While more and more Canadian households are turning to drugs and treatments to overcome infertility, few employers offer group insurance adapted to this reality. Yet the costs – financial, emotional and time-related – are real, and employee expectations are changing.

The Society of Obstetricians and Gynaecologists of Canada reports that approximately one in six Canadian couples experience infertility.

Infertility occurs when a woman under the age of 35 is unable to become pregnant after twelve consecutive months of unprotected intercourse. For women aged 35 and over, this period is reduced to six months.

In 40% of cases, the failure to conceive is attributable to the woman; a further 30% are attributable to men, and the remaining 30% may be explained by other known or unknown factors, attributable to one or both partners.

According to Statistics Canada, the total fertility rate (TFR) for Canadian women reached an all-time low in 2022, at 1.33 children per woman. The TFR represents the hypothetical number of children a woman could have in her lifetime, according to the current fertility rate.

Demand on the rise  

“In 2022, Sun Life was the first major insurance company in Canada to offer coverage for fertility treatments, surrogacy and adoption through the Family Building program,” the insurer stated in an e-mail.

In doing so, the insurer has observed a “significant” increase in claims for fertility drugs: a 20% rise was noted between 2022 and 2023, it says. Since 2019, demand has grown by 90%.

Apart from an 11% drop observed at the start of the COVID-19 pandemic, likely explained by limited access to fertility clinics due to the health emergency, the use of ovulation inducers among Canadian women increased by 14.57% between 2024 and 2023, according to Manulife Canada claims data. 

The use of fertility drugs has been on the rise in recent years, confirms Jennifer Foubert, Manulife's Assistant Vice President, Head of Product, Group Benefits. The trend shows a total increase of around 25% since the start of the pandemic. So, compared to the pre-pandemic period, “we definitely are seeing that this is increasing and increasing year over year."

Ovulation inducers are drugs that stimulate the production of one or more eggs in women who do not ovulate or who have irregular menstrual cycles.

In an interview with the Insurance Portal, Foubert explained this increase in part as a result of “awareness and increased access” to ovulation inducers, as well as an increase in the number of same-sex couples or single people wishing to become parents.

At Desjardins Insurance, the launch of the Family Focus offering in 2023 has generated a great deal of interest among employers. “As soon as we launched it, we saw an increase in demand from members,” says Andrée-Anne Bourgeois, Vice-President, Products, Actuarial and Underwriting, in a telephone interview. 

No statistics were available from iA Financial Group at this time. However, an e-mail indicates that group plans with 50 or more members can enroll in inclusive coverage for fertility, adoption, surrogate pregnancy and gender affirmation.

“As the costs associated with fertility treatments are often significant, ‘fertility’ coverage helps reduce the financial stress associated with the costs of conceiving a child by reimbursing certain drugs, care and treatments,” they state.

Financial assistance varies 

Group insurance products for fertility treatments are designed to complement the financial assistance offered by public health insurance plans across the country.

According to Fertility Matters, a single cycle of in vitro fertilization (IVF) costs patients around $20,000, with several attempts often required “before patients successfully take home a baby.”

Some provinces have chosen, or not, to cover fertility assistance under their public health insurance plans. 

For example, Quebec covers the cost of one IVF cycle, ovarian stimulation and up to six artificial inseminations per live birth for patients aged 42 and under.

Ontario’s offering is similar, except that the number of artificial inseminations covered is unlimited and there is no age limit for the patient. Ovulation inducers are covered, at an estimated cost of $5,000 per IVF cycle.

Manitoba and Nova Scotia offer a tax credit covering up to 40% of the cost of fertility treatments and/or medications, for a maximum reimbursement ranging from $8,000 to $16,000 annually. Saskatchewan's tax credit is more generous, at 50%, but with a maximum annual reimbursement of $10,000.

For its part, Prince Edward Island has set up a financing program for IVF and artificial insemination. Sums paid vary according to the income of the applicant household. 

Newfoundland and Labrador also has a program subsidizing up to $20,000 for fertility care. Residents of British Columbia can subscribe to a similar program, which offers financial assistance of up to $19,000 for the same care.

The Yukon announced in its most recent budget the creation of a tax credit that will cover 40% of expenses incurred for fertility treatment, up to a maximum of $10,000 annually.

Finally, Alberta, the Northwest Territories and Nunavut offer no financial support.

Rare coverage  

These provincial disparities mean that some Canadians find themselves in an unequal situation when it comes to financing treatment. For many, insurance coverage is a determining factor.

While 53% of Manulife Canada's employer members offer coverage for ovulation inducers through their group insurance plans, less than 1% have included coverage for in-clinic fertility treatments, according to the insurer in a press release issued at the end of April. 

At Desjardins Insurance, around one in two employers with a group insurance plan includes fertility-related coverage. Over 90% of these groups cover both drugs and treatments. Very few clients choose to cover only drugs, and even fewer, only treatments, stated the insurer in an e-mail.

Adding fertility care to coverage represents a premium increase of less than 5% in most cases, the insurer adds. Furthermore, organizations that do so also have the option of setting a cap on the amount of coverage offered. “This allows for responsible cost management,” says Andrée-Anne Bourgeois.

This practice is also offered by iA Financial Group.

Without providing figures, Sun Life says that only “a minority” of employers offer coverage for fertility treatments. 

However, in recent years, more and more “Canadians are starting families in different ways,” stated an e-mail. “This has created new group benefit needs for employers wishing to meet the unique needs of their employees."

Increasing demand 

At Manulife, they believe that Canadian companies should review their group insurance offerings in the face of increased demand for fertility care and treatment.

“Historically, benefit plans were designed and set up predominantly with the male workforce in mind of the mid 20th century,” contends Jennifer Foubert. Since women represent almost half of today's workforce, insurers need to review their offering to take into account the needs of this clientele, as well as those of their future families.

In a press release, the insurer “recommends offering coverage of at least $15,000 lifetime per family, although some employers offer coverage of up to $50,000 lifetime per family.” 

"In general, I think that we're seeing, in particular post pandemic, that employees have increased expectations of their employers now. This is a great opportunity for an employer to bring forward services for which we know employees are looking and seeking to have access to,” underlines Foubert, adding that “there are a variety of ways that employers can support their employees in their journey to parenthood."

In addition to paying part of the bill for medication or treatment, employers could offer more flexible schedules to enable people undergoing such treatment to attend medical appointments, or even provide paid leave for this reason, not to mention considering provisions in the case of surrogate gestation or adoption.

At Desjardins Insurance, interest in these services is already well documented. “We continue to improve our offering, and in the past year we've seen a surge in demand for surrogacy coverage," explains Andrée-Anne Bourgeois. Even though it's an altruistic gesture, surrogate pregnancy entails medical expenses for the surrogate. We offer employers the option of adding to their coverage the costs incurred for a member's surrogate mother, even if she herself is not insured under the same plan or a member's dependent." 

In Foubert's opinion, such flexibility in the range of coverage dedicated to the family would pay off for employers. “It's an opportunity for an employer to differentiate from their competition, to attract and retain talent, and provide exclusive benefits that really send a message about the culture and the way that they're supporting their employees,” she says.

Sun Life agrees. Citing a FertilityIQ study conducted in 2021, the insurer mentions that “employees who had fertility treatment coverage at work said they were more likely to remain in their job for a longer period (62%) and more likely to work harder (22%).” 

"Employers therefore have everything to gain from offering more inclusive group benefit plans. In a highly competitive market, this can be a distinguishing feature in attracting and retaining top talent," the insurer contends.

Canada Life did not respond to our request for an interview by deadline.