Fertility in Ontario: A 2026 Guide

By Marta Wais MD | August 16, 2025

Understanding fertility, infertility, available treatments, and Ontario funding from the experts

What Is Fertility?

Fertility refers to the natural ability to conceive a child through unassisted reproduction. In biological terms, it involves the regular production of healthy eggs and sperm, successful fertilization, and implantation of the embryo in the uterus. 

For individuals and couples in Ontario, fertility is becoming a growing concern as more people are waiting longer to start families (trying to conceive) or encountering health-related barriers to conception.

According to the Canadian Fertility and Andrology Society (CFAS), about 1 in 6 Canadian couples experience infertility—defined as the inability to conceive after 12 months of regular, unprotected intercourse. This rate has nearly doubled since the 1980s due to various factors including delayed childbearing, medical conditions, hormonal conditions, and environmental factors. Source: CFAS

What Is Infertility?

Infertility is defined by the World Health Organization (WHO) as the failure to achieve pregnancy after 12 months or more of regular, unprotected sexual intercourse. For individuals over age 35, many physicians recommend evaluation after just 6 months due to age-related decline in fertility. Sources: WHO, Government of Canada   

Why Fertility Is Especially Important in Ontario

Ontario is Canada’s most populous province, and it sees the highest demand for fertility services. With more people postponing parenthood into their 30s and 40s, the province faces a significant uptick in infertility cases.

To address this growing need, the Ontario government introduced the Ontario Fertility Program (OFP) in 2015, offering publicly funded fertility treatments including one cycle of IVF per eligible person, unlimited IUI cycles, and medically necessary fertility preservation. Source: Ontario Ministry of Health

This funding is critical because infertility treatments can be prohibitively expensive, an IVF cycle in Ontario can cost $10,000 to $15,000, excluding medications. Public funding allows more equitable access, especially for:

  • Individuals with medical infertility
  • LGBTQ+ and single-parent families
  • Cancer patients preserving fertility before treatment

Additionally, a new Ontario Fertility Tax Credit, coming into effect in 2025, will reimburse 25% of eligible out-of-pocket fertility expenses up to $5,000 annually. Source: Ontario Budget 2024  

Fertility is a vital public health and social issue in Ontario. With provincial support through public funding and tax relief, more people—regardless of background or income—are now able to access the reproductive care they need to grow their families.

Read more about fertility funding in Ontario.

Key Factors That Affect Fertility

1. Age

Age is one of the strongest predictors of fertility for all sexes, but especially for individuals with ovaries. Egg quality—far more than quantity—is critical in reproductive outcomes. 

Age-Related Decline in Egg Quality

Egg quality—referring to an oocyte’s ability to properly fertilize, undergo cell division, and develop into a healthy embryo—declines significantly as women age. Age-related changes include increased DNA damage (e.g. double-strand breaks), impaired mitochondrial function, and reduced energy production, all of which increase the risk of chromosomal abnormalities and miscarriage. Source: Journal of Obstetrics and Gynaecology Canada No. 346 (SOGC guideline on Advanced Reproductive Age), Hum Reprod Update review on ovarian aging

Impact on Fertility and Pregnancy Outcomes

  • Egg quality affects implantation rates, clinical pregnancy success, and live birth outcomes.
  • Poor-quality eggs are more likely to produce aneuploid embryos and early pregnancy loss. Source: SOGC guideline Pregnancy Outcomes after Assisted Reproduction

Quantitative vs. Qualitative Decline

Though both egg quantity (ovarian reserve) and quality decrease with age, quality declines more rapidly—often playing a greater role in age-related infertility, even when ovarian reserve markers seem acceptable. Source: SOGC guideline No. 346 on Advanced Reproductive Age

Women over 35, especially beyond 40, should be counseled early: declining egg quality significantly lowers chances of natural conception and assisted reproduction success. Source: SOGC guideline No. 346

Even with normal ovarian reserve, poor egg quality reduces the probability of live birth per IVF attempt. Preimplantation genetic testing (PGT-A) may help shorten time to live birth in low-responder patients by identifying viable embryos sooner. Source: ESHRE/PMC guideline review on infertility management and PGT-A

In cases of very poor egg quality or severely diminished ovarian reserve, oocyte donation is considered the most effective option for achieving pregnancy. Source: SOGC guideline No. 346

2. Polycystic Ovary Syndrome (PCOS)

PCOS, or polycystic ovary syndrome, is a chronic hormonal disorder that can affect many aspects of someone’s health. It often goes undiagnosed, even though it can have many effects on someone’s life.  It’s also very often misunderstood both by physicians and by patients, which can lead to significant physical and emotional challenges for those who are affected by PCOS. 

PCOS is one of the most common endocrine disorders in women worldwide. It usually starts in adolescence and can fluctuate over someone’s lifetime. It can vary in terms of prevalence in the population, but anywhere between 4 – 18% of people with ovaries may experience PCOS. At its very core, it’s a hormonal imbalance that disrupts the cyclical function of the ovaries. 

PCOS is one of the most common causes of infertility in women, affecting up to 15% of reproductive-aged females.

  • PCOS disrupts ovulation due to hormonal imbalances.
  • Women may experience irregular cycles and high testosterone levels, making it harder to release a mature egg.

Source: Government of Canada: PCOS  

3. Endometriosis

Endometriosis is a medical condition that affects approximately 10% of people who are born with a uterus. It is a chronic inflammatory condition that can have a wide range of clinical presentations. Some patients will present with horrible pain, while some patients will present with no symptoms whatsoever, regardless of the severity of the disease that they have. 

At its most basic form, endometriosis is when certain cells are located outside of the uterus. The cells are similar to the endometrium, which is the lining of the uterus, which one sheds every month through a period, or menstruation. These cells are very similar but not identical to the endometrium.

Most commonly, cells will be seen in the pelvis, although there are case reports of these cells being located in many other places including the brain, lungs, chest cavity, diaphragm, and even recently identified in the spleen, to name a few areas.

The clinical presentation depends on where the cells are located, so it can be quite varied. 

Endometriosis affects about 10% of reproductive-age individuals in Canada and is diagnosed in 30–40% of people experiencing infertility. Source: Canadian Medical Association Journal

It disrupts fertility by creating pelvic adhesions, distorting fallopian tube anatomy, inducing inflammation, and impairing sperm or embryo transport. Source: Reproductive Biomedicine Online

 4. Male Factor Infertility

Male infertility accounts for about 30–50% of infertility cases. Source: Nature Reviews Disease Primers: Male infertility  

  • It can be caused by low sperm count, poor motility (movement), or abnormal shape.
  • Contributing factors include hormonal imbalances, lifestyle choices (smoking, alcohol), environmental toxins, and varicoceles (swollen veins in the scrotum).

Fertility depends on a range of physical, hormonal, and environmental factors. Understanding conditions like PCOS, endometriosis, and the impact of age or male factor issues is crucial for early intervention and accessing care in Ontario’s fertility system.

Fertility and Lifestyle

Ways to improve female fertility are talked about a lot. According to Dr. Wais, (in)fertility is like a big, one-thousand-piece puzzle and we can “see” about 10 to 15% of the pieces. Those are the pieces that we understand and we can see or measure. Lifestyle factors make up a large amount of those pieces and are important so that you can “finish the picture” and find success. However, it’s not the be-all and end-all of life. For example, you can’t exercise or eat enough kale to reverse the clock on aging! 

Working on lifestyle factors can improve fertility outcomes by 5% or 10% but they can also give people a sense of empowerment – “I’m doing something to achieve my dreams”. This lifestyle factor advice is useful while trying to conceive (TTC), to improve female fertility and is also important for pregnancy and healthy living in general.

This article goes into detail about 6 things that are under our control that can be modified: Lifestyle factors for women.

  1. Nutrition and diet
  2. Body weight: BMI 
  3. Exercise: physical activity 
  4. Alcohol and smoking
  5. Stress management
  6. Environmental toxins

For more information about female fertility, check out these related articles:
The menstrual cycle
Egg freezing
An interview with Dr. Aimee AKA The Egg Whisperer

Now let’s talk about sperm. When it comes to fertility, there is SO much emphasis (and, may we say pressure) on women, that it is important to spend some time also talking about the other side of the coin, which is male fertility. Sperm health is 50% of the equation for procreation!

This article: lifestyle factors for men will dive into the importance of the health of sperm, focusing on ways to enhance male lifestyle factors to improve male fertility, and covers these 6 factors:

  1. Smoking including cigarettes, vaping and marijuana and alcohol
  2. The impact of heat
  3. Food and nutrition
  4. Male vitamin supplements
  5. Sperm renewal
  6. Frequency of ejaculation

However, don’t let this type of information become a tool that you use to punish yourself or to feel guilty because that’s not fair either.

The general rule of thumb is the 80 – 20 rule. Life is about balance. It means do something 80% of the time and 20% of the time it may not happen. And that’s okay because it’s all about consistency. It’s not about getting it 100% right this week; it’s about being consistent over the years for the long term while still enjoying life. 

Remember, you got this. 

Fertility Testing & Diagnosis in Ontario

Fertility Evaluation for Women

1. Anti-Müllerian Hormone (AMH)

AMH is secreted by small antral follicles in the ovaries and reflects the remaining quantity of eggs (ovarian reserve). It can be measured at any time in the menstrual cycle. Lower levels (<1.0 ng/mL) may indicate reduced ovarian reserve, while higher levels may indicate polycystic ovarian morphology.

  • AMH is considered a predictor of ovarian response to stimulation, not natural fertility potential.
  • Interpretation should consider age and be used alongside other diagnostic tools. Source: American Society for Reproductive Medicine (ASRM), 2020 Committee Opinion on Ovarian Reserve Testing

2. Antral Follicle Count (AFC)

AFC is performed via transvaginal ultrasound, typically in the early follicular phase (cycle days 2–5). It counts the number of small follicles (2–10 mm) in both ovaries.

  • An AFC of fewer than 5–7 follicles suggests diminished reserve.
  • An AFC of more than 12 follicles suggests a strong response potential to ovarian stimulation. Source: ASRM & Merck Manual, “Diminished Ovarian Reserve”

3. Day‑3 Hormone Panel (FSH, LH, Estradiol)

This blood test measures hormone levels on the third day of the menstrual cycle.

  • Elevated FSH (>10 IU/L) or estradiol (>80 pg/mL) may indicate reduced ovarian reserve.
  • Abnormally high LH can also indicate ovulatory dysfunction (e.g., PCOS). Source: Merck Manual – Infertility Evaluation

Fertility Evaluation for Men

1. Semen Analysis

Semen analysis is the cornerstone of male fertility assessment. It evaluates:

  • Volume: ≥1.4–1.5 mL
  • Sperm concentration: ≥15 million/mL
  • Motility: ≥40% motile sperm
  • Morphology: ≥4% normal forms

Abnormal results should be confirmed with a repeat sample 2–4 weeks later under consistent conditions. Source: World Health Organization (WHO) Semen Analysis Manual, 6th Edition, 2021

2. Hormonal Testing

If semen parameters are significantly impaired (e.g. azoospermia or severe oligospermia), serum levels of FSH, LH, total testosterone, and prolactin should be assessed to rule out endocrine or testicular causes.

  • Elevated FSH suggests primary testicular failure.
  • Low testosterone with low or normal gonadotropins may point to hypothalamic or pituitary dysfunction. Source: ASRM, “Evaluation of the Male Partner in the Infertile Couple,” 2021

3. Sperm DNA Fragmentation (SDF)

SDF testing may be used in certain cases, such as recurrent pregnancy loss or unexplained infertility. Elevated DNA fragmentation has been associated with reduced fertility potential, though it is not yet standard in initial assessments. Source: European Association of Urology (EAU), “Male Infertility Guidelines,” 2024

Understanding Ovarian Reserve & Male Fertility Benchmarks

Ovarian Reserve:

  • AMH: <1.0 ng/mL suggests low reserve; >3.5 ng/mL may indicate high response or PCOS.
  • AFC: <5–7 follicles = low reserve; >12 = high reserve.
  • These values must be interpreted with age, which remains the most significant predictor of fertility. Source: ASRM 2020, ESHRE Guidelines

Male Fertility:

  • WHO criteria are used internationally to determine semen quality.
  • A comprehensive evaluation includes semen analysis, hormonal testing, and (if necessary) imaging or genetic testing. Source: WHO Lab Manual (2021), ASRM Male Fertility Guidelines

Ovarian reserve tests (AMH and AFC) help guide fertility counseling but do not predict natural conception reliably.

A multifactor approach—combining age, labs, imaging, and history is recommended for accurate evaluation.

Male fertility assessment follows WHO and ASRM protocols, with repeated semen analyses and targeted hormonal testing as needed.

Test/AssessmentPurposeOHIP CoverageBenchmark Insights
Day‑3 FSH, LH, EstradiolIndirect ovarian reserve assessment✅FSH > 8.9 IU/L = possibly low reserve
AMHDirect marker of ovarian reserve❌AMH < 1 ng/mL = possibly low reserve
Antral Follicle Count (AFC)Ultrasound count of small ovarian follicles✅AFC < 4 = poor reserve
Transvaginal/pelvic ultrasoundOvarian and uterine structural evaluation✅Detects cysts, fibroids, etc.
SHG Uterine cavity and fallopian tube health✅Detects blockages or anomalies
Semen AnalysisAssesses sperm count, motility, morphology✅WHO standards used for normality
Sperm DNA Fragmentation (DFI)Chromosomal integrity of sperm❌Used in complex cases
Male hormone panelEvaluates endocrine causes of infertility✅Tests testosterone, FSH, LH, etc.

OHIP Eligibility & the Ontario Fertility Program

Who Qualifies for Public Funding

  • You must be an Ontario resident with a valid OHIP card
  • To qualify for IVF funding, you must be under age 43 at the start of treatment
  • You must not have received a previously funded IVF cycle, except in qualifying circumstances such as acting as a surrogate
  • There is no income-based eligibility, and coverage is available regardless of sex, gender identity, sexual orientation, or family status

Source: OFP. Read more about Ontario fertility funding.

 Fertility Funding Ontario: Summary

CategoryCoverage
Residency & EligibilityOntario resident with valid OHIP; under 43; no prior funded IVF
IVF One funded cycle per lifetime (ovarian stimulation, embryo creation, +/- freezing & transfers)
IUI Unlimited cycles included (monitoring and insemination)
Fertility PreservationOne medically indicated cycle funded (egg/sperm freezing)
ExcludedMedications, genetic testing, cryo-storage, donor gametes
WaitlistsClinic-specific, monitored by the Ministry
New Tax Credit (2025+)25% refund on eligible expenses, up to $5,000 annually.

Wait Times & Clinic Accessibility 

Markham Fertility Centre is expanding access to fertility care across north Ontario. MFC has locations in Markham (main clinic), Barrie, Sudbury (new!), Oshawa and Orillia. Read more about our locations.

Markham Fertility Centre locations, Barrie Innisfil, Whitby-Oshawa, Orillia, Sudbury

Not all clinics offer OHIP‑funded IVF; confirm participation before submitting your referral. On average, wait times can range anywhere from 8 weeks to 6 months or more. 

Choosing the Right Fertility Clinic

Making informed decisions about when to see a fertility specialist and your clinic is imperative. What to consider: success rates, treatment options, funding eligibility, waitlists, inclusivity. 

At MFC we take pride in:

Start your fertility journey at Markham Fertility Centre. Learn about getting started.

Fertility Support Groups & Resources 

Support groups play a vital role in the fertility journey by offering emotional support, reducing isolation, and helping individuals feel understood. They create a safe space to share experiences, validate complex emotions like grief or frustration, and build resilience through peer connection. Support groups also provide practical tools for navigating treatment decisions and communicating with partners or healthcare providers. For many, especially those in marginalized communities, they foster a much-needed sense of belonging. Research shows that emotional support through peer groups can lower stress and improve treatment continuation and overall well-being.

 Frequently Asked Questions (FAQs)

Is IVF covered by OHIP?
Yes—funding covers one IVF cycle per person under 43 via participating clinics.

Is IUI covered in Ontario?
Yes—unlimited IUIs are covered, though medication costs and some bloodwork may not be.

What treatments are not covered by OHIP?
Medications, storage fees, genetic testing, donor gamete expenses.

How long is the waitlist for funded fertility care?
Wait times vary significantly between clinics—some exceed 18–24 months. Check current estimates at each clinic.

Are all fertility clinics in Ontario participating in public funding?
No. Only clinics authorized by the Ontario Fertility Program can offer OHIP‑funded IVF.

What can I do at home to improve chances of conception?
Healthy diet, regular exercise, quality sleep, fertility tracking, stress reduction.

When should I see a doctor about fertility issues?
After one year of trying if under 35; after six months if over 35 or if underlying health concerns exist.

Sources:
Posted in Resources, 2SLGBTQIA+ Family Planning, Counselling, Diagnostic Testing, Donor Donation, Egg Freezing, IUI, IVF, Natural Conception, Preservation, Surrogacy