Seven ways to make the egg-freezing industry better for women

Fertility Inc. is a multi-part series by the Investigative Journalism Bureau that delves into the Wild West of the egg-freezing industry, its aggressive marketing, the high cost and the chances of an eventual successful pregnancy .

The largely unregulated, private fertility clinics that offer egg freezing to women in Canada need stronger safeguards around transparency, advertising and counselling, say many experts who have studied or worked in the field.

Over eight months, the Investigative Journalism Bureau analyzed how egg freezing is marketed and sold to women. It found several examples of what the IJB characterized as aggressive or misleading advertising, a dearth of success-rate data and, often, lack of clarity around the high cost of the procedure.

Reporters consulted Canadian and international experts, and dozens of fertility patients, for recommendations on how the rapidly growing industry should be improved.

There is no central oversight of Canadian fertility clinics. The federal Assisted Human Reproduction Act, passed in 2004, aimed to license and oversee clinics but the Supreme Court in 2010 said these measures were beyond federal jurisdiction, leaving most regulation of fertility services to the provinces.

Even so, the federal government should fund a national website, independent from the fertility industry, showing individual clinics’ success rates and costs for fertility procedures, says Alana Cattapan, a University of Waterloo associate professor and Canada Research Chair in the Politics of Reproduction.

“People should know that a $10,000 outlay is just the very beginning,” she said, adding that many treat egg freezing like an “insurance policy” but without realizing that there may never be a payoff.

Arthur Leader, a reproductive endocrinologist and professor emeritus at the University of Ottawa, wants a federal review of assisted reproduction that would include uniform standards across provinces, long‑term tracking of outcomes, and stronger consumer protections.

Venture capital drives investment in many clinics, reproductive technologies and fertility startups. But “venture capital firms don’t have patients, they have customers or clients. Health professionals have patients, but the conflict of interest turns patients into clients,” Leader said.

Building on Cattapan’s idea, he favours a government-backed reporting system similar to online databases in the U.K. and U.S., which would show the technology is often “not as successful” as some clinics suggest.

Ontario and B.C.’s publicly funded fertility programs do set requirements for participating clinics but do not broadly regulate the sector. Quebec is the only province with a comprehensive regulatory framework for fertility clinics, requiring them to consider medical risks, age and likely success before treatment.

The IJB uncovered myriad examples of aggressive or over-reaching marketing to women, using language that implied egg freezing offers guaranteed results or greater control over future fertility.

In the U.K., fertility clinics are prohibited from making misleading claims about success rates and must be transparent about costs, risks and optional add-ons. U.K. regulators also monitor advertising and issue enforcement notices.

Vanessa Gruben, a University of Ottawa law professor specializing in health law and policy, said provinces should create regulatory frameworks for clinics, including how they advertise. “Providing people with as much evidence-based information as possible, I think, is really necessary for a person to provide informed consent to this particular service,” she said.

The provinces that house most of Canada’s fertility clinics, B.C, Quebec and Ontario, say regulatory colleges are responsible for overseeing clinics. But College of Physicians and Surgeons of Ontario spokesperson Mickey Cirak said its oversight applies only to registered doctors and “does not extend to employment decisions or the business or marketing practices of clinics.”

Leader argues Health Canada and provincial and territorial governments need to agree on a template for oversight of assisted reproduction.

More than 95 per cent of frozen eggs in Canada have gone unused to-date. There are no regulations or laws on storage limits and disposal, leaving clinics and patients uncertain about what happens if someone dies, divorces or simply forgets.

“We don’t have any ability to get rid of frozen eggs or to use them for research or to gift (them to) somebody else to help them start a pregnancy,” said Leader.

Countries such as the U.K., Australia and Ireland have established storage limits, with processes for extensions.

Kathleen Hammond, a fertility expert and assistant professor at the Lincoln Alexander School of Law at Toronto Metropolitan University, said Canadian clinics need clear protocols on ownership, storage limits and disposal so patients understand their options. Currently, clinic consent forms are often “murky,” said Hammond.

The Ontario, B.C., and Quebec governments did not respond to specific questions on unused-egg regulations.

“I think (egg freezing) is as revolutionary as the birth control pill was to me,” said Janet Takefman, a former director of psychological services at the McGill University Reproductive Centre. “I think there’s a lot of positives about it, if it’s not oversold and if women aren’t made to feel guilty if they don’t do it.”

During her decades at the centre, Takefman said she counselled everyone who froze their eggs. She says such support should be standard before patients invest money and hope in the procedure. Counselling is not mandatory at most Canadian clinics. Takefman said patients considering egg-freezing should understand all their options including adoption, life without children or using donor eggs.

Zeynep Gurtin, a lecturer in women’s health at University College London, agrees clinics should offer counselling before egg freezing to clearly explain the procedure, possible side effects, costs and pregnancy chances.

“Considering the kinds of money that clinics are charging, it’s astounding that they can’t afford an hour for somebody to sit down with (a patient) and go through these things,” says Gurtin.

The Canadian Fertility and Andrology Society (CFAS), a nonprofit representing reproductive specialists and health professionals, supports counselling but its guidelines are not legally binding.

Some experts say egg freezing cannot solve the deeper economic pressures shaping family planning decisions as Canada’s birthrate hits historic lows.

Solutions include better parental leave, affordable child care, flexible workplaces and financial measures to make it easier to have children earlier, said Sarah Kaplan, founding director of the Institute for Gender and the Economy at the University of Toronto’s Rotman School of Management.

B.C.’s ministry of health points to measures including pay transparency legislation to address the gender pay gap. Like some other provinces, it has also invested in child care to help reduce some fees, but remains far from its 2017 promise of $10-a-day daycare. And while some provinces fund limited IVF cycles or offer fertility tax credits, these fall short of covering egg freezing.

• Egg freezing is a booming business in Canada. Here's how women are being oversold
• When fertility doctors face potential disciplinary action, it's not easy for patients to find out

Experts such as Waterloo’s Cattapan, however, are not convinced that governments should pour money into a largely private industry.

“I hesitate to think that egg freezing is a good way to spend public funding,” she said. Better uses might include student debt relief, affordable child care, and streamlined adoption, she said.

Within Heather Mosher’s friend group, fertility treatments are a frequent topic of conversation.

The 37-year-old says many women she knows want families but are navigating relationship uncertainty, rising living costs, and declining fertility. When Mosher sought advice from a Metro Vancouver fertility clinic, tests showed she had a lower-than-average egg reserve. She was presented with options such as IVF and egg freezing.

But Mosher struggled to justify spending thousands on a technology she believes offers only the “illusion of control.” She is frustrated that society has embraced options such as egg-freezing rather than financial solutions to enable women to afford to have children earlier.

“You’re made to believe if you spend enough money, then you can just use science to fix the problems,” said Mosher. “It just feels like the whole system has failed us.”

After deciding she couldn’t justify the cost of egg-freezing, Mosher hopes to have a baby “the old-fashioned way” with her partner. She wishes society made it easier to start sooner.

“It feels like my generation was like, ‘Oh, we’ve got this new technology and you can wait,’” she said. “But the best thing you can do biologically is just have your kids earlier.”

— wclarke@ijbureau.org, lculbert@postmedia.com

The Investigative Journalism Bureau (IJB) at the University of Toronto’s Dalla Lana School of Public Health is a collaborative investigative newsroom supported by Postmedia that partners with academics, researchers and journalists while training the next generation of investigative reporters.

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