Faced with Sky-High IVF Costs, Couples Look Abroad to Start Families

In 2011, Amanda Faulkner was fresh out of law school, single and approaching thirty. She knew she wanted to have kids at some point, but she also knew that, as a new lawyer, it wasn’t on the immediate horizon. So Faulkner proactively reached out to a doctor to discuss fertility options. She was twenty-eight years old when she started looking into freezing her eggs. Faulkner’s case wasn’t standard, however; she had never had a menstrual cycle, and from a specialist, she learned that she didn’t have any eggs either. She was diagnosed with primary ovarian insufficiency. She had to confront the fact that, for her, the process of becoming a mother would be more strenuous. She recalls breaking down at work the next day. “I had always kind of assumed that there would be something that [doctors] could do,” she says. Eventually, Faulkner started dating and got engaged to Miles, a long-time friend. In the spring of 2016, ahead of their New Year’s Eve wedding, they started to explore treatment options as Ontario residents, knowing there was up to a two-year wait at the clinics that could offer government funding. Their cost estimates for the necessary treatments included a few rounds of in vitro fertilization (one funded by the government of Ontario), importing donor eggs from the US, and expenses for medications. “All in all, we were looking at between $50,000 and $60,000 just to get the ball rolling,” Faulkner says. Learning how much they would have to spend to start a family “was a punch to the stomach,” Faulkner says. She started doing some internet research to learn more about egg donors. It was on a message board that she first encountered another approach; there was a whole online community of people who shared their experiences of travelling abroad to start a family, oftentimes for cost reasons or for procedures not available in their native countries. These fertility-motivated travellers, who often end up storing their biological material in countries other than their own, could be thought of as eggs-pats. After careful research, Faulkner realized that going abroad would allow her to build her family for a fraction of the cost. Faulkner and her husband decided on Greece, because of her husband’s heritage, and found a fertility clinic in Thessaloniki that coordinated with doctors in Ontario. They could also enjoy a vacation in Greece and relax in a nearby rental house while waiting between procedures. The trip was ten days. “In the end, it cost us, including our trip, about $16,000 to $17,000,” says Faulkner. And while this was still expensive, it was less than the $55,000 it would have cost her in Canada. The most important part of her journey: Faulkner and her husband became parents to adorable fraternal twin boys on their first try in January 2019. Faulkner is happy that the clinic in Greece allowed for the transfer of two embryos, which resulted in twins—something Canadian clinics typically avoid, as carrying multiples is considered a riskier pregnancy. “It was the best-case scenario out of a shitty situation,” Faulkner says. Faulkner required an egg donation, but even less complex fertility treatments can cost tens of thousands of dollars in Canada. Freezing your eggs can run upward of $8,000, with medication ranging between $3,000 to $5,000. IVF treatments are as high as $20,000. And these procedures are more and more in demand; while peak reproductive years for women start in their early twenties and taper off by their mid-thirties, it’s no secret that women are having children later in life. Career developments and advanced education, paired with increased financial instability, mean that, on average, Canadian women are having their first child at thirty, according to data from the United Nations Economic Commission for Europe in 2021. Egg freezing is one treatment that fills the gap between what is socially expected of women and what is biologically possible, and the procedure has increased more than sixteenfold in the past decade, from ninety-four procedures in 2013 to 1,524 in 2022, according to the Canadian Fertility and Andrology Society. Given the costs, it’s not hard to see why many Canadians, like Faulkner, are shopping for fertility treatments in countries like Greece. As a Canadian living abroad, I also opted to freeze my eggs in my country of residence, Sweden. My procedure at a private clinic cost approximately half compared to the going rates at Canadian clinics. Even adding the price of a flight and hotel stay, fertility tourism can be a financially prudent solution. “[Fertility treatments have] really become a private industry for the wealthiest of Canadians,” says Carolynn Dubé, executive director of Fertility Matters Canada, a national charitable organization championing equitable access to fertility care. With foreign clinics stepping in to fill the gaps, more and more prospective parents are weighing their options abroad, where fertility treatment has become a lucrative business opportunity for private clinics that can provide treatment at lower costs. How did fertility care fall so short in Canada, a country with constitutionally mandated affordable and supposedly accessible universal health care for all?

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The global fertility tourism industry is already worth billions and growing. Its market value was $2.2 billion in 2024 and is projected to grow to $8.6 billion in 2030. It’s not that infertility isn’t a problem for Canadians; the Canadian Fertility and Andrology Society says that one in six hopeful parents will experience infertility. Or that there aren’t treatment options available domestically. But currently, there are no provincial or federal regulations that set the cost of fertility treatments in Canada. Prices are determined by competition and market value, much like how a hairdresser might price a haircut. The Canada Health Act mandates affordable, accessible care across the country but vaguely defines what constitutes “medically necessary” treatments. Fertility is one health issue that has fallen between the cracks of constitutional ambiguity, meaning the level of financial support Canadians can receive is determined by the provincial and territorial governments. And it varies greatly between jurisdictions. A couple living in Newfoundland and Labrador, for example, told the Canadian Press that the $5,000 grant for up to three IVF cycles available to residents of the province is a great start, but they still had to take out a loan and fundraise to pay the approximately $35,000 bill. Not to mention that there are no fertility clinics that offer IVF in Newfoundland and Labrador or any at all in Prince Edward Island, so travelling out of province is the only option. That same couple said they had to spend twenty-five days in Calgary to receive IVF treatment. As with Newfoundland and Labrador residents, partial financial support is available for people living in New Brunswick, PEI, and, as of October 2024, the Yukon. In Quebec, residents experiencing infertility are eligible for one round of government-funded IVF, as is the case in Ontario. And as of January, residents of Ontario can receive up to an additional $5,000 annual tax credit, thanks to the province’s $150 million investment over a two-year span into the Ontario Fertility Program. But with IVF, it typically takes at least a couple of cycles to get pregnant. One couple in Ontario, who spent thousands on IVF, expressed devastation to the CBC that if a cycle does not produce a viable egg or embryo, it still maxes out the government tax credit, even though it didn’t work. British Columbia will launch a program in April that covers one round of IVF, including medication. For residents of Alberta, the Northwest Territories, and Nunavut, there is no government support whatsoever. Depending on where they are located in Canada, prospective parents might face long wait times too. Across Canada, there is a crisis when it comes to wait times for care, especially when seeing specialists. In Ontario, for example, wait times at fertility clinics that offer government-funded treatments can be eighteen months, from the initial referral to the consultation. “Some people will age out because their ovarian reserve or their egg quality has dropped, and some provinces have age limits on these programs,” says Dubé. If prospective parents have additional needs, such as an egg or sperm donation, expenses can soar even higher—and it might be easier, and cheaper, to book a transatlantic flight than to navigate the bureaucracy of Canadian fertility treatments. There are legislative reasons why the cost of fertility treatments involving donors is so high. Canada’s 2004 Assisted Human Reproductive Act prohibits buying reproductive materials, including eggs or sperm, as well as the buying or selling of embryos for IVF. The actions are subject to a penalty of up to $500,000, ten years in prison, or both. That means that the donor cannot be paid or, in this case, compensated. While this act was created with the intention to limit exploitation, it has also caused a ripple effect of problems. For instance, experts believe that these Health Canada regulations have impacted the number of people willing to donate in Canada and, therefore, have diminished the pool of potential donors. “We’ve got a very small national sperm bank, and we’re really struggling to create a Canadian egg bank,” says Sara Cohen, a lawyer specializing in reproductive law at Fertility Law Canada. As a result, Canadians rely on the same national donors again and again. Furthermore, there are currently no national records that could be important for donor-conceived children, such as the health of the donor, how many times the same person has donated, and possible siblings. “We’re a country that’s supposed to value reproductive freedom,” says Gary Nakhuda, a reproductive endocrinologist and co-founder of the Olive Fertility Centre in Vancouver. “But when it comes to [egg donation], we still don’t feel that competent adults can make up their own minds, to donate or be carriers.” Prohibiting compensation for egg and sperm donation in Canada has created a gap in the market that for-profit agencies have sought to fill, Nakhuda says. And while it’s not true of all agencies, Nakhuda has come across some bad actors in this space during his more than twenty years of practice in the field. “Hypocritically, while we can’t pay donors in Canada, patients can still purchase gametes, through egg and sperm banks, from donors who were paid in other countries,” Nakhuda says. For prospective parents looking for egg donations, the laws in both Greece and Spain state that donations must be altruistic in nature. But the laws also allow for donor compensation up to approximately €1,200 ($1,800) for costs such as travel, lost wages, or biological stress. As a result, European Union countries like Greece and Spain have become popular destinations for those seeking fertility treatments. Some clinics have even opened international departments to facilitate patients from abroad. Saúl Mizrahi, an English-speaking business and patient coordination manager at Vida Fertility in Spain, for example, estimates that 70 percent of their patients have been foreigners since opening the doors to their two clinics in 2023. The company has English-, Italian-, German-, and French-speaking departments dedicated to patients coming from abroad. Newlife IVF Greece, the clinic Faulkner and her husband used, opened its international department in 2015 after identifying the UK as a potential market due to treatment costs, gaps in National Health Service care, and wait times for fertility treatments. Soon after, the clinic expanded its international department to include other countries. About half of all of their patients come from abroad, and approximately 10 percent of their international patients were from Canada in 2024. Nakhuda says that hundreds of patients each year at the Olive Fertility Centre seek treatment abroad for various reasons, from costs to surrogacy to donor access. Other times, it’s to get treatments that are not available in Canada, such as sex selection, implanting multiple embryos, or more aggressive procedures. Fertility tourism has helped many families grow, but the unexpected can hinder even the best-laid plans. For any sort of fertility procedure abroad, Cohen encourages all parties—prospective parents and donors—to consider what happens in the event things go awry. Is there liability for the doctor? For the clinic? Are they insured? What happens if there is a medical emergency? If something goes wrong, navigating any sort of legal proceedings across national jurisdictions would be incredibly difficult, says Cohen. If Faulkner and her husband, for instance, had used only one embryo during their 2018 trip to Greece, they unknowingly would have had to wait years to add to their family, as COVID-19 travel restrictions and lockdowns would have made it impossible to go back to Greece for another IVF round. And shipping embryos across the Atlantic Ocean during a global pandemic would have been, at best, a logistical nightmare and, at worst, impossible. Within Canada’s borders, Faulkner thinks, provinces could do more to support Canadians financially. “The cost is just prohibitive to a number of people,” she says, noting that it is amazing that some Canadians get IVF support. But it is not nearly enough. Infertility doesn’t discriminate based on where you live or how much you make. Having a clinic in each province and territory, and travel subsidies to reach those clinics, would be a start for the Canadians already experiencing the hardships that come with infertility. Universal coverage for fertility, or at least better coverage in the public health care system, could also help Canadians get the treatments they need—and to get those treatments here in Canada. “We’re very proud of the fact that we provide universal health care, but this is a woefully ignored segment of health,” says Nakhuda. “Infertility is a medical issue.” Meanwhile, I’m not the only eggs-pat I know. My eggs are in good company: at the same clinic, my friends, a multinational couple, have embryos frozen. In another clinic a train ride away, my Australian friend has eggs on ice, just in case; she wanted to be sure her eggs could go with her when she moves back to Australia. Whether I eventually use my frozen eggs or if they survive the defrosting process is another story. If my partner and I ever decide to relocate, I could bring my frozen eggs with us, but it would cost a couple of thousand dollars to transfer them to Canada. And we would have to navigate regulations around transferring biological materials across national borders. It might just be easier to make sure I’m in Sweden when and if I need them. For now, it’s nice knowing I have eggs in the freezer—and that they can travel.The post Faced with Sky-High IVF Costs, Couples Look Abroad to Start Families first appeared on The Walrus.