November 8, 2024
The Empire Club of Canada Presents
The Future of Fertility – Access Challenges and Opportunities in a Changing World
Chairperson: Jenna Donelson, President, Board of Directors, Empire Club of Canada
Moderator
Teri Hart, Journalist & TV Host
Panellists
Zane Colt, Board Chair, Conceivable Dreams
Dr. Meivys Garcia, Medical Director & Senior Partner, Markham Fertility
Maya Khurana, Associate Vice President, Healthcare Strategy, Manulife Group Benefits
Head Table Guests
The Honourable Sylvia Jones, Deputy Premier and Ontario’s Minister of Health
Javed Alam, Managing Director, EMD Serono
Welcome Address by Jenna Donelson, President, Board of Directors, Empire Club of Canada
Good afternoon, and welcome to the Empire Club of Canada. I’m Jenna Donelson. I’m chair of this historic organization, and your host for today’s event.
To formally begin, I want to acknowledge that we are gathering on the Traditional and Treaty Lands of the Mississaugas of the Credit, and the homelands of the Anishinaabe, the Haudenosaunee, and the Wendat Peoples. I encourage you all to learn more about the Traditional Territory on which you live and work.
I would also like to begin by recognizing our sponsors today. The Empire Club is a non-profit organization, and none of this would be possible without the generous support of our sponsors, who also make viewing online complimentary. So, please join me in thanking our Lead Event Sponsor, EMD Serono. And thank you, as well, to our VIP Reception Sponsors, the George and Helen Vari Foundation, and Ferring Pharmaceuticals. And thank you, as well, to our Supporting Sponsor for this event, Twig Fertility. And I also want to thank our In-Kind Sponsor for this event, the Human Resources Professionals Association. Thank you. I also want to extend my thanks to our Lead Season Sponsors, Bruce Power and Hydro One, and our VIP Reception Season Sponsor, Waste Connections of Canada. And finally, thank you to our Media Partner, the Toronto Star, and our AV Partner, Bespoke Audio Visual.
If you have questions for our speakers, please scan the QR code that is found on your program, or through the Q&A function, if you’re online. For those of you online, if you require technical assistance, please reach out to our staff, using the chat button.
Today’s event is about a deeply personal and timely topic, fertility. According to Statistics Canada, Canada’s fertility rate reached a record low last year of 1.26 children per woman; this is the lowest record recorded since the agency began collecting data. Canada also ranks among the lowest low-fertility nations. And many of us have heard about how this decline has significant implications for our population growth, for our economy, and for our society. But more importantly, for the people who are struggling to conceive, these are not statistics; it’s something they’re living with, thinking about, and struggling with. And it seems to me that, in the past, fertility wasn’t always discussed. Couples really felt like they were on their own. But I believe we’re seeing an end to that stigma. And by bringing their journeys out into the open, more and more people are realizing they don’t have to feel alone or unsupported. In fact, I’m sure, if we walked around this room today, we would all know someone, or perhaps even be someone, who’s faced these sort of challenges. So, I think it’s very fitting that, for the first time in our 121-year history, the Empire Club is taking the lead in hosting an event on fertility.
Often, at these events, I look back at our long history as a club, to reflect on the evolution of Canada’s ongoing and important conversations. But today’s a little different, because this is a first-of-its-kind event at our podium. We’re bringing together key leaders at the intersection of politics and policy, business, medicine, and advocacy, many of which also bring lived experience to this discussion. And it’s not lost on me that we are all here today, because many people bravely committed to ensuring that conversations about fertility and care were not just relegated to living rooms, and doctors’ offices. And so, here we are. All of you sitting here today, those of you watching online, like me, are eager to hear from our panel of experts. So, thank you for joining me, as we create a little history here, both for the Empire Club, and we hope for a more accessible future for fertility care in Ontario and Canada.
To begin today, I’m thrilled to introduce the Honourable Sylvia Jones, Ontario’s Deputy Premier and Minister of Health. Minister Jones will open up today’s conversation, by diving in to the government’s recent commitment to expand the Ontario Fertility Program, something I think every person in this room is probably aware of. And I know we’re all keen to hear from her. So, without further ado, please join me in welcoming to the stage the Honourable Sylvia Jones.
Opening Remarks by The Honourable Sylvia Jones, Deputy Premier & Minister of Health for Ontario
Thank you so much, Jenna. It’s great to be back at the Empire Club. Good afternoon. It is truly a pleasure to join you all today. You know, when Premier Ford appointed me as the Minister of Health, he had some pretty clear messages. And one is show progress, one is celebrate success, and collaborate. I think this qualifies. What do you think? It’s wonderful to be part of a conversation about the future of fertility in Ontario, and to highlight the action our government is taking, to connect more families to the care they need closer to home. I want to thank the Empire Club for the opportunity to join you here today, and to the many healthcare partners and advocates who have joined us, thank you for everything you do, to provide care and support for those wanting to start or grow their family.
Under the leadership of Premier Ford, our government is making record investments in healthcare, to make it easier and more convenient for families to connect to the care they need at every stage of their life. Our province is proud to lead the country, adding the greatest number of new healthcare workers, achieving the highest rates of access to a regular primary care provider, and some of the shortest wait times for surgeries. And we are not stopping there. Our plan is called Your Health, and it is focused on taking bold and innovative actions, to make changes to provide more people with the right care in the right place. Our government is expanding capacity in hospitals, and shortening wait times, getting shovels in the ground for over 50 hospital developments, and adding 49 new MRI and CT machines, across Ontario. We are increasing access to primary care, to connect every single person in Ontario who wants a primary care provider to have one in the next five years. We’re doing that by expanding interprofessional primary care teams, connecting more than 600,000 people to primary care, which we’ve already started. And of course, launching the largest medical school expansion in over a decade, adding new medical schools in Brampton, Scarborough, and Vaughan, breaking down barriers to highly-skilled, internationally-educated primary care providers, and establishing a new primary care action team. Our government is also improving access to key services, like publicly-funded fertility treatment.
A few weeks ago, as part of our government’s Fall Economic Statement, our government announced we were tripling the number of new and growing families that can access government-funded in vitro fertilization cycles close to home. This investment of 150 million dollars to expand the Ontario Fertility Program, and creating a Fertility Medical Expense Tax Credit, is truly a game-changer for families in Ontario. Through the Ontario Fertility Program, our government currently provides access to publicly-funded fertility services, like in vitro fertilization, or fertility preservation. For 1,300 growing families, access care at 50 clinics across Ontario. We recognize that there is more that can be done, to give everyone in Ontario that special chance at parenthood. Taking the step to start or grow your family can be a stressful time. The last thing you should have to worry about is whether you’ll be able to access the support and services you need on this journey.
I remember meeting with some families in Windsor, in the fall of 2022, when our government announced funding to support nearly 150 families each year in Windsor-Essex, with access to publicly-funded in vitro fertilization treatments. I heard firsthand the challenges they faced. The hours of travel down the 401, the financial strain, and the emotional toll of trying to build a family far from home. I also saw the relief and the hope that our investment brought. For families in the region, it meant that that opportunity to grow their families, with the support of government-funded services, was no longer out of reach. It meant each year 150 families would not have to choose between paying out-of-pocket for services, leaving home for help, or giving up the dream of having children. That is one step on our government’s expansion of fertility services. And now, through this year’s Fall Economic Statement, we are extending that same hope and relief to new and growing families across Ontario.
Starting in 2025-26, our government’s investments will help tens of thousands more Ontario families connect to in vitro fertilization close to home, by reducing wait times at community and hospital clinics, helping cover the cost of what can be overwhelming expenses, and giving Ontarians more choices, by expanding the Ontario Fertility Program to more clinics. To further provide financial support for families seeking fertility treatment, our government’s new tax credit, effective January of 2025, will cover up to 25% of eligible expenses. The new tax credit will build on Ontario’s existing Medical Expense Tax Credit, and help cover expenses such as IVF cycles, fertility medications, travel for treatment, and diagnostic tests. For example, a family who incurs $20,000 for a privately-funded IVF treatment could be eligible to receive $5,000 in support. Easing—thank you—it’s all about easing the strain for families, on their journey to grow their families. Our announcement will make it easier and faster than ever before for more families to access key fertility treatments and care, closer to home.
Facing infertility or difficulty conceiving is an incredibly difficult and painful experience. Concerns about how to afford fertility treatment can add to that anxiety and stress. Supporting more families to access fertility services is one more way our government continues to take action to connect more people to the care they need, where and when they need it. Thank you to all the families, the advocates, the healthcare partners across Ontario, who have made this change possible, including many of you, who have joined us today. Our government truly has appreciated your insights and supports, as we’ve worked to make this change, and we hope will bring new and growing families across Ontario. Together, we are building a more connected and convenient healthcare system. Thank you, again, for the opportunity to join you. Stay well.
Jenna Donelson
Thank you, Minister Jones, for sharing that good news and for those thoughtful remarks, and we are always honoured to have you at our podium, here at the Empire Club. Fertility care is a complex topic, and there are a lot of different angles that we can view it from. Fortunately, we have a panel of experts with us today, who bring an amazing amount of depth and diversity to this conversation. Today, we’re gonna have a multifaceted conversation that obviously has a medical element, but also is a policy conversation, and an HR and business conversation, because they have a role to play, in helping make it easier on employees who are going through this. That’s why we have our diverse panel with us. Our skillful moderator today is Teri Hart, a familiar face in Canadian media. She has interviewed industry leaders across various sectors, and currently hosts Teri Hart’s Super Channel Super Picks. She has also worked as a public speaking coach, and she empowers people to communicate effectively. Please join me in welcoming to our stage, Teri Hart.
And before I call our panellists up, I’d just like to recognize that Ayman Alvi, Vice President of Global Pension and Benefits at Scotiabank, was unable to join us today, due to an unforeseen issue. But thankfully, we still have a wonderful group of panellists, and I’m delighted to welcome them up on stage. They are Dr. Meivys Garcia, Medical Director and Senior Partner at Markham Fertility Centre, who brings invaluable clinical insights from her experience in fertility care. We also have Zane Colt, Board Chair of Conceivable Dreams, who has long-championed accessibility to fertility treatments in Ontario. And Maya Kurana, Associate Vice President of Healthcare Strategy at Manulife Group Benefits, who leads strategies for healthcare and wellness innovations, bringing a broad perspective on businesses’ role in supporting fertility. So, please join me in welcoming our moderator and distinguished panel to the stage.
Teri Hart, Journalist & TV Host
Hi everybody. It really is a thrill to be here, for this really groundbreaking conversation at the Empire Club. Thanks so much for your wonderful words and introduction, Jenna. I am thrilled to be here to help remove the stigma and really to continue the momentum in conversations about infertility, especially that wonderful announcement that we just heard about the Ontario Fertility Program. Thanks so much for that. I personally am incredibly passionate about the epidemic of infertility. I am child-free, not by choice. And if there’s anything I can do, in my lifetime, to impact and improve the experience that people find themselves in, while trying to build their families, then my time here will be very, very well spent. This is an experience that one-in-six Canadian couples face. So, it’s incredibly relevant.
Before we dive in, I know we have a lot of people here from Bay Street, and a lot of people here from executive offices. And if you are sitting there, and wondering how exactly does this impact me? Do I really know anybody? Here’s what I guarantee you: somebody in your office has gone to the bathroom, in your office, to give themselves a shot. Somebody in your office has taken a phone call, to find out whether they are pregnant or not, or whether that cycle that they are being monitored for will continue to the next step, or not. This is happening in offices across the world, and certainly, in Canada. So, it impacts us all, whether you see it or not.
So, I just wanna start. Thanks so much for being here, everybody. We’re gonna have more fun than that little tidbit, though, I guarantee ya. Let’s start with Dr. Garcia. I, no matter how many years I’ve done this, I think there really is a huge information gap around the time commitment for individuals, for couples, who are in a cycle-monitoring phase—that terminology may be new to some people, here. So, can you give us some insight into what a cycle-monitoring phase is, in terms of helping somebody to conceive? And can you walk us through what that means, in terms of fertility treatment?
Dr. Meivys Garcia, Medical Director & Senior Partner, Markham Fertility
Yes, absolutely. And understanding the need of fertility patients during cycle-monitoring is key to having their empathy and their understanding, in the workplace. So, cycle-monitoring refers to doing bloodwork and ultrasound, and it is a very important part of any IVF, any, any fertility treatment cycle, whether it is IVF, or IUI, or embryo transfer. This appointments….
Teri Hart
I’m just gonna—’cause we get so close to this, IVF being….
Dr. Meivys Garcia
In vitro fertilization.
Teri Hart
In vitro fertilization. And IUI being…
Dr. Meivys Garcia
Intrauterine insemination…
Teri Hart
Thank you.
Dr. Meivys Garcia
…and embryo transfer.
Teri Hart
Thank you.
Dr. Meivys Garcia
These appointments have to be done in person—appointments for consultation can be done virtually, but appointments for cycle-monitoring have to be done in person—and they have to be done at a specific time of the cycle. That means an employee, for example, cannot just schedule these appointments three months in advance, because we don’t know when the menstrual cycle is going to happen, how the cycle is gonna progress, how the person is gonna respond to the medications. So, they kind of, people usually get one or two days notice of when they have to come for the appointments. The appointments are also happening at a specific time of the day. It’s not like we could do it at 4 p.m. or 5 p.m., or after hours; they have to be done in the morning. Because fertility specialists need that information, in order to make the decisions for the next step in the cycle.
Teri Hart
And what time of the day? So…
Dr. Meivys Garcia
It’s very early in the morning.
Teri Hart
…it’s very early in the morning.
Dr. Meivys Garcia
It’s usually six, seven, eight in the morning. Usually, different cycle-monitoring appointments are done.
Teri Hart
And your window for cycle-monitoring closes at about?
Dr. Meivys Garcia
Usually, around 8:30.
Teri Hart
8:30.
Dr. Meivys Garcia
At most clinics, yeah.
Teri Hart
So, you go, and you have a transvaginal ultrasound?
Dr. Meivys Garcia
Transvaginal ultrasound, bloodwork, and then the patients have to meet with either a fertility doctor or a nurse, to understand what is happening in the cycle, like how well the ovaries are responding to the medication, what kind of medications you’re gonna need for the next step. And then, usually, around lunchtime, they get those phone calls, or those messages, saying, “Yes, your estrogen level is doing great….”
Teri Hart
Your uterine lining is this.
Dr. Meivys Garcia
Right, it is now time for the next step. And that next step could be an egg retrieval, which is a process where the patients have to have the eggs removed. It’s done in the clinic, it’s done under sedation. They absolutely need the day off, for that procedure, and they’re only getting 36 hours notice, in order to book that treatment, because that’s just the nature of how the cycle-monitoring is.
Teri Hart
And when you’re in a cycle-monitoring month, how many days are you going for the bloodwork, the transvaginal ultrasound, the information, and waiting for that phone call that happens between noon and one o’clock?
Dr. Meivys Garcia
Yeah. That, usually it’s about four to six times, in a menstrual cycle. The cycle-monitoring phase is usually lasting about 10 to 12 days, and about four or five of those days, the patients are gonna need to go for cycle-monitoring.
Teri Hart
Okay. So, that gives some insight into the time, from a medical standpoint. Zane…
Zane Colt, Board Chair, Conceivable Dreams
Yeah.
Teri Hart
Everybody’s like, whoa. It’s anybody who didn’t know.
Dr. Meivys Garcia
Yes.
Teri Hart
People who knew are like, uh-huh. So, I do think that you are the perfect person to kind of expand on what Dr. Garcia just outlined for us, in terms of, if you can expand on not just the time, but also from a cost, and a drug, and a medical intervention, mental health perspective. You just went through this process, you and your wife…
Zane Colt
Yeah.
Teri Hart
…had an IVF retrieval.
Zane Colt
Yes.
Teri Hart
Congratulations on getting to that stage. And so, give us an idea of all the different elements that go into that experience.
Zane Colt
Yeah, I think Dr. Garcia summed it up very, very well. But we got a, a negative pregnancy result. We’re on a surrogacy journey, so our surrogate got a negative pregnancy result. And the following morning, my wife’s day one, she, you know, began her menstrual cycle. And so, we had a decision to make. We’re out of embryos, we wanna continue building our family; clinics kinda closed the last week of December for cleaning and things, and the holidays. So, we wanted to strike while the iron was hot, and we had to go into the clinic and begin our day one with, with little notice. And yeah, she was in clinic every other—first every three days, then every two days, then every day, leading up to an egg retrieval; taking time off work to be able to do that, getting more and more uncomfortable, more and more bloated. And of course…
Teri Hart
I just wanna interrupt, ’cause another thing that is happening, when you’re in cycle-monitoring, when you’re having a cycle that you are having medical intervention in, is 9 times out of 10—correct me, if I’m wrong on that, Dr. Garcia—but you are also on a huge drug protocol.
Zane Colt
Yeah.
Teri Hart
A drug protocol that is hoping to create more eggs, and improve your uterine lining, and a bunch of other things that need to happen.
Zane Colt
Yeah, and there’s, there’s side effects of those drugs, right? And you think about women who have to wear tight-fitting clothing, or a uniform every day; as they get closer and closer to their egg retrieval, it’s gonna be less and less comfortable. So, yeah, there’s, there’s a mental health element there. There’s a bit of body image issues, in the short term. Obviously, anxiety leading up to an egg retrieval, and just fear and, and nerves. In terms of the drugs, our bill was about $5,600. You know, I work for, for a company where there is a drug plan that covers fertility drugs. So, most of that is covered—I sent in the receipts, I hope to get a check in the mail, in the next couple of weeks, but we’ll have to wait and see, it’s supposed to be covered. But so many don’t. And as an employee, I was asking the, when I was getting a contract, I was asking for the benefits booklet. I wanted to know what’s gonna be covered, because I knew that we had this on the horizon for us. And I think it’s a decision that employees are going to be making in the future, to say, I’m not just looking for the best salary, I’m looking for the best whole package, here. And I need to know whether fertility medication or fertility treatment is included in that.
Teri Hart
Zane, you just teed me up like nobody’s business.
Zane Colt
Over to Maya.
Teri Hart
Right over to Maya. Hi.
Maya Khurana, Associate Vice President, Healthcare Strategy, Manulife Group Benefits
Hi.
Teri Hart
I can barely see you. Our angle is off. Now I feel better, I can see you. So, in a lot of ways, insurance companies are the middle person between employees and employers, and coming up with programs and benefits that companies can purchase, so that those employees feel supported within fertility treatment, and other aspects of life as well. Can you give us some examples of where we are making progress in this area, specifically, when it comes to fertility treatment?
Maya Khurana
Yeah, absolutely. So, most of the progress that has been made in fertility coverage has been over the last five years. Prior to then, it was more discussed on an ad hoc basis. So, an employer might go to an insurance company and say, “I want this covered for my employees.” And we’ll think about ways of making it work. But now, there’s a standardized fertility product on the shelf, which includes coverage for IVF, IUI, egg freezing, egg donation, surrogacy adoption, which are sometimes the only way couples and individuals can grow their families. So, there’s been good progress over the last five years, and we need to continue building on that momentum, ’cause the journey does not stop here.
Teri Hart
No, it doesn’t.
Maya Khurana
No.
Teri Hart
We, we’re at the beginning.
Maya Khurana
Yeah.
Teri Hart
Five years is a very short period of time. We’ve got a long way to go. And getting there is going to take conversations like this, and understandings like this.
Zane Colt
Just because the product is offered, it still needs companies to sign on, and want to purchase that…
Maya Khurana
Absolutely.
Zane Colt
…for their employees, right?
Teri Hart
M’hm (affirmative).
Zane Colt
The product’s on the shelf, they have to take it off the shelf.
Teri Hart
Right.
Maya Khurana
The voice of the employer is really, really influential. So, we need a lot more noise, more volume, employers asking for it, Canadians asking for it. And that will improve penetration…
Teri Hart
Amazing.
Maya Khurana
…and make sure more people have access to it.
Teri Hart
Incredible. We’re gonna dive more into that, as we go through the conversation. We just heard from the Honourable Sylvia Jones about—Ontario’s Deputy Premier and Minister of Health—about that wonderful improvement to the Ontario Fertility Program. Zane, Conceivable Dreams was a driving force behind this change, and this announcement. What will, like, tactically, what will this change mean for patients?
Zane Colt
So, in the short term, they’re, they’re saying that waitlist, wait times are going to be halved, or they’re going from 5,000 cycles of IVF in any given year to up to 20,000, over the next two years. People are aging out of the program, while they’re stuck on wait lists. People are saying, you know, what, it’s taking too long, I wanna be able to build my family, I might as well just pay out of, out-of-pocket, and not use this funded cycle that’s available to me. You also have to think about the, the bucket of funds for IVF is the same bucket of funds as fertility preservation for oncology patients, for example. So, there were women who were facing, staring down the barrel of, of chemotherapy, and the clinics were telling them, “I’m sorry, we ran out of funds for this year.” And so, now there’s more funds available, so that they’re able to freeze their eggs, in advance of going for, for treatment for oncology, for cancer. So, that’s, that’s huge, that’s significant, and it’s gonna be life-changing for patients all over Ontario. The, the tax credit is something that we were really pushing, pushing hard for, from a patient perspective. Because, in addition to the cost of IVF, the cost of treatment, there’s so many other costs that go into this. For, for my wife and I, we’re spending a lot of money on PGT testing—what’s, what is the acronym for it?
Dr. Meivys Garcia
Pre-implantation genetic testing.
Zane Colt
Pre-implantation genetic testing, to make sure that we don’t only have, we know we have embryos available. We want the best and the brightest. We want the ones that are chromosomally normal. We want—there’s also a genetic mutation in the family; we wanna be able to screen that out, to give our child the best opportunity for success. And to biopsy those, those embryos, they laser shave off a couple of cells, and they’re able to test them under a microscope, is incredibly expensive. For others, there might be, you know, no drug coverage. And so, the, the tax credit can go to offset the cost of those medications, or repeat cycles. You know, you get your, your first cycle covered by the program—or maybe, you pay out-of-pocket for the first one because you’re stuck on the wait list—but you’re able to offset a number of those, those treatments, and have the funding flexibility that we were looking for. Because no two journeys are the same.
Maya Khurana
Absolutely.
Zane Colt
So, that was a great move by the government. We’re thrilled about it.
Teri Hart
Dr. Garcia, how do you see this message impacting clinics?
Dr. Meivys Garcia
Well, clinics want nothing more than to help our patients. So, this announcement is certainly gonna help, it’s gonna help more clinics, help more patients. Zane is absolutely right, that the waiting lists are very long. And when I have a patient in front of me who is 42-and-a-half, and I have to tell her, you know, the waiting list is a year, and I have other patients that have been waiting a year for this spot, it’s very hard. So, certainly, this announcement is gonna help clinics and physicians be able to offer more cycles, so that the waiting lists are shorter. Now, it’s also gonna represent a challenge to clinics, because we do need to deliver more services; we need to still maintain a high quality of care that our patients deserve. And that means more resources. So, we’re gonna have to hire more nurses, hire embryologists, pay them well, invest in technology and innovation, and basically, increase our resources, in order to be able to meet the demand that this announcement is going to generate.
Teri Hart
Interesting, thinking of the demand, because of this announcement…
Maya Khurana
M’hm (affirmative).
Teri Hart
…is a crucial part of your end of this business…
Maya Khurana
M’hm (affirmative).
Teri Hart
…of this journey for people. Maya, when we see this kind of commitment from our government around the issue of fertility, how does that impact the private sector, and the choices and behaviours of the private sector?
Maya Khurana
Yeah. Can everyone hear me? I think I was given this mic.
Teri Hart
You look good with it, very cool.
Maya Khurana
Thank you. So, I think firstly, I would like to congratulate the government on this immense progress. It’s really important, it’s very encouraging, and it’s great to see things going in the right direction. But it doesn’t change things for us as much. It’s, it’s encouraging—to some of the points that Zane was making earlier—there’s still quite a lot of variability in coverage by public plans, across different provinces. And when we think about building our business, we think across Canada.
Teri Hart
M’hm (affirmative).
Maya Khurana
So, we’ll continue to compliment what the public system offers. They might cover one cycle of IVF; for the other two, you’re coming to your employers, you’re coming to the insurers. For egg freezing, it might be covered by a public plan, if you have, if there’s a condition that requires for you to do so, or warrants that. But we wanna make egg freezing available to our members as a choice, should they choose to delay parenthood, and prioritize other aspects of their lives. So, we work hand-in-hand, and we add and we create more options for people.
Teri Hart
You know, here’s what we know: the cost of fertility treatment is, is one of the biggest factors in how people are able to access care. Simply, the cost of it. Most Canadians spend an average of—I don’t wanna get this wrong—most Canadians spend an average of $20,000 out-of-pocket, for infertility treatment. And for many, that is a drop in the bucket. Speaking personally, one of the factors for my family, for my husband and I, when we faced the decision about continuing or not, was between selling our house, or continuing to try to build our family. That’s where we were at, in terms of the expense of this for us. Maya, I’m gonna jump back on you—and I know we have some questions; I promise I’m gonna get to them, I do, I am, and thank you for the questions, keep them coming. What can be done to get other benefit providers on board, to come up with innovative solutions to support fertility care?
Maya Khurana
Yeah. I mean, last five years has been tremendous. We need to continue building on it. And I think one of the most important things here is education and awareness. I don’t think that most organizations truly understand the depth of the challenges that people face, going through a fertility journey, the impact it has on your mental health, your financial wellbeing, which impacts your mental health…
Teri Hart
Yeah.
Maya Khurana
…and disproportionately so on women. So, we need to raise more education and awareness, for people to truly understand how difficult this is, and get organizations to act. Employers’ voice matters a lot. And we make sure we work with—I know Ayman’s not here today, but Scotiabank has been an excellent partner for us in this space, to make sure we continue to innovate, and bring new services to their employees. The other thing that’s also worth mentioning is, everything comes at a cost. And I think we collectively, as an ecosystem—industry, employers, third-party providers, innovators, startups—we need to hold hands together, and think of this as a Canadian problem, and come up with innovative business models, commercial models, to make things more widely accessible. We have a product, we need to get it in the hands of more people, and that’s gonna require some creative thinking, on the math.
Teri Hart
I also think it’s really important for businesses to understand that employees who require this benefit are in a very specific time in their life. This is not a benefit that employees are going to require for the entire time that they work for your company. This is a crisis period in somebody’s life, in somebody’s family’s life, and it is, it is a relatively small window for many, many people. And I think that that is a really big part of the conversation to have between insurance companies and…
Maya Khurana
Absolutely.
Teri Hart
…and industry. Zane, you were very generous in letting us hear some of your own personal journey. But through Conceivable Dreams, can you give us an idea of how much of a difference a robust plan that Maya talks about can affect the choices that people can make, and somebody’s journey? What do you hear, through Conceivable Dreams?
Zane Colt
So, we know that the average drug plan will cover up to $6,000 in, in coverage. But 53% of employers don’t have anything at all. So, for those that have it, it’s great….
Teri Hart
I just wanna repeat that number.
Zane Colt
Yeah. 53% of employers in Canada don’t have any sort of fertility plan at all. So, are you seeing similar numbers? I don’t….
Maya Khurana
Yeah. Particularly, in the small, mid-segments; smaller businesses, medium-sized businesses, they tend to not have them.
Zane Colt
Right. And as you were saying, Teri, it’s not for everyone, and it’s not for the entire length of your time as, as an employee. But you, you also have to think about, especially with coordination of benefits, as well, that my wife’s, when we did our first cycle, my wife’s coverage only covered the first $1,000. And so, the rest fell on to, to my plan, to offset that. So, we have to weigh the two. And, and so, it might not necessarily be the female employees’ plans, but the family together. And you have to look at it as a whole-of-benefits approach, as opposed to a whole-of-government approach. And, and yeah, what we’re hearing from patients and patient advocates is, is they’re eager to talk to their employers, they’re afraid to have that—no one likes to talk to HR. It’s never a good thing, when you get called into the principal’s office, or when you have to go….
Teri Hart
We have an HR sponsor here, Zane. I’m just….
Zane Colt
I know. And they need to improve their image of how approachable HR can be, in some cases. Because it can be, it can be daunting. And especially, if you’re in treatment, especially if you’re already looking at IVF, and are nervous about this, but then to say, “I really wanna stay, is there anything you can do?” And you have to take your advocacy to the person that writes your cheque, at the end of the month. Like, it’s daunting.
Teri Hart
And also, from a woman’s perspective, offer up the fact that you’re planning on having a child, and probably taking parental leave.
Zane Colt
True.
Teri Hart
Dr. Garcia, we haven’t heard from you in a bit. Welcome back.
Dr. Meivys Garcia
I’m still here.
Teri Hart
What have you heard—’cause this is fascinating to me, what you hear from patients about the decisions they’re able to make, and how you guide them through the process, based on whatever support and insurance coverage that they have.
Dr. Meivys Garcia
M’hm (affirmative). Infertility is a devastating disease. There’s no question about it. But patients understand that it’s not their fault, they understand that there is treatment. And then, there’s the barrier of affording the treatment. And certainly, when patients have insurance, it is an absolute game-changer for patients. Like, it’s the difference, it really is the difference between having a baby in arms, or not. They can, if they’re able to afford the medication—sometimes I’ve had patients that get it from the cycle, but they still need to pay $5,000 for medication, $3,000 for pre-implantation genetic testing, and they still can’t afford it, even though they’re getting it from the cycle. So, it’s amazing that the government is doing that. But there is still a very high proportion of the population that is not being helped. So, I like what Maya was saying and Zane is saying, we do need to work together.
When patients, I have patients from Scotiabank—you’re right, Scotiabank is amazing, in supporting families—so, when they are sitting in my office, and they tell me I work for Scotia, or any of the other banks, or any of the employers that I know can afford it, it’s, I mean, I’m able to offer them more. And I know that they’re more likely to be able to achieve their dream, because they have the support from their employers. And they tell me, “I will never leave Scotiabank,” or “I would never leave this place of employment, because of what they’re doing for me.” So, I think it does make a huge difference. And if there’s anyone here in the audience today that is in a position of power to offer this to your employees, I beg you to think about it, to, too advocate with your companies. Because, from the fertility point of view, it really is the difference between that employee being parents, or not.
Teri Hart
It truly, truly creates and changes lives.
Maya Khurana
M’hm (affirmative).
Teri Hart
I cannot emphasize it enough. Back when I was in my journey—so, my journey ended about 13 years ago. I had five miscarriages, and we spent tens of thousands of dollars. But I cannot tell you how grateful I am to be sitting here in front of you all, and be able to talk about infertility in this open and transparent way, and hopefully, change lives. Because back in my day, it was a whisper network. It was a whisper network of where to go. It was a whisper network of like, are you taking CoQ10? Does CoQ10—how many milligrams of CoQ10 do I have to take? Anybody? Some people smiling like, yeah, I know the CoQ10 world. You know, and not to mention, you know, going for, these are all things that we’re talking about in the traditional medicine category. There are all kinds of things that people in fertility treatment go through, from, you know, Chinese medicine, to all kinds of things that are also hugely expensive to avail to yourself. So, this is something that impacts every aspect of your life. And when you’re on the journey, and you’re making a decision to try and build your family in any way you can, you will do anything you can. So, any help that you can give to your employees makes such a huge difference.
Back to how much it’s changed in these, in the years since my time, when it was exactly that—I’m not exaggerating, it was much more of a whisper network. And here we are, having a lunch and learn about infertility. Thank you so much, Empire Club. What difference does that make? I’m just gonna ask each of you, if you can—maybe Zane, we’ll start with you—if you can talk about the importance of transparency and openness on this topic…
Zane Colt
Yeah.
Teri Hart
…and how that impacts your intersection with infertility, through Conceivable Dreams, and personally.
Zane Colt
So, my wife and I know transparency better than most. We, in looking for a surrogate, we started a blog called “Not My Tummy, But I’m Still Mommy,” to, to share our story openly from the beginning, to birth registration at the very end. We knew that finding a surrogate in Canada is very challenging. Typically, there’s one surrogate for every one hundred intended parents looking, in Canada. And we knew the best way to do that was to share our own story, and be in control of our own narrative. So, we made an Instagram page, and we had a video that went viral—and in fact, our surrogate reached out to us, after 700,000 views on a video. So, we know the importance of openness, and that has actually converted itself into so many other people reaching out to us to say, “I wanna be able to find a surrogate, just like you.”
And my wife is in the media and communications space, and launched a, a shop, an agency, for media and communications, and helping tell your story, to find your perfect surrogate match. And we find that, even if you’re using a traditional surrogacy agency, or you’re going out on your own, being in command of your own narrative helps you find a better, faster match, just like we have with our surrogate who, who only lives about an hour-and-a-half away, and we’ve become the closest of family friends, because of that. So, it’s so important to, to put yourselves out there. And whether you’re talking to your employers, or whether you’re trying to find a surrogate, we don’t want patients to have to live in the shadows. We don’t want this to be, there to be stigma associated with it. Because talking about it will only help to improve it, and bring awareness, and bring funding, and bring tax credits, and everything that the minister just talked about.
QUESTION & ANSWER
Teri Hart
Yay. Maya, before you answer that question—’cause we’re running out of time, so I wanna get to a couple of questions here. I’m gonna go for this one, for Maya: how frequently are businesses choosing fertility support as an employee benefit? 10 percent, 30—is it accelerating? Large versus smaller employers? Thank you.
Maya Khurana
Yeah. So, it’s definitely more large employers, I would say, that are prioritizing it more than small to mid-business segment ,like I talked about. We’re seeing pretty much all of the large employers asking for it, and more so the volume of requests has gone up in the last few years. So, it’s heading in the right direction, but, you know, we talked about this, we need to do more to support the not large employers, and how do we get them on board, how do we create the right product packages for them, so that this can be affordable and be accessible to their employees, as well.
Teri Hart
I’m gonna ask this question to you, Dr. Garcia. $20,000 for one cycle. Is that correct? And how many clients need more than one cycle, in order to conceive?
Dr. Meivys Garcia
M’hm (affirmative). $20,000 for one cycle is approximately correct. That would include the actual IVF cycle; it might also include pre-implantation genetic testing, and the medications that are needed, as well. So, that is, that figure is accurate. How many people need more than one cycle? That really depends on many factors. Age is an important one. Certainly, for women over 35 years of age, many times, they will need more than one cycle, in order to achieve a pregnancy.
Teri Hart
Those are the raw numbers, folks. So, this is about looking forward, and this is about continuing the conversation. So, before we wrap it up—and we do just have under a minute here—Maya, where do you see opportunities in the benefit space, going forward?
Maya Khurana
So, we need to continue thinking about building fertility benefits that suit families of all shapes, sizes, and compositions of being more inclusive and diverse in our thinking—thinking about same-sex couples—just make sure we continue building on that. There’s also a lot of opportunity to support couples, prior to they get to a clinic. Oftentimes, it’s quite a difficult time. There’s a lot of information coming in. You need a safe space, where you can get information with no strings attached, and make the right decision for your family. So, there’s more to be done on like, care navigation, coaching, mental health support. Of course, that’s available through your health plan, but it’s nice to have a champion to go along that journey with you. That’s something we’re seeing a lot in the US, and we’re hoping to do more in that space in Canada, as well. And it doesn’t just stop at fertility. You have to support the young mothers, in those crucial post-baby months, where there’s a lot of change happening in their lives; they’re often alone, vulnerable. We need to extend the conversation, to make sure that we are thinking about our young moms, as well. So, that’s where I see this going.
Teri Hart
I love that. Dr. Garcia, outside of medical advancements—because they’re changing every day—how are clinics helping patients manage what we started talking about, at the beginning of this conversation, with time commitments, and the worst word in the world, balance?
Dr. Meivys Garcia
There’s many ways in which we’re doing that. The appointments that are not cycle-monitoring can be done virtually, and can be done at any time of day, for convenience for patients. The appointments are cycle-monitoring, most clinics have a process set up where the cycle-monitoring is smooth, and there’s technology that we use. Many clinics have apps for communication, as well. There are many clinics, including my own, that are, are, we’re going through renovations, and we’re gonna create a workspace, so that patients can have a private place to put the laptop, and have Wi-Fi, and be able to work from the waiting room, while they’re waiting for their appointment. Has a fertility specialist, always writing letters to employers, letting them know—obviously, at the patient’s request—that the patient’s required this time off, in order to do the cycle-monitoring. And I am here advocating for that, because ultimately, this is not going to happen just because one clinic does something. It’s gonna happen when everybody works together: the clinics, the fertility specialists, the patient’s advocates, the insurance benefits, and government.
Teri Hart
Absolutely. Zane, just to wrap up with you, what are the top three priorities for Conceivable Dreams, in the near future?
Zane Colt
So, like every championship team, after we had a big win, we’re gonna go back and have a rebuilding year, probably. We’re gonna have to do a strategic plan, and look forward on what we wanna tackle next. Off the top of my head, I see improving patient experience at clinics, the way Dr. Garcia was talking about. Encouraging clinics to better communicate with their patients, and streamline that process, to make it as smooth as possible, to have workstations, or phone booths, or allied health professionals available to bring in direct billing for pharma, so that we don’t have to put that money out-of-pocket, and then hope the cheque comes back in the mail, and then have a fight on the phone with them, when it’s not as much as you were expecting it to be. I do think that there is something to be said about our Fertility Benefits Matter campaign, to encourage that conversation with employers, with everyone’s employers.
And lastly, to start to work more with family doctors, to have conversations about future fertility challenges in adolescence. I think that there’s a learning opportunity for family docs, when they have patients that are in their late teens and early 20’s, and they’re in their offices, to say, “What does family building look like to you? Because this is what egg quality looks like.” And, and let’s see how we can align. We’ve heard so many patients come, patient advocates come to Conceivable Dreams to say, if only I had known, back when I was 25, I would have frozen my eggs. And now I’m 35, or I’m 40, and I have diminished ovarian reserve. And I’m paying $20,000 at minimum, $100,000 at maximum out-of-pocket, to try to scramble, before that window closes. But no one told me about what future fertility challenges could look like, when I was that much younger. And I would have gotten a handle on it, if I could. So, I think we need to do some more education with our family doctors, to, to have the conversation. And that lowers the expenses to government later on, right? They would get off the list of OFP; it would ease that burden. But the conversation has to happen sooner.
Teri Hart
If only I had known.
Dr. Meivys Garcia
Yeah. If I could add to that, to what Zane was saying, I’m also work with Conceivable Dreams—I have the pleasure of working with Zane—we’re also gonna work with the northern communities. Because this is a population that, on top of all the challenges that we just discussed here, they also have the geographical barrier of getting to a fertility clinic in the GT area. So, that is something that, as well, we’re gonna be working on in the, in the new year. Right?
Zane Colt
Yeah.
Teri Hart
Lots of work.
Zane Colt
Improving patient experience, all around.
Teri Hart
Improving patient experience, allowing people to be patients, if they want to be patients.
Dr. Meivys Garcia
M’hm (affirmative). That’s right.
Zane Colt
Yeah.
Teri Hart
We’ve gotta let you go—that’s what happens, in the lunch and learn. We gotta go back. Maya, Zane, Dr. Garcia, thank you so much for being here, your expertise, sharing your time, sharing your own experiences, and being advocates for this very, very, very important part of what so many people are facing. My name is Teri Hart; it has been a thrill to be here. As we said earlier, we are around to have chats with. I think that maybe Maya didn’t have a mic for her first question, so if you wanna ask her about that, she is available for that. Thank you so much for being here. Just to reiterate what Zane said, so many people say, you know, if I had have only known. We all are in this room now, and now we, hopefully, know so much more, and now we can do so much more with that information. I hope you do. Thank you.
Zane Colt
Thank you.
Jenna Donelson
Thank you, Teri, and a real heartfelt thank you to all of our panellists, for that insightful and engaging discussion. I also wanna thank Alex Johnson, who generously donated a copy of her book, “Inconceivable: My Life-Altering Eye-Opening Journey from Infertility to Motherhood” to each of our panellists. A portion of those book proceeds will go to Conceivable Dreams, and Fertility Matters Canada.
We’ve learned a lot today, and this conversation was an important reminder of the core humanity behind the science, policy, and business of fertility. It’s also a reminder for those going through this journey that you’re not alone, and I hope you feel that way, coming out of this discussion. I’d now like to invite our Lead Sponsor, Javed Alam, managing director at EMD Serono, to come share some appreciation remarks. Welcome, Javed.
Note of Appreciation by Javed Alam, Managing Director, EMD Serono
Thank you very much. Completely our honour to be here, and be the Leading Sponsor, along with so many others. I would like to really thank the Empire Club, for choosing this topic, all the presenters, for having, really touching that, the essence of the challenge that we face, and everyone here, to take out time, in showing your commitment for this important cause. Also, the Honourable Minister was here, the announcement about expanding the fertility program, with a generous funding of 150 million over the next few years, coupled with the tax credit. I think this is going to go a long way, and help the patients significantly.
Just a brief few points about our company. We are the affiliate of Merck KGaA, Darmstadt, Germany; we are a leading science and technology company. Our purpose is simple, to help create, improve, and prolong lives of patients. And I would like to share, we are really proud to say that one of the first IVF babies in North America, Amy Carr’s small girl, she was born with the drugs that we manufacture. So, that makes us really, really, very proud. And education is really important, when it comes to fertility care, but so is access. As an employer, we understand the value of public and private plans, and as a company, what we have done over the years is—because the needs are very different, as was spoken about, many patients might need multiple cycles, and that’s where public and private plans really come together nicely. As a company, what we’ve done is, we have transitioned our plans to a full comprehensive support, whatever that takes, and it has helped hundreds of patients and their families. So, we’re here, and thank you very much. My team and I, we have learned a lot, and we’ll continue to do our best, and show our commitment to this field. Thank you very much.
Concluding Remarks by Jenna Donelson
Thank you, Javed, for those great remarks, and thank you once again to EMD Serono, for your support in making today’s conversation possible. I’d also like to recognize some of the students and young leaders we have in the room. We have some students from TMU, and from Queen’s University; we’re glad you’re here with us today. Thank you for joining us, in these conversations I’m having.
And in closing, I’d like to remind everyone that the Empire Club of Canada is more than a platform for discussion; it’s a record of the conversations that shape our nation’s history, and our future. And as we’ve seen today, those discussions continue to evolve, to meet the moment. If you’d like to stay connected, please subscribe to our newsletter, by scanning the QR code that you will find on your table, and I hope to see many of you at our upcoming events.
To name a couple, tomorrow, please tune in virtually for our Remembrance Day event, “Canada and War: Changing Experiences and Attitudes,” which is hosted by the Empire Club Foundation, and will go back into our archives, in commemoration of Remembrance Day. And on November 14th, we’ll be hosting our first “Empire Nights” event of the season, which is focused on addressing Canada’s housing shortage. This event will feature a panel of leading experts in the housing sector, along with special remarks by Dr. Mike Moffatt, Senior Director of Policy and Innovation at the Smart Prosperity Institute. If you know Mike, you know that he can always be counted on for providing a realistic assessment of the challenges ahead.
As a club of record, all Empire Club events are available to watch and listen to on our website, and a recording of this event will be available shortly. Thank you all for being here with us today. I wish you a wonderful afternoon ahead. This meeting is now adjourned.
