Licinio and Kim Santos hold their son, Austin, as well as an embryo photo of him in Kelowna, B.C., on Feb. 29.Aaron Hemens/The Globe and Mail
After more than two years of trying unsuccessfully to get pregnant, Kim and Licinio Santos emerged from a Kelowna, B.C., fertility clinic, hurrying down the stairs in hopes of reaching their car before the tears fell from their eyes.
In her hands, Ms. Santos clutched a folder of paperwork breaking down the costs of various tests, medications and procedures involved in the in vitro fertilization (IVF) treatment they had inquired about. It totalled $20,000 for the first cycle – a prohibitive cost for the elementary school teacher and journeyman electrician, then both in their late 20s.
“My husband said, ‘Well that’s completely out of reach; we can’t do that,’ ” Ms. Santos recalled in an interview. “I think I was a little blindsided by that, saying, ‘Why are you saying we can’t?’ But it was 100 per cent money. We can’t afford that. We can’t put ourselves into debt to make that happen.”
What followed was an arduous fertility journey of struggle and sacrifice that included Mr. Santos living and working in northern Alberta for long stretches at a time to help pay for fertility treatments. In all, the couple spent nearly $80,000 over seven years to get pregnant.
As part of its election-year budget, the British Columbia government announced in February that it would publicly fund one cycle of IVF beginning in April, 2025. It’s a move that brings B.C. into line with seven other provinces that publicly fund IVF to some degree, and comes as Canada’s fertility rate falls to a record low. In the U.S., IVF has made headlines, with the Alabama Supreme Court ruling in mid-February that frozen embryos can be considered children under state law – a decision that has put a chill on IVF in the state and could have broader implications for fertility treatment in that country.
Ms. Santos called B.C.’s announcement “incredible news,” and said it would have made a world of difference to her family had their first IVF cycle been covered.
“If we had had funding, that would have taken so much stress off at a time when everyone says all you should focus on is not stressing,” she said. Her husband could have come home, she added. “We would have had more opportunity to work on our mental health, to not feel so guilty to take a day off if we needed it. It would have been invaluable to have that peace of mind.”
A 2023 report by the World Health Organization found that about 17.5 per cent of adults worldwide – or roughly one in six – experience infertility. The report analyzed 30 years of studies from around the world and found little variation between regions and low-, middle- and high-income countries.
The B.C. government says it is forming an expert clinical group to develop the program over the next year, considering details such as age limit cut-offs and pathways to access the treatment throughout B.C. The province is earmarking $34-million annually for the initiative.
Most provinces already offer some funding for IVF programs. Ontario and Quebec both cover one cycle, though Ontario does not cover fertility drugs. Manitoba and Nova Scotia both cover up to 40 per cent of the cost of fertility treatment, for a maximum yearly credit of $8,000.
Prince Edward Island, which does not have an IVF clinic, offers up to $10,000 in funding based on family income for treatment elsewhere. New Brunswick offers a one-time reimbursement of $5,000, while Newfoundland and Labrador, which also lacks an IVF clinic, provides up to $5,000 per cycle, for up to three cycles, for out-of-province treatment.
Alberta, Saskatchewan and the territories do not have any publicly funded IVF programs.
B.C.’s subsidy comes on the heels of new data showing that Canada’s fertility rate fell to a record low in 2022, reaching 1.33 children per woman. British Columbia had a fertility rate of 1.1 children – the lowest in the country – but also the highest rate for women aged 40 and older, a long-standing pattern according to Statistics Canada.
Kate Choi, an associate professor in sociology and director of the Centre for Research on Social Inequality at Western University, said many Canadian couples are delaying having children because of socioeconomic factors.
“It is largely attributable to the fact that women are staying in school longer,” she said. “It’s also the case that it’s a competitive market so it’s taking young adults longer to find secure and high-paying jobs. There are also affordability issues – particularly housing affordability issues – and, as a result, you have an economic barrier that is precluding adults from having children at younger ages.”
The decline in fertility, which follows a general pattern observed for about six decades, means the country will have a smaller proportion of younger people over time.
“When a population ages, that means that the working population has to sustain a larger share of the retired population, and that has implications for the solvency of social-security programs,” Dr. Choi said, adding that it could also contribute to a shortage of caregivers and a steep rise in health care costs.
Caitlin Dunne, clinical associate professor at the University of British Columbia and co-director at the Pacific Centre for Reproductive Medicine, said infertility is a disease and a public-health issue, and called it “validating” for the B.C. government to help fund IVF.
“Talking about infertility in a public forum also starts to peel back the stigma and shame associated with it, and it becomes easier for people who are struggling with infertility to get support,” she said.
“The other thing we don’t mention is that fertility is not just a women’s issue; in fact, up to 50 per cent of infertility is due to male factors. So this is both a men’s and women’s issue.”
Kim and Licinio Santos stand at a park as their son, Austin, plays on the swings.Aaron Hemens/The Globe and Mail
The Santos’s visit to the fertility clinic that day in late 2014 came after months of intrauterine insemination (IUI), a procedure that is less invasive and less expensive than IVF but had still cost the couple about $5,000 with no success.
After deciding to proceed with IVF, Mr. Santos turned the temporary electrical work he had been doing in northern Alberta into a five-year endeavour to cover the “astronomical costs” of testing and procedures – an arrangement that would often separate the couple for more than a month a time.
The two kept in touch through frequent phone calls when Mr. Santos had reception. He told his wife of the shady motels, camper trailers and crawl spaces that he slept in to save every penny possible. She in turn updated him on her latest efforts to boost fertility: Chinese herbs, naturopaths, yoga, massage, pomegranate, Brazil nuts.
Ms. Santos estimates she had had 16 cycles of IUI and IVF and four miscarriages when she slowly began accepting that they might just remain a family of two, with a dog. As a final effort, they sent three remaining embryos to a fertility doctor in Las Vegas who specialized in recurrent pregnancy loss.
“That very last cycle was what our counsellor would have called a ‘closure cycle,’ which we didn’t want to admit at the time,” Ms. Santos said. “But that was our very last one, and we said at this point, if it doesn’t work, we’re done. We’re done financially, we’re done mentally, we’re just done.”
She was sitting on her couch on Remembrance Day, 2018, when she learned she was pregnant. Austin Santos is now 4½ years old.
“I still sometimes look at my son and think, ‘Are you real?’ ” Ms. Santos said. “I’ll ask him to his face, like ‘Are you sure you’re real?’ And he just gives me the sweetest little smile, like, ‘Of course, mom. I’m right here.’ ”
Andrea Woo