Sponsored: The medical side of infertility

Like most women, Christine Roy assumed that when she was ready to start a family with her husband, Stephan, the couple would conceive easily, announce their pregnancy, and find themselves, nine months later, in the maternity ward, snapping shots of their newborn. It was a pretty reasonable assumption on her part, judging by how quickly her friends were sharing results of their positive pregnancy tests.

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It turns out that things didn’t happen so lickety-split for the Roys. After trying to conceive for almost a year with no luck, Roy, then 27, was worried. “It seemed so easy for everyone else, and we were wondering what was taking us so long,” she says. Soon after, the couple was referred to a fertility clinic in a city almost an hour away from their Niagara Falls, Ont. home.

After an initial diagnosis of Polycystic Ovarian Syndrome (PCOS) it, thankfully, took just two months on a combination of the drugs Metformin (to treat her PCOS) and Clomid (to stimulate ovulation) to conceive. Roy carried her baby to term, and they welcomed a healthy 9 lb., 3 oz. baby girl named Maddy.

Fast-forward three years, three types of medication, two devastating miscarriages and a chemical pregnancy, hormone injections, a $15,000 bill, an incalculable amount of stress and grief, and Roy is still hoping to make Maddy a big sister.

Infertility statistics The Roys are not alone in their hope for a bigger family. Fertility problems and infertility are on the rise for Canadian couples. According to research published in March 2012 in the Journal Human Reproduction, 16 percent of heterosexual couples (where the woman is 18 to 44 years old) are dealing with infertility. That statistic has nearly doubled over the last decade. Not everyone knows that problems conceiving also affect the under-30 crowd—up to almost 14 percent of Canadian women 18 to 29 have also had a tough time getting pregnant.

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The physical toll it takes while trying to have a baby is only part of the story. Dara Roth Edney, an assisted fertility/infertility counsellor based in Toronto, who, thanks to surrogacy after experiencing infertility herself, is a mom of two, says the emotional toll of being diagnosed with infertility is profoundly excruciating.

“Studies show that the psychological impact of ongoing infertility is comparable to the depression women who go through cancer treatments or suffer from heart disease experience,” she says. “When a couple receives a diagnosis of infertility, it colours everything in their world,” confirms Ottawa mom Gillian Wood, who spent five years and $38,000 in treatments, including the reverse vasectomy her husband had when he was 33, and one round of in vitro fertilization (IVF) to conceive. “It results in financial hardship and problems concentrating at work. It causes divorce. It shatters dreams and hopes. It is life altering,” she says. It can push a fragile couple over the edge. So can dealing with people who don’t understand that infertility is a medical condition.

The latter is something we didn’t expect to hear from readers when Today’s Parent, in partnership with EMD Inc., Canada (a company that provides drug therapies that address patient needs in fertility, endocrinology and neurodegenerative diseases) conducted a survey earlier this year. Of the more than 1,000 people who responded, we were surprised that a quarter of respondents believe that not being able to have a baby is caused by something other than a health problem. (Many people believe that lifestyle choices, including waiting longer to start a family, are the most common causes of fertility issues.)

Infertility as a medical condition “If it’s not a medical condition, what is it?” asks Ellen Greenblatt, the head of the Division of Reproductive Sciences and the medical director of the Centre for Fertility and Reproductive Health and IVF unit at Mount Sinai Hospital in Toronto. “Some people aren’t very well informed,” she says, especially those who believe that infertility only affects women older than 35. Whether or not you agree with infertility being a health problem, the World Health Organization (WHO) says it most certainly is, and the United Nations (UN) recognizes a person’s right to have a family. “People don’t choose to be infertile; it’s not a lifestyle choice, it’s like having any other condition,” Greenblatt says.

Jason Hitkari, an obstetrician and gynaecologist, and co-director of the Olive Fertility Centre in Vancouver, says there’s a misconception that having children is a “perk” and not guaranteed to everyone. “We need to move away from blaming the patient for the predicament they are in and start supporting those who want what some of us more easily obtain.”

Infertility support And besides empathy and emotional support for couples, financial assistance comes into play. 68 percent of all respondents to our survey said that they believe the government should provide financial help for people undergoing fertility treatments. But unless you live in Quebec (where treatments—including IVF—are covered by the provincial government) or Manitoba (where the province offers a tax credit), you pay for treatment out of pocket. Countries such as Australia, Sweden, Israel and France also cover treatments. “Infertility is a disease of the reproductive organs,” explains Roth Edney. Hitkari agrees that because it is a disease, the government should help people who can’t conceive on their own. “A person can smoke a pack of cigarettes a day for 30 years and develop all kinds of medical complications, and treatment of every one of these complications is covered by provincial health authorities,” he says. “However, a woman who has problems with her fallopian tubes and can’t conceive receives no funding for her fertility treatment. As a developed society, I am embarrassed by this discrepancy. Many other countries are much more ready to recognize infertility as a medical issue and have been funding treatment for some time.”

Wood considers herself very lucky that their first IVF treatment resulted in a successful pregnancy and the birth of her daughter. “My husband and I had hoped to go for IVF again, to give our daughter a sibling, but it’s too costly, and, in the end, we’d never be certain to get as lucky as we did the first time around,” she says. “To those who don’t believe it’s a medical condition, how would you feel if your daughter couldn’t conceive and give you a grandchild? Or if, at Christmas dinner, there were never young children, only the family growing older and fewer? No one to give cherished family heirlooms to? No one to watch as they grow up?” At this point in their lives, they’ve decided to put a halt on Number Two. “We are a family of three and we will have to remain that way, even if it wasn’t our plan.”

As for the Roys, the couple recently took a break from trying, and then began treatment again at a new fertility clinic. They’re working with their doctors on a new plan to conceive. They’ve had to go through more testing to find out why they lost three pregnancies, but Christine is trying to stay positive. “We certainly didn’t expect to have such a hard time. Tests are evasive and the simple fact of not knowing whether you will be pregnant at the end of the month is hard,” Christine says. “I never knew we would have problems conceiving and carrying a baby to full-term, especially after having Maddy. Three years later and we’re still praying for another miracle.”

A version of this article appeared in our May 2013 issue with the headline "The medical side of infertility," pp. 54-55.

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