In 2024, Statistics Canada released new data showing that 2023 had recorded the country’s lowest ever fertility rate for the second year in a row. The total fertility rate (TFR) has been declining for more than 15 years, reaching 1.26 children per woman in 2023. With this new data, Canada joined South Korea, Spain, Italy and Japan in a group of the “lowest low” fertility countries, says StatCan.
There are many factors behind this fertility phenomenon. Economic uncertainty, high cost of living, lifestyle changes and choices around work and family planning are among them.
Infertility struggles also impact the TFR. According to the Canadian Fertility and Andrology Society, one in six Canadians experience infertility. Many couples look to IUI (Intrauterine Insemination) and IVF (In Vitro Fertilization) for help conceiving in the midst of fertility challenges.
Overview of IUI and IVF
Intrauterine Inseminuation (IUI)
The Mayo Clinic defines IUI as a process in which “specially prepared” sperm are inserted directly into the uterus around the time an ovary releases the egg or eggs, to boost the chances of pregnancy. Ideally during this procedure, the sperm and egg join in the fallopian tube, leading to conception.
IUI is often used in sperm donation situations, whether the person looking to conceive is single, or partnered with someone with a low quality or quantity of sperm. It is also used as a first-line approach along with medication in infertility cases related to endometriosis, a painful condition where tissue similar to the lining of the uterus grows outside of the uterus. Additionally, IUI can be used for cervical factor infertility, when the cervical mucus is too thick and impedes the sperm’s journey, and in ovulatory factor infertility, in which there is a lack of ovulation or a reduced number of eggs.
In Vitro Fertilization (IVF)
IVF is a more complex series of procedures that also boost one’s chances of getting pregnant. First, mature eggs are taken from the ovaries and fertilized by sperm in a lab. The embryos are then inserted into the uterus. The IVF process may use a couple’s eggs and sperm, but may also include eggs, sperm or embryos from a donor.
In vitro fertilization is sometimes employed after other treatment options, like medication and IUI, but it may be the first and only treatment in certain situations. In cases of fallopian tube damage or blockage, IVF is an option. It might also be considered for people with ovulation disorders, endometriosis, uterine fibroids, issues with sperm, genetic disorders, or to preserve fertility amid cancer and other health conditions.
Success Rates and Efficacy
The Cleveland Clinic says that, especially when fertility drugs are used, the pregnancy rate of IUI can be as high as 20%, which is around the same as “normal” conception rates. This also depends on the underlying cause of infertility, and the age of the parent. The IUI process is about the same length as a regular menstrual cycle, i.e. 28 days. If one attempts three to four rounds of IUI, this would lead to a cumulative success rate of 40% to 50%.
Age is one of the strongest factors in terms of IVF success, and the chances of becoming pregnant under 35 years old is much higher than if the person is over 40. According to The Cleveland clinic, the live birth rate when the birthing parent is under 35 and using their own eggs is about 46%. The birth rate of a 38-year-old using their own eggs is roughly 22%.
Cost and Accessibility
There are certain barriers to getting timely and affordable care for infertility in Canada and worldwide, with long wait times and limited healthcare options. More Canadians are seeking fertility care each year, according to a 2023 Global News interview with Dr. Sony Sierra, who was, at the time of the article, the president of the Canadian Fertility and Andrology Society.
Fertility costs can be expensive, varying from province to province, ranging from $10,000 to $20,000 per cycle. This is according to Fertility Matters Canada’s contribution to the Women’s Health study, conducted by the House of Commons Standing Committee on Health. In this study, the FMC discusses this significant financial burden, and suggests the government invest further in these essential services.
The FMC also lays out the funding standards for fertility care per province:
- British Columbia, Alberta, Saskatchewan and the three territories do not cover any of the cost of IVF or IUI.
- Ontario funds one IVF cycle for women up to 42 years of age, and all IUI. It does not cover the additional cost of medication.
- Quebec funds one IVF cycle for women up to 41 years of age, while covering medication and the freezing and storage of embryos for a year. There is also a tax credit application available for residents.
- Manitoba and Nova Scotia offer a tax credit equal to 40% of the cost of fertility care.
- PEI reimburses between $5000 and $10,000 annually for IVF and/or IUI, which includes medication. This is based on family income.
- Newfoundland and Labrador provides some treatment in the province; the IVF Subsidy program offers $5000 per cycle to people who have to travel elsewhere for IVF.
- New Brunswick covers up to 50% of costs for IVF or IUI procedures, including medication, up to a maximum of $5000 in a one-time grant.
The issue of accessibility is an important one, because IVF and IUI procedures can only be successful if the people who need them can afford them. When fertility care is only available to straight, upper middle-class and otherwise privileged individuals and couples, it creates a less diverse, less healthy society where not everyone has an equal opportunity to grow their family.
Comparing IUI and IVF
IUI is less expensive and less invasive than IVF, which is why it is often recommended as a first step in a person’s fertility journey.
IVF, on the other hand, is for more severe cases, and would likely be recommended after several unsuccessful rounds of IUI.
While IVF technically has a higher rate of success, the Cleveland Clinic says it’s important to recognize the unique challenges of each person’s situation. Raw data and percentages aren’t necessarily helpful to rely on when it comes to the specifics of an individual’s body.
It’s important to assess the physical, financial and psychological challenges associated with both procedures. On top of being expensive, fertility treatments can take a toll on one’s mental health, especially when an attempt to conceive is not successful.
Seeking out help from a medical practitioner should be one of your first steps in deciding whether to choose IUI or IVF. IUI may be used as a first-line treatment, or, depending on your current health status and specific conditions, your doctor may recommend going directly to IVF.
Conclusion
Regardless of what you decide is best for you in terms of fertility care, all people deserve options on their journey to start a family. They deserve access and affordability, as well as the opportunity to advocate for themselves in choosing the path that’s right for them.