on treatments alone. I think there needs to be better oversight and more centralized oversight. There should be a national standardized system for reporting clinic errors. There currently isn't one. I also think we need to think more about access.

The idea that some provinces and territories don't have a single IVF clinic, I think people in some parts of the country will be very surprised. to hear that. You know, we need to really expand public funding, so it's not just the wealthy who can access treatment. And so people don't have to wait months or years to start a funded cycle when time is of the essence. And we need employers to step up and start offering more coverage through their own insurance plans. So those are really nice takeaways for the system at large, right? But what about

for an individual who is potentially starting their journey? What do you recommend people look into or do before starting their own fertility journeys? I mean, I want people to investigate their fertility. I don't want you to be scared of the answers. Seek them out. It's better to know than to not know. You know, protect your heart. Know that you might need more patients than you ever expected.

You know, you go into treatment and maybe you're like me. Maybe you think it's going to work. And maybe for you it does. And I'm so happy for you. Like, if that's your experience, that is so wonderful. But for a lot of people, it's not. So I think it's really important that we go into it knowing that. And most of all, I know this sounds a bit contradictory, but I think people need to be hopeful.

It's a crazy experience, but it can be a beautiful one. It can get you to where you're going. And no matter what, I'm here to tell you that it's going to get easier. One way or another, it's going to get easier. So what is your life like now? It's chaos. Yeah, no, there's like I'm three years out now. Like my boys are three years old.

My daughter, Sydney, is eight. and I still can so easily access the gratitude that I felt because the trauma of what I went through is still like, you know, it's just beneath the surface, right? So when I hear a baby cry or like, I guess they're not babies anymore, when I hear them cry or scream or fight or whatever it is, you know, yeah, I get frustrated. But there is this part of me that immediately goes to like, oh God, I would have so like just a few years ago, I would have done anything to hear these sounds in my house. And so, you know, it's nuts. Like, it's pretty wild in my house. I was going to say, I'm glad you're honest that, you know, it's not, just because it went to this thing. No. Oh, my gosh. It's beautiful. But it's there. But it's still annoying sometimes.

It's hard. It's hard. It's really hard. But I'm grateful and I'm joyful. And, you know, our house is full. Our hearts are full and our hands are full. Catherine, thank you so much for coming on the show and telling this incredible story. Really appreciate it. Thank you so much for having me. I really appreciate the opportunity. That was Catherine Blaisebaum, an investigative reporter for the globe, and author of Infertility, the story of a miracle and the big business behind it. That's it for today.

I'm Cheryl Sutherland. Ali Graham produced this episode. Our producers are Madeline White, Rachel Levy McLaughlin and Mahal Stein. Our editor is David Crosby. Adrian Chung is our senior producer, and Angela Pichenza is our executive editor. Thanks so much for listening.