Lack of fertility treatment on Vancouver Island

Even though about one in six couples experience infertility, there are no fertility ­clinics on Vancouver Island that offer full IVF services

Victoria’s Emily Bruser talks about her three-month-old baby Ivy with all the warmth and gratitude of a new mom who fiercely wanted a second child and had one through the wonders of in-vitro fertilization.

But Emily Bruser is also angry. And she’s not alone.

The process was long and costly and involved multiple trips to the mainland for treatments — something anyone from the Island who is undergoing the same journey faces.

“It is shameful that such limited infertility care is being offered to Island residents,” the 39-year-old says.

Bruser and husband Dustin Kleissen naturally conceived their first child, Aoife, in 2015, but while they were stationed in Africa and the Middle East, where Bruser worked as a communications officer for the UN, Bruser failed to get pregnant again.

The couple escalated their efforts to in-vitro fertilization in 2019, but due to the pandemic, the family was repatriated to Canada, and was forced to leave embryos behind.

Back in Victoria in August 2020, Bruser’s initial relief to find a fertility clinic in the capital region soon gave way to disappointment when she realized the major steps of IVF — harvesting the egg and transferring the fresh embryo back into the uterus — must take place at the centre’s Burnaby facility. “We undertook five trips across the water in the coming months, worsening the considerable stress that accompanies ­infertility,” said Bruser.

Even though about one in six couples experience infertility, there are no fertility ­clinics on Vancouver Island that offer full IVF services, regarded as the most successful treatment option. As well, there is no comprehensive coverage in B.C. for the procedure, which costs $10,000 to $20,000.

In mid-2019, the Pacific Centre for Reproductive Medicine in Burnaby purchased the Victoria Fertility Clinic from Dr. Stephen Hudson, an obstetrician and gynecologist.

Dr. Ken Seethram, who co-founded the Pacific Centre for Reproductive Medicine in 2006, says the Saanich clinic was accredited when established in 2003, but no longer meets standards for non-hospital surgical facilities required by the College of Physicians and Surgeons of B.C. for IVF.

In IVF, eggs are removed from the ovaries and fertilized by sperm in a lab. After a number of days, the embryo is genetically tested and frozen or returned to the womb to grow. It’s considered minor surgery, but requires the same standard as a hospital operating room when it comes to air system, room size, recovery suite and medical-device reprocessing area.

While other procedures, such as ultrasounds, blood testing, hormone injections and co-ordination of the IVF cycle, take place in Victoria, Island clients must travel to Burnaby for the egg retrieval and fresh embryo transfer, although Seethram and his team continue to investigate an expansion or relocation of their Saanich clinic.

If renovation within the existing building is not possible, “we’d be looking at relocating … somewhere else in the Greater Victoria region,” Seethram said.

To offset costs of travelling to the mainland, clients are given travel credit of about $500.

An alternative option is coming in March, with the opening of the Olive Fertility Centre on Yates Street, although it also won’t initially offer full IVF services.

Dr. James Graham and Dr. Ginevra Mills are both taking new clients who have doctor referrals for consultations online until March, when the clinic will open its doors.

The two full-time reproductive endocrinologists and fertility specialists live in Victoria, but, like PCRM, Olive Fertility Centre will operate as a satellite office to headquarters in Vancouver, and egg retrieval and transfer will happen on the mainland.

“We are going to try to minimize the emotional affects and the number of times they have to go to Vancouver, but unfortunately at this time it’s still a reality,” said Graham, adding he hopes the clinic will eventually open a larger clinic offering full IVF services.

“Personally, I believe the women of Vancouver Island deserve a full-service clinic,” said Graham. “The demand is definitely here.”

Bruser said infertility patients live on “shreds of hope” under the emotional strain of hormone therapy and financial stress of costly private treatments that have no guarantee of working, and each added stressor — waits for referrals and appointments and travel — has a cumulative effect.

‘PERIOD OF DARKNESS’

When her first embryo transfer failed, Bruser said she experienced “a period of darkness” and received little support from the PCRM clinic. Phone tag with the Burnaby office for test results felt “humiliating and stressful.”

After a second embryo-transfer attempt in March 2021, Bruser said her care was “clinical” and the facility was run at that time on a skeleton staff with only visiting doctors.

“When I encountered spotting and asked if I could urgently come to the Victoria clinic to check the viability of my pregnancy, I was informed that there was not anyone there that was qualified to perform obstetrical scans,” said Bruser. She instead sought out a private medical imaging clinic. “I felt incredibly alone.”

Bruser said she shared her dissatisfaction with the staff and doctors many times, but did not make a formal complaint.

Seethram said the clinic had been staffed six days a week by nurses, a nurse co-ordinator and a rotating physician from Vancouver after its two physicians left to do sub-specialty training.

Today, the clinic says it has two full-time doctors with another in orientation and scheduled to start in April. “We also have a part-time physician starting in April, and another full-time physician starting in June,” the clinic said in an email.

Seethram said he’s not aware of a written complaint and would want to talk to any unsatisfied patient to address their concerns and give them closure.

Every IVF clinic in the country would advise a patient having a miscarriage or a tubal pregnancy to go to the hospital, he said. Doctors and nurses do a lot of counseling around client concerns and unsuccessful procedures, and the centre has a relationship with online support groups and allied professionals such as psychologists that can be accessed through most extended-health care plans, he said.

Bruser, who spent $20,000 on IVF, wants to see some form of provincial funding to make such treatments accessible to everyone, regardless of income level. She also wants to see access to egg retrieval and embryo-transfer procedures made available on the Island. “We must demand more compassionate, comprehensive infertility care for the sake of all of those unlucky enough to travel this path,” she said.

IVF costs up to $20,000 and more for people who need a donor egg or sperm, or surrogacy.

B.C. funds diagnostic procedures — X-rays, ultrasounds, sperm and hormone tests — and medication, while Ontario, Quebec, Manitoba and New Brunswick pay for some level of IVF — Ontario for example pays for a single cycle per patient, per lifetime.

The B.C. Health Ministry says the province’s funding or lack thereof is not a comment on the value of IVF, “but rather reflects the limits of available public funding.” The province said its focus is to ensure that British Columbians have access to “effective, medically necessary procedures, while keeping health-care costs sustainable.”

But fertility coach Laura Spencer, who had her own struggles with infertility, says that lack of government funding adds to the pervasive feeling amongst the infertile of being unworthy of motherhood.

Infertility still brings with it such stigma that it pushes underground the very people — infertile couples, singles and LGBTQ2A+ individuals— who would advocate for change, Spencer said.

“There aren’t teams of women and couples knocking on the legislature door saying this should be funded because for some people, there’s a bit of shame and embarrassment around it.”

Spencer has called on federal politicians to provide equal coverage of IVF across Canada, to pressure provinces like B.C. to cover infertility treatment under the universal health-care system. The federal Liberals in their election platform promised to make the cost of IVF an eligible health expenditure and give tax credits to surrogate mothers.

‘A DOUBLE WHAMMY’

Despite having a master’s in public policy focused on women’s health, a career in health-care management and research, and a physician in the family, Spencer, 40, said she was unprepared to navigate the trauma of an infertility diagnosis, the stigma that accompanied it, and the treatment system, with its exorbitant uncovered costs.

“We’re kind of left behind and forgotten — most couples are suffering behind closed doors,” said Spencer, who switched careers to become a full-time fertility coach in 2019.

“For Victoria it’s a double whammy because you have the high cost of living, the cost of IVF, but then you also have to travel to the Lower Mainland for your egg retrieval,” said Spencer, who administers two IVF Facebook pages. “It comes up all the time as an issue — there’s so many members in Victoria.”

Spencer, who was born and raised in Lantzville, met partner Emanuel Nazareth, a scientist, online while in Toronto. They had similar interests and backgrounds in health, and both answered “100 per cent yes” in their dating apps in wanting to have children.

The couple married in 2014 on a picturesque beach in Lantzville. After a year of trying to have a baby — amid a move back to the West Coast and new jobs — concern set in: “We thought, OK, what’s going on here? It’s a hard thing to swallow. It’s scary to think that you might be infertile.”

Spencer had a fertility condition that could be treated with medication, but after a diagnosis of “male-factor infertility” they took a deep dive into fertility treatments and side-effects that included a suspected blood clot.

Spencer used Olive Fertility Centre in Vancouver, one of about 10 fertility clinics in the province, but said it was a fertility coach that was her personal saviour — which is why she sought out the same profession.

Son Ethan is now three and thriving, but like Bruser, Spencer said her infertility journey left her with emotional battle scars: “It’s traumatizing.”

That trauma also compelled Amber Andresen to speak out.

Now 30, the Victoria woman has been with her husband since they were 18. The couple married in 2015 and planned to have their first child two years later. Six months in without a pregnancy, the couple questioned their fertility.

There was no history of infertility in either of their families and Andresen had not been on birth control in years.

Having lost their family doctor, the couple had to go through Telus Health for a telemedicine appointment to get a referral to the Pacific Centre for Reproductive Medicine in Victoria, waiting about 10 months before the clinic accepted the referral.

After several tests, it was concluded the couple have what’s called “unexplained infertility,” one of the most common reasons for treatment.

Andresen said she spent a year trying different medications to trigger multiple eggs to ovulate before she was recommended for the more expensive and invasive IVF. She said she and her husband navigated the system on their own, relying on Facebook groups in the beginning, “which is why I’ve been very vocal about it, so that I can help people who may be going through the same thing — because it’s daunting.”

In the end, the couple spent about $20,000 on IVF, including medication, of which about $5,000 was reimbursed through Andresen’s extended-health coverage. “The province considers it an elective procedure which is a little insulting,” said Andresen, who believes students should learn about infertility in school.

She is now 15 weeks pregnant, and, like Bruser, has her remaining harvested embryos frozen and stored by the Pacific Centre for Reproductive Medicine.

Andresen said her elation at having a successful IVF treatment is undercut by the knowledge she has gained of what can go wrong before childbirth. “It’s hard to feel excited or happy because you’re always waiting for the next bit of bad news and the next fee and the next procedure.

“I’m on pins and needles every week.”

DEMAND ON THE RISE

Fertility clinics have seen a surge in demand for both fertility treatment and egg freezing during the pandemic. “The number of patients we have seen for IVF and egg freezing has increased by over 30 per cent,” said Dr. Beth Taylor, co-founder and co-director of Olive Fertility in Vancouver.

There are many reasons for rising demand, including women delaying having children (the average age of PCRM clients is about 37), rising male infertility, the LGBTQ+ community desiring families, single women and people with ovaries who choose fertility preservation such as egg freezing, and couples who want genetic testing for embryos before implantation.

But the pandemic itself has played a role, prompting people to “reorganize their life priorities,” said Seethram, noting PCRM has seen a 25 to 35 per cent increase in demand for consultations.

“People are not going to Hawaii and they’re looking at that new kitchen reno and wondering what it all means. People seem to be thinking more about what’s really important in their lives. It’s retooled people’s priorities.”

There’s demand “all over the Island” for fertility treatments, said Seethram, adding that for patients in Campbell River and Tofino, access to Victoria and then Burnaby is an added burden. Some clients move to Burnaby or Victoria for a week or two for the procedures, he said.

The biggest area of demand for fertility services right now is women freezing their eggs to be thawed for use in coming years, an elective procedure called “social egg freezing,” said Seethram.

There is also high demand for onco-fertility, where people with cancer undergo IVF egg retrieval prior to chemotherapy or radiation treatments so as to have pregnancies later in life when they are well.

Seethram says fertility treatments can be as inexpensive as counselling on the regularizing of periods, correcting hormones or endocrine issues, lifestyle counselling on smoking cessation or exercise and weight loss, or fertility pills that may cost up to $70 a month.

Intrauterine insemination, called IUI for short, where sperm is placed directly into the uterus using a small catheter, costs $650. Superovulation can cost $1,000 to $2,500 per month, whereas IVF is a lot more, with pre-implantation genetic testing ranging from $12,000 to $15,000, while drugs cost another $3,000 to $6,000.

“IVF is one option of usually many many options,” said Seethram.

For those who can’t afford IVF, affordable methods with lower success rates can be used, he said. “I think the big obstacle really is time, you know, for so many patients,” said Seethram. “If they’re 39, and they don’t have children, and they really want a family of two, then there’s this huge pressure of time on them to try to do IVF, to get pregnant, but also to freeze embryos for that second or third baby if they want a larger family.”

Graham, who worked at the former Victoria Fertility Centre with Hudson prior to PCRM buying the clinic, and convinced Taylor to set up a satellite office in Victoria in hopes of providing more services locally, is optimistic a second fertility clinic could ease waitlists. About 700 people were on the waitlist for the Victoria Fertility Clinic when it sold in 2019, he said.

He said the goal is to expand to four doctors in the future, adding some have expressed interest, although the doctor shortage is widespread. “There’s a shortage of everybody these days.”

As demand increases, he also hopes it will put pressure on the provincial government to fund infertility treatment in some form, although he says there should be limits on that funding, including age and number of treatments.

“I would love for it to be covered,” said Graham. “

Seethram, who has been in practice for 24 years, agrees. “We, as physicians, consider this a disease and it should be, for all intents and purposes, treated like any other disease,” said Seethram. “Part of the problem with it is that the technology around the treatment is expensive and therefore sometimes it makes it cost-prohibitive for some governments.”

ceharnett@timescolonist.com