Canadians are having children later than previous generations, and fertility treatments are becoming an increasingly common part of starting a family. This episode of DemograFix explores the surge in IVF use, the rising age of patients, the costs and waitlists involved, and the uneven access to treatment across provinces.
Cara Stern and Mike Moffatt examine how housing costs, education, careers, and other pressures are reshaping when Canadians start families, and what that means for healthcare and public policy.
If you enjoy the show and would like to support our work, please consider subscribing to our YouTube channel. The pod is also available on various audio-only platforms, including:
Below is an AI-generated transcript of the Missing Middle podcast, lightly edited.
Cara Stern: It sometimes feels like everyone I know is struggling to start a family. I’m just past the age where all my friends were getting married, and I kind of expected everyone to have kids by now, but for many, that hasn’t happened yet. For the ones where it has, it feels like most have needed fertility treatments to get pregnant—including me.
My mom tells me this is something new. She says in her generation, sure, some people struggled, but it was way less common. Most people just tried to have a kid or didn’t try, and they just had one. It made me want to start looking into it, and that made me realize that starting a family looks very different now than it did a generation or two ago. People are spending more years in school, building careers, paying off student debt, and taking longer and longer to afford a home before having kids. By the time many people feel they’re ready, they’re older, and that can come with a whole new set of challenges and costs.
Mike Moffatt: Those costs aren’t trivial. Globally, in vitro fertilization, or IVF, is a $40 billion CAD a year industry, with those costs being split between families, insurance companies, and governments. Speaking of governments, last April, the Government of Ontario announced a $250 million investment in expanding access to IVF across the province. The societal shift to families having children later in life has real economic consequences.
Cara Stern: We want to talk about it because one of the goals of this podcast is to explore how life in Canada has changed across generations. We often focus on housing or jobs, but even something as fundamental as having a baby seems to be getting more complicated than it was 50 years ago. The inevitable question it led me to think about was: do more people need fertility treatments than ever before, or is it simply that more people have access to treatments?
Mike Moffatt: We went and pulled the national numbers, and it turns out it’s not just a “Cara and her friends” problem—fertility treatment usage is way up. In Canada, IVF births in Ontario went from 1.7% of all live births in 2014 up to a full 3% in 2023, according to the Canadian Assisted Reproductive Technologies Register, which tracks all of the fertility clinics in Canada. Of course, Ontario is not all of Canada, but it’s actually where most of the country’s fertility clinics are.
Cara Stern: When I read those numbers, my first thought was that the jump could just mean the science is getting better—like maybe the same number of people are using IVF, but the clinics have gotten way more successful at turning those cycles into actual babies. But it turns out that’s not true. Success rates per cycle have actually stayed relatively flat over the last decade, roughly 37% per cycle, though other factors have changed.
Part of that is because we’re fighting a war against biology: as technology gets better, the average patient age goes up, keeping success rates relatively stable. The real growth is in the sheer volume of people walking through the clinic doors. I do want to point out here that IVF is only one form of fertility treatment you can get, but it’s where we get the best numbers, which is why we’re talking so much about it in this episode.
Mike Moffatt: If you look at the raw patient numbers from the registry, that surge is undeniable. In the 2023 data alone, Canadian clinics reported over 28,000 patients doing IVF. 2005 was the first year that the Canadian Assisted Reproductive Technologies Register was able to collect data from all fertility clinics in Canada, and there were about 25 at the time. Back then, there were about 11,000 cycles—and a cycle means a single full round of IVF treatment, from the start of hormone medications through to retrieval or embryo transfer. Interestingly, from around 2013 until the pandemic, the numbers were relatively stable at about 17,000 or so.
Cara Stern: Obviously, there was a drop during the pandemic because many clinics had to reduce their services due to regulations and restrictions. I’m not surprised there was a big jump afterwards to over 20,000 with people trying to catch up on lost time, but it has actually stayed and grown since then.
I did wonder why so much of the data I was finding was so Toronto-centric. I know we feel like we’re the centre of the universe, but I also know that’s not true. It turns out that of the 36 clinics that operated last year in Canada, half of them are in the Greater Golden Horseshoe—within 90 minutes or so of Toronto, depending on traffic. By contrast, there were only two serving all of the Maritimes until this year, when a new one opened in Newfoundland.
Mike Moffatt: There’s a real geographic lottery here, and it actually goes beyond where the clinics are located because the range of services covered differs from province to province. In Ontario, for example, you get one funded IVF cycle. British Columbia just launched their program last year with variable funding depending on household income. In Saskatchewan, a tax credit was recently introduced, whereas in Alberta you don’t get anything—they recently launched a plan to cover fertility treatments, but only for cancer patients. So there’s a real, uneven playing field. Quebec actually has the most support, which might not be surprising given that they’re more generous on parental leave and childcare: they cover a full cycle, as well as medication and embryo storage for up to a year.
Cara Stern: Let’s dig into the why. This is really an extension of everything we’ve said on this podcast about people starting families later than they used to. The age numbers alone tell a lot of the story. The average age of a mom at the time of her baby’s birth was 31.8 in Canada, based on StatsCan’s latest data, and no province is below 30. B.C. was almost at 33. If we zoom in and look at just the age of moms at their firstborn’s birth, the average age was just over 30 years old—higher in B.C. and Ontario. I suspect if you look even closer, we’ll find it’s even higher in cities than in more rural regions.
It matters here specifically because you can delay a lot of things in life—like starting your first job or buying your first house—but you can’t delay biology. Fertility drops off meaningfully after 35. So when you push the average age that far back compared to what people did historically, of course you’re going to get more people who need help conceiving.
Mike Moffatt: That changes who actually goes to the clinics. If you walked into a Canadian fertility clinic 30 years ago, the average patient was around 31 years old. Today, the average age of someone starting an IVF cycle has climbed past 35.5, pushing toward 36. People 35 and older now make up 60% of all the cycles in the country.
Cara Stern: I sometimes hear people talk about celebrities who have kids well into their 40s, and that’s seen as proof that you can take control of your own timeline and don’t need to rush to have kids under 40. But I really want people to understand that’s not something you should count on. Science and lots of money were almost certainly used for most of them—whether or not they talk about it—probably with eggs they froze when they were younger if they had the money early enough and knew they had extreme career ambition. On top of that, they have access to the best treatments money can buy. The biological cliff after 35 or 40 is still the same as it’s always been. Even though treatments can help a little bit, it makes for a long, expensive, emotional, and stressful situation—and it often doesn’t even work.
Mike Moffatt: Even when it does work, if we’re having kids later and then they’re having kids later, I think about how I might not have grandkids until I’m about 80! The experience I’m probably going to have as a grandparent is going to be very different from past generations. All of these milestones getting pushed back makes a real difference.
Cara Stern: It’s not just an age story, though—clinics are seeing more patients in their 20s and early 30s. These aren’t necessarily people who waited too long, but they’re still struggling. We’re seeing a rise in diagnoses that complicate conceiving, and clinicians don’t fully understand why yet, though researchers are looking at environmental factors and metabolic health.
The silver lining is that younger patients usually have better egg quality, so their success rates per cycle are higher. But it still makes the cost of having a kid incredibly high even before you actually have a baby, which is when a lot of people think the expense should start. That’s not including the impact on your career and life, because you have to show up for regular early-morning appointments or miss work for treatment. It has a big impact when you’re doing treatments, no matter what age you are.
Mike Moffatt: We should also point out that this isn’t just a story about women delaying parenthood. Male factor infertility accounts for roughly a third of all fertility cases today, and we’re learning more over time that a man’s age also plays a role in fertility.
Cara Stern: The good news is we’ve seen big changes in fertility coverage over the past decade, which has made it more accessible to people who could never afford it before. These cycles aren’t cheap—a cycle can cost something like $10,000 to $15,000 in Ontario, plus another $5,000 to $10,000 on medication, and more if you’re paying for genetic testing or embryo storage.
Nowadays, many provinces have a round of procedures covered, a budget you can use funded by the province, or a tax credit. But like so many other things, if you’re not paying with money, you’re paying with time: waitlists can be brutal in provinces where it is covered.
Mike Moffatt: Exactly. This shows the macro effect of all the societal changes that have delayed childbirth, which then impacts our health insurance systems. Right now in Ontario, 30% of patients wait under six months for publicly funded IVF, another 30% wait six months to a year, and 10% wait longer than 18 months. Some of these waitlists can get pretty long.
Cara Stern: That’s a big problem. It’s not just the annoyance and inconvenience of not being able to get started when you want to; with fertility, time is such a big part of the story. An 18-month wait for someone already in their late 30s can be the difference between a viable cycle and permanent infertility.
Mike Moffatt: As a 49-year-old, I can tell you that your 30s go by pretty quickly, so that 18 months really makes a difference.
Cara Stern: Each clinic has its own waitlist in Ontario, too. I know someone who travelled to Toronto from Ottawa for their treatment because the wait times at the one fertility clinic in Ottawa were so long, whereas in Toronto they found shorter wait times. But that obviously expands the cost because they have to pay for travel, time off work, or figure out how to work remotely if they’re lucky.
Mike Moffatt: When we talk about the expense of this, it’s easy to over-focus on just the immediate financial costs that show up on a bill. But the time off, travel time, and so on make this incredibly expensive—not just for the people undergoing it, but for society as a whole. If you’re spending all your time driving between Ottawa and Toronto, that’s time you’re not at work or doing something else. It affects all of us.
Cara Stern: Yeah, and it’s not like you go in for the day, do your treatment, and that’s it—it’s a process that takes many weeks. Even once you’re at the top of the waitlist, there can still be a lot of waiting. In fact, I always describe fertility treatment as being a lot of waiting, followed by “go, go, go,” but most of it is actually just waiting.
There’s a benefits plan angle to these increased numbers that I found quite interesting: claims for fertility medications at workplaces rose 21% over the last five years, according to Manulife. Yet, fewer than 1% of workplace plans actually cover the treatment itself, which is the most expensive part—especially if you live somewhere in this country without funded cycles or if you’ve used up your provincial coverage and it didn’t work.
At the same time, we’re seeing an increase in workplace benefit coverage amounts and in who is able to access it. Over time, the net has widened for people wanting fertility treatments who may not have a medical need, but want to become a single parent, are part of a same-sex couple, or need egg or sperm donations to make it work.
Mike Moffatt: I expect this is only going to grow over time simply because the pressures leading to increased IVF usage don’t seem to be going away.
Cara Stern: Manulife, in the data released based on their claims, found a 13.5% increase in the number of women between 25 and 34 with fertility-related claims, and a 24% increase for women between the ages of 35 and 44.
To recap: the number of people accessing fertility treatments has increased dramatically over the past couple of decades. It’s happening because of the intersection of people intentionally starting families later in life, an expanding definition of who gets to build a family, provinces slowly opening the funding taps to make these procedures accessible to the masses, and people in their 20s and early 30s needing these treatments more than they used to. As demand explodes, our healthcare infrastructure is struggling to keep up—between the geographic lottery of where you live, gaps in corporate insurance, and the biological reality that time waits for no one, I suspect fertility treatments are going to continue increasing in Canada for the foreseeable future.
Mike Moffatt: I think you’re right. We are going to see a policy response where provinces try to increase access and address waitlist issues and expenses. But policymakers also need to take a step back and look at the macro issues around why young people are having to wait until their late 30s to have a kid. I really see a lot of this as a housing issue and a jobs issue—people starting their careers later, expectations around staying in higher education longer, and so on. Policymakers need to look at this not just through the narrow lens of IVF policy, but by taking a step back to ask why so many people are having kids later in life, and addressing the barriers preventing them from having children earlier.
Cara Stern: Thank you so much for watching and listening. Our producer is Meredith Martin, and our editor is Sean Foreman.
Mike Moffatt: And if you have any thoughts or questions about my favourite Nirvana album, please send us an email to [email protected].
Cara Stern: And we’ll see you next time.
Additional Reading/Listening that Helped Inform the Episode:
Publicly funded in-vitro fertilization (IVF) program - Province of British Columbia
Canadian assisted reproductive technologies registry CARTR PLUs annual report
CARTR Reports - Canadian Fertility & Andrology Society
Provincial coverage | Fertility Matters Canada
Ontario Connecting More Families to Fertility Supports
Global In Vitro Fertilization (IVF) Market Size, Share, Growth Analysis Report - Forecast 2034