Nova Scotia has long aimed to get its population over one million, relying on immigration from around the world and the rest of Canada.
But many people are denied access to medical treatment that could help them increase the population the old-fashioned way — making babies.
Statistics Canada reports 15 per cent of Canadians will face infertility and advocates say Nova Scotia's current rules leave people facing enormous bills to treat the medical condition, and that people who are poor, LGBTQ or single face even more barriers.
Alexandra and her wife, Samantha Conway, married two years ago and live in Halifax.
"We've been trying to grow our family pretty much since we got married," Alexandra Conway says. "We have four pets. We didn't have any known fertility issues. The only thing holding us back, obviously, was being two women."
They joined a waiting list for an initial consultation with a doctor to explore their options and saw a physician after four months.
All fees must be prepaid and the initial consultations cost around $300 — for them, and for single people.
For heterosexual couples, the first meeting is covered by taxpayers. That's because heterosexual couples are seen to be discussing options covered by MSI, and singles and same-sex couples are discussing things not covered by MSI.
"Nobody wants to have to go through such a mentally and physically draining route, but it's really our only option to grow a family," she says. "Everyone should be treated equally."
The Conways knew they'd have to pay about $10,000 for in vitro fertilization, but were shocked to learn the accompanying medicine would add $800 a day for 12 days.
"Overall, we've spent more than $20,000 on IVF and IUIs (intrauterine insemination) this year, and we still do not have a baby. It's wild to think about."
'Nova Scotia is lacking'
She thinks same-sex or single people should get the same coverage as opposite-sex couples, and doesn't understand why P.E.I. funds the procedure, but Nova Scotia doesn't.
"I think Nova Scotia is lacking in this area and I think the fertility community really feels unseen and not listened to by the province."
Conway says she and her wife feel like they have to "break your family's heart along with your own" every time a cycle doesn't result in a baby.
"I think it's a bit harder for straight couples because there is stigma against not being able to conceive naturally," she says.
"I feel like some of the friends we've made will be lifelong friends and hopefully one day we'll all have babies and they can also be friends."
Emma Griffin and her husband, Mike Johnson, share that hope. The Dartmouth couple borrowed money to obtain university degrees and to buy a home. They got pregnant, but lost the baby. They learned they'd need IVF.
"We did everything right, as they say. We got a good education, jobs, bought our house, got married, and then realized that we weren't going to be able to have a healthy baby unless we paid for it," Griffin says.
Griffin calls it "financial sterilization," as many people would struggle to come up with $20,000.
"If you don't choose the treatment, don't go ahead with the treatment, don't find some way to finance the treatment, then you're just not going to have children.
"We talk about Canada having free health care and insurance covering things, and then we have this, which is a treatment for a health condition and it's not covered."
She thinks the government should see it clearly as a medical issue that disproportionately affects women, and is "ignored" in part because of that, she says.
Her friend Aimee Terrio of Hammonds Plains calls herself an "infertility warrior" whose own experience has led her to become an advocate for menstrual and reproductive health.
Terrio says she and her husband struggled to get a family doctor, who then diagnosed her with polycystic ovary syndrome, a hormonal disorder that can affect fertility. They started an online fundraiser to pay for IVF.
"This is essentially our only chance to have a natural child. I did it with absolutely no shame, no guilt about it, because I felt my community, my family, my friends, they want that for us too."
It did bring pressure to keep that community updated, and so far the updates have all been that nothing has changed.
"There are a lot of people that are suffering because they feel ashamed or because they feel unworthy or because society doesn't look at fertility as a medically necessary [procedure]," she says.
"I did feel ashamed of my body and what it wasn't able to do and I did feel that I was unworthy. I still really struggle with that — every day I have to remind myself that I'm worthy."
5 provinces cover some of IVF
Carolynn Dube is the executive director of Fertility Matters Canada, a charity that helps people find resources and urges better public policy. Dube says five provinces offer some coverage for IVF, but the rest offer nothing. There is no national strategy.
In New Brunswick, people have to pay up front and apply for a one-time grant for half the costs — up to $5,000. P.E.I. has a fertility fund that factors in household income and offers up to $30,000 over three years.
Quebec is changing its model this fall from a tax credit to a fuller plan. Ontario covers one IVF cycle. Manitoba offers a tax credit.
Zach Churchill, Nova Scotia's health minister, did not respond to request for an interview on Nova Scotia's policy.
Dube says some employers will cover it via insurance, but that means people have to talk to their boss about their desire to get pregnant.
"Most people don't go tell their boss, 'I'm going to try to get pregnant,'" she says. "Women especially are worried that if I have that conversation, will it affect my ability to grow within the company? Am I going to be looked over or seen as a threat to the company because I want to have a family?"
Dube says infertility affects about 5.5 million Canadians, including 155,000 Nova Scotians. Canada has 37 clinics and 17 of those are in the Toronto area. That means many Canadians must travel for treatment.
She says the World Health Organization categorizes infertility as a disease, either through a medical diagnosis or through "social infertility," which includes LGBTQ and single people. And studies show getting an infertility diagnosis hits as hard as a cancer diagnosis.
"But in Canada, we don't recognize it like that. And that may be part of it," she says.
Bank loans for babies
Dr. Heather Cockwell is one of three physicians at Halifax's Atlantic Assisted Reproductive Therapies, one of two facilities offering IVF in Atlantic Canada. The other is Conceptia in Moncton.
AART is a non-profit and it offers services at cost, but that still adds up to a big bill. She says many people take two or three cycles to get pregnant, which can cost $50,000.
"I've had people who have had to mortgage their homes to do this," she says. "I see a lot of patients who want to pursue fertility, but they say, I just can't afford this. And that's really devastating to them as a couple and as an individual, because this is sometimes their only chance to conceive."
She says Nova Scotia stands alone among Maritime provinces in its approach to funding.
"The initial work-up and investigations are covered — if you are a heterosexual individual. Interestingly, they do not cover the initial consultation, follow up and investigation if you are a same-sex individual, LGBTQ+ or non-binary, or people in non-heterosexual relationships."
She's working with Doctors Nova Scotia to bring awareness to it and to offer the same access to all people seeking fertility treatment.
Fertile couples trying to conceive have about a 25 per cent chance each month. For infertile couples, IVF raises their chances from zero to about 50 per cent.
That means about half of people who seek IVF do not end up with a baby.
Cockwell says the whole process often leads to depression, anxiety and a sense of shame. Some people withdraw from social life, finding it too troubling to celebrate with pregnant friends, births and birthdays.
Her clinic consults with about 500 people a year and does up to 300 IVF cycles for people mostly from Nova Scotia, Newfoundland and Labrador, and P.E.I.. They also do about 300 frozen embryo transfers per year and 150 insemination cycles.
"It is kind of funny that the people coming from P.E.I. coming to Nova Scotia have funding, but the people in Nova Scotia don't."
She thinks if Nova Scotia covered IVF, around 1,000 people would go through the process each year.
Brittenay Bell volunteers with East Coast Miracles, a patient-led advocacy group in Atlantic Canada. They want to make IVF more accessible and affordable.
"IVF is a chance at a baby," she says. "You put yourself through the toll of the procedure just to then unfortunately go through multiple losses. And you do hit a wall: do I want to go through with this? Is it worth it?"
She knows many people who started out feeling alone, but found others through East Coast Miracles and social media, and knows how it can be hard to help someone decide to stop trying.
Bell says infertility takes a toll on mental health and on the couple's relationship. Individually and as a couple, they have to balance the hope of a child with the effort and cost of trying again, set against the knowledge that for many people, the journey ends without a baby.
Little support for men
While she found a supportive community online, her husband, Aaron, says few men talk about infertility.
"That's what I think was most shocking — how many people just don't speak about it because maybe they're afraid, maybe they feel ashamed of themselves. I can't speak for everybody, but how common it is, how quiet it is, is very alarming," he says.
"Just trying to be the provider and supporter as we went through that, it's no one's fault, but you still don't know. It almost feels like giving false hope while you're trying to support. Just trying to be the rock of the family when it felt like everything was tearing down."
He spoke to CBC to encourage other men to be more open about the difficulty of going through IVF. "It's OK not to be OK. There are a lot of males that might feel the same way in this situation. It's OK to talk about it," he says.
For the Bells, it worked and they have a 13-month-old boy named Nathan. It took six years and multiple miscarriages.
"Against literally zero per cent odds, we have an amazing 13-month-old boy who I would do it all over again for. Every shot, every procedure, all the heartache that came from it. For him, I would absolutely do it all."
"It does get better. Just hang it in there."
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