the ongoing challenge in fertility treatment: age vs. innovation
8 minute read
dr. jenna gale of the ottawa fertility centre, not pictured, is pioneering a very specific technique on ultrasound to look for endometriosis that is increasing the rate of detection.
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back in 1978, the birth of one baby through in-vitro fertilization (ivf) was widely regarded as a scientific miracle. today the process, where eggs are removed from a woman’s body and fertilized with sperm in a lab before being implanted back into the womb, is a powerful option that’s helping millions become parents, with advancements in the field increasing the odds of success.
of course, you have to go in with eyes wide open. ivf is not a sure thing and it’s costly, but, as the society for reproductive technology reports, 55.6 per cent of live births after the ivf cycle occur in women between 30 and 35 years old. the initial embryo transfer has a 41.4 per cent live birth percentage, and the rate of live births for later embryo transfers is around 47 per cent. these numbers represent when a woman in this age group uses her own eggs rather than donor eggs.
now when it comes to family planning there are more conversations about egg freezing to extend your reproductive window or fertility treatments to help with conceiving. that’s an important shift, given as many as 15 per cent of couples in canada are affected by infertility. that number may climb as people are waiting longer to have children—which is not just a women’s issue. advanced age is the big factor here for both men and women. (though a man’s biological clock doesn’t tick as loudly as a woman’s, it does count down, impacting fertility and the health of their baby.)
there is considerable research about infertility and pregnancy complications in maternal age, but fewer studies have looked at reproductive factors in men. for women, advanced age is 35 to 37, when egg quality drops off sharply, but studies vary for men’s advanced age as anywhere from 35 to 50 as semen volume, total sperm count and sperm motility decline. a large population study out of the u.k. in 2020 shows that conception is 30 per cent less likely for men older than 40 than it is for men younger than 30. in fact, infertility can be traced back to men 30 per cent of the time and to women 40 per cent, according to the society of obstetricians and gynaecologists of canada.
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canadians are more aware of fertility issues, but gaps still exist
for canadian fertility awareness week (april 20 to 26, 2025) four fertility clinics across the country, generation fertility, grace fertility, heartland fertility and ottawa fertility centre have released new data from an online survey of 1,563 people who are members of the angus reid forum, revealing that canadians are well-informed about fertility and early family planning. notable highlights include the recognition by 65 per cent of canadians that fertility challenges affect both men and women equally, shifting the narrative beyond a women’s-only issue. as well, nearly half say people should start thinking about family planning between age 25 to 30, with men (25 per cent) more likely than women (18 per cent) saying fertility awareness should begin even earlier.
“unfortunately, a lot of patients are quite surprised when they hear the degree of impact that comes with age because we see it in the media and we hear stories about friends of friends who have successful pregnancies in their early, mid and sometimes even later 40s but we’re not necessarily hearing the whole story,” says dr. jenna gale of the ottawa fertility centre. “there’s a whole host of people who have challenges and don’t talk about it, so that’s a big area that we do a lot of education around.”
she also highlights misperceptions surrounding miscarriages where the average person isn’t aware that about one-quarter to one-third of pregnancies end in miscarriage. although an emotional hardship, miscarriage may not be a red flag unless you’ve gone through more than one.
“thankfully we are seeing more patients who have recurrent miscarriages. so, if you had one miscarriage, it doesn’t necessarily indicate that there’s a problem, but if you’ve had two or three miscarriages, you should definitely request a referral to a fertility specialist. because a lot of the time, we can find a reason why it’s happening, and even if we don’t find a reason, there’s things that we can do to minimize the risk of another miscarriage.”
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as well as specializing in reproductive endocrinology and infertility, gale completed a master’s degree in clinical epidemiology at harvard university. as a clinician researcher, she brings a critical eye to evaluating the evidence of treatment innovations in what she describes as a rapidly evolving field. her team is constantly making changes to procedures based on evidence.
her clinic is leading the diagnosis of endometriosis, a common condition for about 10 per cent of the general population of people who have ovaries. many people don’t experience symptoms, but endometriosis has been linked to infertility for up to half of patients who are having difficulty getting pregnant, she says. as many as 30 per cent of couples referred for fertility services have an infertility diagnosis that can’t be explained (which is hard for people to hear). she’s pioneering a very specific technique on ultrasound to look for endometriosis that is increasing the rate of detection.
“so every patient who has infertility and gets a work-up, they always get an ultrasound.” this pelvic ultrasound won’t detect every case, but when it does, she can recommend more effective fertility treatment.
“there’s a much higher chance that patients with advanced endometriosis will need ivf in particular. ivf tends to be the best treatment option because it bypasses the abnormal anatomy related to endometriosis as well as bypassing the other impacts of endometriosis disease on eggs and embryo development.”
how far has ivf advanced over the decades?
for that first successful procedure, the eggs were retrieved laparoscopically, where women required a general anesthetic and surgery, gale explains. “instruments were put into the abdomen to drain the follicles through the abdomen, and you couldn’t inject sperm into eggs. you had to just mix eggs and sperm in the lab.”
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now the start of an ivf cycle typically begins by injecting hormones that help the ovaries make more than one egg develop at a time. egg retrieval happens in a doctor’s office with medication to prevent pain and promote relaxation. an ultrasound device placed in the vagina detects the follicles where the eggs are located, and a thin suction needle is inserted to collect the eggs. healthy sperm and mature eggs are mixed and kept in an incubator, or with the procedure intracytoplasmic sperm injection (icsi), a single sperm is injected into each mature egg. icsi comes into play when semen quality or number is an issue or when fertilization attempts in prior ivf cycles failed. implanting the embryos often happens after five days for improved success.
“we’ve come from getting one egg in that laparoscopic surgery and mixing that with sperm and successes way under 10 per cent per cycle, to where a patient who is under 35-years-old who needs ivf, their chance of having a good clinical pregnancy from a single cycle of ivf is over 70 per cent. that advancement is just amazing.”
dr. michael hartman at generation fertility in vaughan, ont. is equally as passionate about his work and improving outcomes for patients. he talks about big wins like the vast reduction of multiple births with assisted reproduction technology. “it used to be that you would hear about triplets and quadruplets and even the octomoms of ivf. and that has become a thing of the past.” the procedure of single embryo transfer (implanting only one embryo at a time) has “revolutionized ivf.”
for example, between 2011 and 2014, 313 fewer multiple pregnancies resulted from ivf, a 23 per cent drop, despite a 17 per cent increase in the number of ivf cycles started in canada over the same period, reports the canadian fertility and andrology society in reference to collected data. the society attributes the reduction to improvements in technology and education in support of single embryo transfers.
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hartman says the technique is now used in 95 per cent of ivf cycles in canada.
another important development in the field is the technology for harvesting and freezing eggs for future use. previously, the freezing and thawing wasn’t as successful, but the last decade has seen the majority of fertility clinics in the country performing vitrification, where instead of a slow freeze for ice crystals to form inside an embryo, flash freezing is safer and has improved results. embryos can be frozen and stored for years, he says.
genetic testing of embryos is another advancement, with about 80 per cent of ivf cycles at his clinic performed with this option added in at the patient’s request. the testing is done primarily as a screening tool for any chromosome abnormalities. and with people waiting longer to have children, advanced age comes with a higher chance of having chromosome abnormalities.
“by doing this testing, we take a few of those cells that become the placenta, the outer cells, before we freeze an embryo, and we can actually do genetic testing on it to make sure that we’re only putting in embryos that are tested and have normal chromosomes.”
age remains a key part of the conversation around infertility
like gale, hartman says what’s most important is messaging about age as a significant contributor to infertility. while he mostly sees patients age 30 to 42, older patients reflect the rising health problems in the general population, like diabetes, cardiovascular disease and obesity. add in environmental exposures that may have a negative impact on hormonal and reproductive health, and overall fertility decline in canada can be expected.
“no two situations will be treated the same,” he says of the preliminary testing which often reveals a less involved approach. “in most people, ivf is not the first line treatment. we’re going to try some more basic medications to either make cycles more regular or we may try things like intrauterine insemination (where a sperm sample is inserted into the uterus) as a way to improve chances of conception before considering ivf, unless there is a more serious concern or time pressure that would prompt us to be more aggressive.”
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just as canadians are becoming more informed about fertility, reproductive health, age-related decline and egg quality, hartman says that people are often waiting a little too long to get an evaluation. for men, there are a number of tests to assess sperm count and motility, as well as overall reproductive health. for women, he advises, “if they’re in their early 30s and they are not in a situation where they’re looking to conceive in the next few years, they really should get checked out and see if they have a reasonable number of eggs. should they be considering trying to preserve their fertility or freeze eggs for future use? how many children do they want to have? it’s important to have conversations and do a basic work-up and just explain to someone what it all means.”
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