Host: Treating infertility comes at a cost both financial and emotional. You inject yourself with drugs for weeks, go through various procedures, and at the end of all of that, it might end up in failure. And the whole thing can add up to tens of thousands of dollars. If you can afford to keep going. For a lot of Ontarians, it's out of reach. But the provincial government says it's working to change that. It already covers one cycle of in vitro fertilisation, and it's dedicating $250 million over three years to increase the number of clinics participating in the Ontario fertility program.

Host: There is no role more special or important than being a parent, which is why we are shortening wait times to make fertility care more accessible to Ontario families.

Host: You can also claim some eligible expenses on your taxes. So that all sounds good, but how much of a difference will it make? We look at who can access fertility care in Ontario and who can't. Then we talk to investigative reporter Kathryn Blaze Baum about her new book, which chronicles her personal experience of infertility and what she learned about the industry that promises miracles at a price. This is The Rundown. The Ontario government will be investing $100 million this year to support 27 IVF clinics across the province. It's all part of their multi-year plan to make fertility treatment more accessible. So is it working, and what else needs to be done? Doctor Preethi Sharma is the president of the Canadian Fertility and Andrology Society, and she joins me in studio. Great to have you here. How are you doing.

Dr. Preethi Sharma: I'm great. Thank you for having me. And thank you for allowing me to speak about this incredibly timely topic.

Host: Well, let's talk about it. I want to better understand how does government funded fertility treatment right now? What does it cover currently?

Dr. Preethi Sharma: So the Ontario funding program allows any patient who's a resident of Ontario and has a valid OHIP card to receive one IVF cycle. Now, there are certain stipulations. You must be under the age of 43 at the time of your eligibility. An IVF cycle includes ovarian stimulation and the egg retrieval, and all embryo transfers from viable embryos that result from that cycle.

Host: I'm assuming it does not include medications or anything that's on the side.

Dr. Preethi Sharma: You are correct. It does not include medication or any add ons, like genetic testing of embryos currently.

Host: In terms of a cycle, how long does that actually is it or is it measured in a calendar year? How long is typically a cycle?

Dr. Preethi Sharma: Yeah. An IVF cycle typically takes about two weeks. You start ovarian stimulation at the beginning of your cycle, typically on day 2 or 3. Take medications that are injectable for about 10 to 12 days, followed by an egg retrieval under sedation and either a fresh transfer or a frozen embryo transfer at a subsequent time.

Host: All right, let's talk about some supports there. The Ontario government introduced the fertility treatment tax credit last year to help with these medications and the add on costs. What isn't covered and what is it supporting?

Dr. Preethi Sharma: So as you said, medication is not covered. Genetic testing of embryos is not covered. And the purchase of donor gametes, sperm or eggs is not covered. And so these are significant costs to patients that can be up to seven, ten even up to $20,000. So this is where the Ontario Fertility treatment tax credit has become really complimentary and helpful for patients. They can claim up to $5,000 expenses, $20,000 of expenses for a maximum of a $5,000 credit annually. And so it really does help defray the costs.

Host: All right. Now, the Ontario government announced a new $100 million in funding. This is really about access and affordability. How does that actually fix it?

Dr. Preethi Sharma: Well, first of all, we'd like to applaud the Ontario government for this significant investment. Fertility care is truly health care, and we're just so happy to see this investment in helping build families. So the first 50 million that was given this year covers about 5000 additional cycles. That's really incredible because many Ontarians who could otherwise not access high quality fertility care or would have to be on waitlists for up to two years, are now accessing care within a couple of months, if not immediately, there'll be another 100 million deployed each year, for a total of $250 million over three years. So you can imagine that's almost an additional 10,000 IVF cycles. And so many Ontarians are going to be able to access the fertility care they need.

Host: You say many Ontarians, do you ever can you give us an idea of how many families are using and people are using in vitro fertilisation?

Dr. Preethi Sharma: I mean, I think the data shows over 100,000 people are using it. But when we talk about the fertility landscape, we know that women are delaying their fertility due to economic concerns, finding the right person, wanting to be financially stable. And so the age at first pregnancy is increasing. So that number of people who need IVF to build their families is growing. The LGBTQ plus population is growing steadily, and they have unique fertility needs. Often they need an egg donor or a sperm donor or a surrogate, and this is only accessible through IVF.

Host: All right, let's pick up on access. Ontario is pretty large. Yes. In terms of there are two new clinics also that are going to be built Brampton, Oakville. A lot of it is concentrated in southwestern Ontario. What is access look like in sort of northern communities in this province?

Dr. Preethi Sharma: Yeah, this is a great question, and Cfas would love to partner with the government. That's the Canadian Fertility and Andrology Society to help increase access in the northern communities. Now, the mandate of the government is truly there. They want to help these patients. So we really appreciate that. But you're absolutely right. A patient who lives in Timmins is very different from a patient who lives in downtown Toronto. Their access is dependent on their postal code. The patient who lives in Toronto probably has 15, 20 clinics to choose from, whereas the patient who lives in Timmins has lots of travel costs monitoring, diagnostic testing. They might need to make 10 to 15 trips to Toronto, which can cost upwards of 2 to $3000 in order to complete their cycle. And so what does that look like in the future? We see this as an opportunity for improvement. If we could build a hub and spoke model where we could have satellite monitoring centres in northern Ontario, in my dream world, I'd love to see a free standing, full service IVF centre that covers the northern region so that patients would not even have to leave that community, because we know that cost can be significant. So we ask that in the future, the government look into potentially helping fund or helping clinics build satellite clinics, build an IVF centre, talk about what infrastructure is needed, talk about the workforce and the strategy that we need to be able to populate those clinics so that we can service and allow geographic equity.

Host: Well, let's look into the future. The funding from the government says it's meant to standardise care by 2028. What does that actually mean?

Dr. Preethi Sharma: Yes. Well, ultimately, we want the patients to receive the highest quality health care that's available, especially in the fertility space. And so standardisation can involve multiple levels. All the clinics will be required to report their funded cycle outcomes to the Carter database. This is our aggregate national database that looks at all cycles outcomes. And we use this data ideally to make improvements in the way we deliver care. That's based on evidence. In August of 2025, we actually submitted a proposal to the federal government for a pan-Canadian national database. And the reason why is data metrics are important to allow us to deliver higher quality care. We want to be able to Analyze that data appropriately. We want to create evidence based recommendations for the future. All the clinics also need to participate in Accreditation Canada, and they need to be accredited by 2028. What does this look at? This looks at patient safety outcomes of treatment cycles, financial stability, governance of clinics, infection control. And again, this is to deliver high quality best in class care to our patients.

Host: All right. So we've got data. We've got potentially better infrastructure in the north. What else is needed to help Ontarians access this kind of treatment?

Dr. Preethi Sharma: I think full coverage is really important. As we said, medication costs are significant. Some patients have a drug plan, but most low income families don't. Pgt-a, which is preimplantation genetic testing for aneuploidy, looks to choose the embryo that has normal genetics and allows us to do elective single embryo transfers with the highest success rates.

Host: Doctor Sharma, we are going to leave it there. This was really insightful. Thank you so much for your time.

Dr. Preethi Sharma: Thank you so much for having me.

Host: When investigative journalists Kathryn Blaze Baum wanted to have another child, she ended up turning to IVF and surrogacy, starting a journey of hope, heartbreak and hundreds of thousands of dollars run down. Producer Carla Lucchetta sat down to talk to her about her new book, Infertility The Story of a Miracle and the Big Business Behind It, and a content warning for our viewers. This interview involves a discussion of miscarriage.

Kathryn Blaze Baum: I went into IVF with the total wrong mindset. I had no idea the physical toll that this was going to take on me.

Host: Catherine, thanks for having us to your home today. Briefly describe your fertility journey for us.

Kathryn Blaze Baum: So our daughter Sydney was naturally conceived, relatively easy to make, straightforward pregnancy. Giving her a sibling is where we ran into trouble and it was near impossible. So we had multiple miscarriages, uterine surgeries ultimately turned to IVF and through that process was not straightforward whatsoever. And it was years long involved multiple retreat egg retrievals. Embryo transfers ultimately be turned to surrogacy. And in the end, we were very fortunate that we did come out the other side with not just one sibling for our daughter Sydney, but two. So we ended up with two baby boys born four months apart, one via surrogacy and the other unexpectedly via me.

Host: That's wonderful. Why did you want to write about this in your book called infertility?

Kathryn Blaze Baum: So I'm a journalist, I'm an investigative reporter. I've been doing that kind of work for the better part of two decades. So while I was going through this head spinning, totally consuming experience, I would lie on the exam table and sort of look up at the clinic ceiling and think to myself, you know, one day I'm going to write about all of this. And I didn't know exactly what form it would take, but I just had so many questions about what was going on around me, why things were the way that they were, and I realised that I wanted to write the book that I wish I had when I was going through surrogacy. I wanted it to be deeply personal and deeply reported. So it's part memoir and part journalism.

Host: I was really interested that you interviewed the first test tube baby, Louise Brown. What were her revelations? Did you get any revelations from anything you spoke to her about?

Kathryn Blaze Baum: I just thought it was so interesting because it felt sort of like this snapshot in time or like a time machine, I guess, where she was born in the late 1970s in Oldham, in England. And just hearing her sort of talk about how she learned that she was sort of the world's first IVF baby, and the fact that sort of by the time she really understood it, she was already in textbooks and she was sort of being taught it in the classroom. I thought that was really interesting. And one thing that really resonated with me, and it's why I included it in the book, was she explained that her mother and her father had been told by doctors that, you know, they had a I think she said, you know, a 1 in 1,000,000 chance that she might be able to get pregnant. And many people would hear that as a very low probability. And what her mom heard was there's a chance. And so I thought that was just very indicative about the mindset of somebody who wants this so badly.

Host: How does access affect a person's ability to start their IVF journey?

Kathryn Blaze Baum: I think there's a few things to talk about when we talk about access. Obviously, the first thing that we should talk about is financial access. IVF is expensive. It's somewhere in the order of 15 to $20,000. It can be a little bit less. It can be more depending on the medications and the protocols and whether you avail yourself of any sort of add on treatments. But it's very expensive. And I think it's also very important for people to know that it doesn't typically work the first time. So that $20,000 can quickly become 40. If you can afford it and scrounge it together, it can escalate beyond that as well. And so, you know, yes, there are some provinces and territories that offer some amount of funding to help support people through a fertility journey. But it's not there's not a single province or territory that funds it entirely. The other thing that we should talk about is geographic access. I think people will be surprised to know that there are some provinces and territories that don't have a single IVF clinic that does the complicated work of an egg retrieval or an embryo transfer. You have to get on a plane or drive. And these are very complicated treatments that have to be timed to your cycle. So it's very unpredictable. So you're layering on the finances, geographic access, and then, you know, there's waitlists too, right? Like if you're doing a private pay cycle, you can usually get in for a clinic consultation. But if you're trying to go through sort of the public funding process, there's a waitlist and they can be months long, they can be years long. And that goes against everything in fertility, where we're told constantly that time is of the essence.

Host: Understanding that it varies individually. What was the physical toll for you? I mean, you had E.R. visits. You had very difficult physical moments throughout five retrievals. Tell me a little bit about the toll it took on you.

Kathryn Blaze Baum: I went into IVF with the total wrong mindset. I had no idea the physical toll that this was going to take on me. This is separate from the emotional toll, the financial toll, the toll on relationships. Physically, it was very difficult. I am somebody who responded very well to the medications, which is what you want. I would have 50 follicles growing. They would remove 30 some odd eggs from my body. That's that's what you want. Because the more eggs you have, the higher the chances are that you're going to be successful. What it also meant was that I had complications from retrievals where I would, you know, fill up with fluid and I would have like this bloating where I would, it was horrible because you would look really pregnant. And that's all you're wanting is to be pregnant. Like, I couldn't wear pants, I was tired, I had excruciating headaches, I would get dizzy. There were a couple of times where during the process, due to the medications, I fainted, including one time where I woke up on the bathroom floor in the middle of the night with blood everywhere. And then I started vomiting, went into shock, ended up in the hospital needing 11 stitches in my face. And you would think that that would be some sort of rock bottom. But I did it again. And I did another retrieval and I fainted again. And the paramedics came because my blood pressure was so, you know, it's for some people, it can be straightforward. It can have not such a dramatic toll. But I interviewed people for this book and I've read a lot for this book, and I have learned that being told that you should take the day off of work to do your egg retrieval, but you can go back to work the next day isn't true for a lot of people. And I think we're not calibrating people's expectations about what it feels like.

Host: And you had some complications also that required surgery. Can you talk a little bit about that?

Kathryn Blaze Baum: I had a miscarriage when we were beginning our journey to give our daughter, Sydney, a sibling, and that miscarriage resulted in the need for a D and C, which is a dilation and curettage procedure to remove some retained tissues of pregnancy that my body was having trouble sort of naturally expelling, and I didn't know it at the time. But the theory is, and my doctors believe that through that D and C, there's the scraping that I had developed scar tissue in my uterus, and that the scar tissue in my uterus was actually potentially responsible for the miscarriages that I had afterward, because it can interfere with implantation. So I did end up needing uterine surgery twice to try to repair the scar tissue in my uterus.

Host: You've been through a lot physically. So talk a little bit about the toll it took on you mentally and psychologically as well, that you were in this grip of IVF.

Kathryn Blaze Baum: IVF for me and for many of the patients that I interviewed for the book is very consuming. It is, for many people, an existential fight for like for life, literally. And it can become just very consuming. And it takes over your mind entirely. It takes over your days, it takes over your calendars, it makes your calendar a landmine because you know, are you going to be pregnant at this friend's baby shower? Or are you going to be miscarrying? Or are you going to be devastated by a transfer that didn't work? It it's really the white noise of your life is the way I sort of describe it.

Host: And the toll it takes on relationships. For instance, with either family members or friends or colleagues that are having babies when you're not able to get pregnant. What was that like?

Kathryn Blaze Baum: Yeah, there's there's a serious toll, I think, on relationships that can happen in some cases. Of course, they can be strengthened because you find that people show up for you in these beautiful ways and you feel really supported. It can also cause a fair amount of distance between yourself and friends or siblings or relatives who are having an easier time and who maybe aren't being super sensitive to what you're going through, or you're just triggered by their very existence. And so, you know, it can be very isolating. Oftentimes people don't know how to talk to you about it. You don't really know what you want to hear or what you want to say. And that's part of the reason I wrote the book, is I wanted people to have a place where they can sort of work through some of these emotional sort of trauma that they're going through, this uncertainty that they're going through in a way that has them feel seen and supported, but not necessarily having to explain everything all the time to a loved one.

Host: I think it's a little bit like grief, right? People don't know what to say to you when you're grieving the loss of a loved one. In many ways, the fertility journey is a series of grieving, is it not?

Kathryn Blaze Baum: I think that's I think that's right. In my case, I did feel a lot of grief along the way. There was the grief of not making your way to the family that you envisioned and sort of your grieving this, this inability to get to where you thought you were going to be. But then there's like the more sort of tangible grief of, you've gone to an ultrasound, you've seen the heartbeat, you've held the sonogram image, you've put the hand on your tummy, you've felt the changes in your body. Those cells have become somebody to you. And so when you lose a pregnancy, I felt like I was losing a baby. And it is it was completely overwhelming to move through that in such a gory way, oftentimes and in such a physical way. It's a lot because there's the emotional loss. But then there's also this physical thing that's happening to you, and you're angry at your body for shutting down a pregnancy, and you're frustrated that, why is this happening to me again? And I think, you know, we talk about it more now, but it happens so frequently, right? Like 1 in 4 women, it's estimated experience miscarriage. And I feel like there is a lot of grief that happens in an IVF journey. And it's sometimes it's these smaller things along the way. And sometimes it's these big things. You know, I spoke with women who had stillborns and it's unfathomable.

Host: And when your journey went along and you came to the part where you were looking for a surrogate, how did you make that transition?

Kathryn Blaze Baum: So I think for us, and I write about this, that at the point in our journey where we turned our attention to potentially going through a surrogacy journey, I was still hopeful that in the end, I was actually going to be the one that was going to get pregnant and stay pregnant. And so I think it was a good time actually, to start thinking about that, because I was able to sort of move through it in maybe a less emotional way, sort of having the consultation calls with the surrogacy agencies and understanding the process. And then when it came time to actually embark on that journey, I had lost so much trust in my own body that I knew that we needed help. And it turned from this kind of sort of scary thing where you're relinquishing control to this hopeful avenue that I knew could actually be quite beautiful. And once we got on the phone with a potential surrogate named Stacy, I could tell right away that I just had this, like, relief go through me that, okay, you know, I think I think I can do this, I think we can do this. And it was this wonderful thing where I was able to trust her. And ultimately our second surrogate, because it was a very complicated journey to do this, because they gave us every reason to trust them.

Host: I just would love to hear how it was for you when you found out you were naturally pregnant after, you know, three months of your second surrogate's pregnancy.

Kathryn Blaze Baum: So our surrogate Kendra, bless her, was around, you know, 20 ish weeks pregnant. And at that time, I was thinking like, I'm not feeling well. I was nauseous and tired and my skin was kind of having these changes that I thought were maybe indicative of something going on in my body. But I remember saying to my husband, like, if I didn't know any better, I would think maybe I was pregnant. But for many reasons, you know, chief among them, the fact that my uterus had not been particularly hospitable in recent years, we didn't think that that was the case. But I was so nauseous one afternoon that I did take a pregnancy test. And before I could even put the, like, little pink cap back on, I looked down and there were two lines and I was just my brain like, could not compute what was happening. And so I called my husband and I'm like, come here, come here, come here, hand him the test. And he's like, what is this? Using much more colourful language. And I just sort of burst out laughing because it seemed so like comical and nonsensical and unbelievable to me that after everything that we had been through, when we were finally on this sort of straight line of a journey with a surrogate that was 20 weeks pregnant, that all of a sudden I too was pregnant. And we did the math and we realised I was about seven weeks. And so it wasn't until we went into the fertility clinic and actually saw on the ultrasound the flickering heartbeat, that I let myself think that this might actually be real, because we'd had so many losses. And as somebody who had been through miscarriage, and I think I can speak for a lot of women who have, you don't really trust the pregnancy test anymore, and you don't really let yourself go to that place. You don't really let yourself feel excited. And it took a while, like many weeks, for us to actually believe that this was real, that this was happening. And as the pregnancy went on, we were like, this is real. And we were so joyful because I, we wanted we wanted lots of kids.

Host: How do you think IVF would benefit from the marketing push that perimenopause and menopause are getting right now?

Kathryn Blaze Baum: I am grateful for the push that perimenopause and menopause are getting right now. Like I am a woman in my early 40s, like I am headed in that direction. And I am so grateful that there is this loud conversation that is happening. I'm sure there's much more that needs to happen, but how wonderful that this isn't happening in the shadows. How wonderful that we see it on bus stops. How wonderful that we're talking about it. And I think that there is more conversation around fertility that's happening, but there needs to be even more. And I think we need to be having it in much more frank and honest terms. And I think we need to understand and convey to people that fertility does decline with age. Miscarriage rates increase with age, IVF success rates decline with age. We need to be very clear about that so that people can sort of measure their expectations. And I also think we need to be more clear about the financial toll, the physical toll and the emotional toll that this can have on people, because by the time you show up at a clinic, you're usually at a pretty beaten down place, but you're trying to be hopeful because you're about to do something different and you're about to do something new. And science is here to help. And in many ways it does. And obviously, I am very grateful for IVF and modern science. But there are limits, and I think we need to talk about those. And I think we need to be much more clear with patients, women, men, everyone, all people about what this actually involves and what it can look and feel like.

Host: With two babies in arms. What would you tell women or couples who are embarking on this journey?

Kathryn Blaze Baum: I mean, I would say first and foremost, like, please measure your expectations, understand what the success rates are for somebody in your personal position. Ask a lot of questions because as fertility patients embarking on this existential journey, we are oftentimes quite desperate and oftentimes quite uninformed. So that can be a dangerous combination. So please ask questions and do your research. And then I would also say in this kind of maybe sounds a bit contradictory, but I think you also need to have hope because it is what's going to carry you through. I say that it sounds contradictory because I'm also asking you to measure your expectations, but I think you can kind of calibrate your expectations and still have hope. There's a difference between expecting something to happen and hoping for something to happen.

Host: Great. Thank you very much.

Kathryn Blaze Baum: Thank you.

Host: I'm Jeyan. Thanks for watching The Rundown. What do you like or not like about what we're doing so far? Send us your feedback at TVO.org/rundownfeedback, or as always, leave us a comment on our YouTube page. Until then, I will see you next week.