This is the latest article in a Global News investigation into fertility in Canada, and the emotional and financial impact infertility has on Canadians struggling to conceive.
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Danielle Milley isn’t ready to think about what she and her husband will do if their next attempt to conceive a child doesn’t work out.
The couple, like tens of thousands of other Canadians, have faced an uphill battle in their attempts to start a family. As of this month, they have been trying for nearly two years, and after several rounds of intrauterine insemination (IUI), a miscarriage and a round of in-vitro fertilization (IVF), they are back to square one and examining their options.
“We fall into the unexplained infertility group, there’s nothing medically wrong,” Milley explained. “I am 37, so there are the factors associated with age.”
At the moment, the couple are still “firmly under the belief that we will one day be successful if we keep trying” and are preparing for more IUI and perhaps IVF procedures.
WATCH: What you need to know about a possible high-risk pregnancy.
Adding to the complexity of the couple’s decision is the fact that fertility treatments don’t come cheap. An IUI procedure can run up to $4,000, while IVF (which has a better chance of working) can top out at over $10,000.
If Milley and her husband don’t become pregnant with the help of these treatments, however, they may need to consider alternative options.
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According to reproductive endocrinologist Dr. Marjorie Dixon, of the Anova fertility clinic in Toronto (who is not Milley’s physician) there are four possibilities. And almost all of them involve seeking help from a third party.
“You could get somebody else’s eggs, you can use somebody else’s uterus, you can do nothing further or you can consider adoption,” Dixon explained.
Donor eggs and surrogacy
Sperm that aren’t able reach a woman’s uterus on their own can be helped along by modern medicine, with doctors injecting them right into the egg.
But, said Dixon, “when eggs are bad, they’re just bad.” As a result, donor eggs are normally a good way to overcome the problem of eggs that aren’t viable.
“In the U.S. it’s very commonplace, in Canada it’s fairly commonplace,” she said.
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Surrogacy, meanwhile, involves having another woman carry the fetus to term, whether she is impregnated with the genetic material of the prospective parents, a donor, or using her own eggs.
(These options are both a necessity for gay men, Dixon pointed out, who require a donor egg and a woman to carry their child to term regardless of their own reproductive health.)
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Both surrogacy and donor eggs introduce additional layers of legal and emotional complexity. Under Canadian law, surrogates can’t be paid for the ‘rental’ of their womb and donors can’t be paid for their eggs or sperm, although they can be compensated for certain expenses.
“I still make all my patients have the legal arrangements,” Dixon noted.
“The patients think I’m a big giant pain when I’m like, ‘no no no, you have to have independent legal counselling for you, and the egg donor, and the gestational surrogate, plus infectious disease screening and quarantining.’ It’s complicated … it’s tough.”
In many cases, the child conceived will also not be biologically related to the mother or the father, and that holds different importance for different people.
“The question I ask (patients) is, do you just want to be parents now, or are you still wanting it to be your own (sperm and eggs)?” Dixon said.
In spite of these challenges, Dixon said her practice is full of people who have made the choice to move forward with donors and surrogates.
Adoption
Patients in Dixon’s practice will also sometimes leave her care and never return, she said, and she often wonders how many have opted for adoption.
In Canada, adoptions can be carried out through the public system, with children being adopted from foster care.
According to the Adoption Council of Canada, there are thousands of children, including infants, waiting for homes across the country, although the majority in the public system are over the age of six.
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The council acknowledges that children who are placed in foster care have often suffered neglect, abandonment or abuse, but that shouldn’t discourage potential parents.
“Loving foster families and ultimately, permanent adoptive families give these children the best chance at successful outcomes and [a] bright future,” the organization’s website notes.
Canadians can also arrange a private adoption, often through an agency, which will be subject to specific rules set by each province and territory.
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And they can look to the international community to adopt a child, an option than is frequently more expensive and complicated.
Remaining childless
The decision to stop all attempts to have a child is one that some patients continue to make, said Dixon, and like the other choices, it’s intensely personal.
Couples or individuals may be financially, emotionally and physically exhausted by the effort to conceive, and choose to proceed no further for their own well-being.
“It stresses a couple to do this,” Dixon noted.
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For Milley and her husband, the path forward is still uncertain. But she said that for now, they’re not considering any of the alternative options listed above. They’ve spoken to a counsellor about them, however.
“We don’t like to think about the what-ifs right now,” she said.
“It’s difficult to imagine going through or learning about the challenges of adoption or surrogacy when we’re really still trying to focus on conceiving ourselves.”
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