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Fertility Inc. is a five-part series by the Investigative Journalism Bureau that delves into the Wild West of the egg-freezing industry: its aggressive marketing, its high costs, and the chances of an eventual successful pregnancy.
Melika Dolaty is researching the merits of egg freezing because she wants to become a mother one day, just not yet. But she’s frustrated by the lack of data fertility clinics share.
“One hundred per cent that would help me so much to know the success rates,” said the Toronto-based financial consultant, 33. “That’s a big deal for me.”
Dolaty tried to find that information — including data for women of colour, who, studies show , can face unequal health outcomes in fertility care — on the websites of several Toronto-area fertility clinics. She failed.
That’s because in Canada, unlike the United States and United Kingdom, fertility clinics are not required to publicly share their individual success rates.
“It doesn’t give anyone a real understanding of what their likelihood of success is at a particular clinic,” said Kathleen Hammond, an associate professor at Toronto Metropolitan University’s law school specializing in health law.
Egg freezing involves collecting and storing eggs — sometimes for months or years — until a woman wants to have a baby, at which point the eggs are thawed, fertilized and transferred to the uterus to try to achieve pregnancy.
There is no public list of how many Canadian fertility clinics provide elective egg-freezing. The Investigative Journalism Bureau found 42 clinics with 110 storefront locations across seven provinces, most privately owned.
For many clinics, reporters found data was selectively presented, offering little meaningful information about the likelihood the procedure would lead to a successful birth.
For example, the website of Toronto’s Tripod Fertility says that, with “over 600 babies born, a 4.4-star Google rating, and nearly a decade of experience,” it is “known for personalized care and excellent outcomes. This makes it a top choice for egg freezing and IVF in Toronto.”
The Tripod website offers no specific statistics from its own clinic about fertility outcomes. Tripod Fertility did not respond to multiple requests for comment.
It is not known exactly how many of the 4.1 million babies born in Canada between 2013 and 2023 came from frozen eggs. Data from the Canadian Fertility and Andrology Society (CFAS), an industry association of reproductive specialists and health professionals, has tallied 70 born in that period through the 37 clinics that voluntarily provide data to it.
Only one per cent of egg-freezing cycles in Canada to-date are estimated to have resulted in a live birth, according to CFAS’s data, mostly because many people have not yet, or will never, use their frozen eggs. Only 25 per cent of the embryos created from frozen eggs and transferred into women’s wombs in Canada have resulted in a live birth, according to the CFAS.
While CFAS publishes a general, national snapshot of fertility success rates using data from most known clinics, its annual report does not give results for individual clinics.
CFAS executive director Emily McIntosh said there is broad support for increased transparency around clinic-specific outcomes from fertility clinic owners who are members of the organization.
There is a “wide variability” of outcomes between clinics, said Dr. Arthur Leader, a University of Ottawa obstetrics and gynecology emeritus professor who obtained success rate data for some Ontario fertility clinics through a Freedom of Information request.
The anonymized data from 2019 that he received shows live birth rates for women under 35 at Ontario fertility clinics ranged from less than 10 per cent at the worst clinic to over 60 per cent at the province’s highest-performing clinic. Reasons for this variation can range from physician skill to the quality of lab environments, but without data, patients live in a “void,” said Leader.
“People are being asked to judge the efficacy of a clinic by the waiting room, the clinical staff — the nurses, the sonographers, the psychologists — without really having any clue as to what goes on in the back room.”
The U.S., U.K. and Australia do present searchable birth-rate data for individual clinics.
In the U.S., clinic-specific egg-freezing success rates are published by the Centers for Disease Control (CDC) in a searchable database that includes filters for age and medical challenges that can cause infertility.
In the U.K., clinics are legally required to share patient-outcomes data. The government’s s earchable database includes the percentage of IVF treatments that result in live births.
In Canada, clinics provide their data for the CFAS report on a volunteer basis and don’t have to post their own clinic-specific data to their websites. There is no searchable database for patients.
‘A lack of clarity’
There is a distinct “lack of clarity” on how clinics define success, said TMU’s Hammond. Some, for instance, promote their services based on general outcomes in the age groups that are most fertile.
For example, the website for Ontario’s Anova fertility chain says “women between the ages of 30 and 37 have an 80 per cent chance of conceiving a child using frozen eggs.” It doesn’t provide a source for this statistic, and doesn’t state whether this rate applies to its own clinic. Anova did not respond to multiple requests for comment.
A number of centres don’t publish even general success-rate data.
Saskatoon’s Aurora clinic says one reason it doesn’t post its data is because “IVF success rates can be tricky to interpret.” Its website cites challenges in interpreting success rates, noting that “clinics can differ in the patient population they treat,” which can affect reported outcomes.
It urges people to find a “comfortable, convenient” clinic with a good medical team.
Clinics that publish success data can apply for a CFAS compliance seal, but only three, all of them private, have one: Ottawa Fertility Centre, Pacific Centre for Reproductive Medicine, and Olive Fertility in B.C. The seal indicates statistics are presented in a standardized way, but allows success to be based on “clinical pregnancy” — the first early sign of pregnancy captured by ultrasound, which is not the same as a live birth.
The U.K. government’s Human Fertilisation and Embryology Authority told its clinics in 2021 to be clear about live birth rates.
Some industry watchers argue clinics may use clinical pregnancy rates because they might not know their clinic’s live birth statistics if they don’t adequately track patient outcomes.
Vancouver’s Olive Fertility, which says it has “among the best pregnancy success rates in Canada,” does have this information.
After following 646 egg-freezing patients from 2013 to 2022, Olive doctors published a study that found 65 of those 646 patients eventually thawed their eggs and of those, 23 embryos were successfully fertilized and transferred into the women. Fifteen patients — about one-quarter of those who thawed eggs and just two per cent of those who froze them — had “at least one delivery or ongoing pregnancy.”
Olive Fertility did not respond to multiple requests for comment.
What’s in a consent form?
Reporters posing as clients asked a dozen clinics if they could see the consent forms signed by their customers. Almost all said the explanations or warnings contained in these documents could be seen only by paying customers.
OriginElle Fertility of Montreal was the only clinic to share its form, which the IJB analyzed based on a seven-point framework developed by TMU’s Hammond. Her framework recommends the document include comprehensive information on how egg freezing works, the risks and financial obligations, and success rates.
OriginElle’s document warned patients that eggs “may not survive the freezing, storage and thawing process,” and may not be suitable for fertilization. It lacked specific data on some of Hammond’s other suggested steps, including disclosing live birth rates and specifying that egg freezing is not “insurance” for having a baby.
Hammond, who analyzed egg-freezing consent forms from 11 Canadian clinics, has called for a standardized template to be used by all clinics, to “give people an adequate amount of information” about success rates or potential complications.
Michel Dahan, reproductive endocrinologist at the OriginElle clinic, told the IJB he was open to a standardized consent-form framework, but stressed the importance of physician communication in the process.
“(Hammond) raises some very legitimate points,” said Dahan. “I think it’s very important to address all those issues transparently to the patient. Whether it’s in the consent form or in a discussion with a patient really depends a lot on how you expect the patient to absorb (the information).”
Not a ‘guarantee’
In Canada, the main federal legislation that governs fertility services, the Assisted Human Reproduction Act, was passed in 2004. Experts say updates haven’t kept pace with the emergence of egg freezing.
Health Canada communications adviser Karine LeBlanc said the legal framework around the Act only lets Health Canada regulate the safety of donor sperm and ova used in assisted reproduction.
CFAS has pressed the federal government to update it, and requested that the government fund the national collection of data from all fertility clinics, McIntosh, the CFAS executive director, said.
“There’s a lot of room for improvement. And I think we’re at this pivotal point in (the industry) where this is becoming a serious part of economic growth, social health, reproductive rights, equity,” McIntosh said.
“The public wants to know. And we want to be able to facilitate the information, to make sure that there’s trust in the care that’s being provided.”
Few provincial health ministries, with the exception of Quebec, make it mandatory for fertility centres to report their success-rate outcomes to the government, including live births. In Ontario, for example, clinics must report wait times, but success-rate data is voluntary.
Industry concerns exist that clinics forced to share live birth rates publicly might reject clients with lower odds of having a successful pregnancy — if they feel that including these patients will make their public statistics look bad.
Leader dismissed that argument as “nonsense,” noting that fertility clinics in the U.S., where success-rate data is public, “continue to thrive.”
— wclarke@ijbureau.org, lculbert@postmedia.com
Next: The high cost of egg freezing
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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