INSIDE REPRODUCTIVE HEALTH PODCAST

Episode #47 - Geographical Differences in 3rd Party Reproduction, An Interview with Liz Ellwood

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With the introduction of the Assisted Human Reproduction Act in Canada, Canadian clinics and families have been struggling to find quality third-party reproduction partners while remaining in accordance with the law. After going through her own journey and learning the challenges of the process, Liz Ellwood decided to make a difference in the lives of hundreds of Canadian families struggling with infertility by co-founding Fertility Match, an agency that matches families with donors. On this episode of Inside Reproductive Health, Griffin talks to Liz about her story and what she is doing to make the third-party reproductive process easier on families in Canada.

To learn more about Liz Ellwood, Fertile Future, and how you can help, visit www.fertilefuture.ca.

Want to learn more about Fertility Match? Visit them at www.fertilitymatch.ca.

The details of the Canadian Assisted Human Reproduction Act can be found at https://laws-lois.justice.gc.ca/eng/act/a-13.4/

To get started on a marketing plan for your company, complete the Goal and Competitive Diagnostic at FertilityBridge.com.

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Welcome to Inside Reproductive Health, the shoptalk of the fertility field. Here, you'll hear authentic and unscripted conversations about practice management, patient relations, and business development from the most forward-thinking experts in our field.

Wall Street and Silicon Valley both want your patients, but there is a plan if you're willing to take action. Visit fertilitybridge.com to learn about the first piece of building a Fertility Marketing System--The Goal and Competitive Diagnostic. Now, here's the founder of Fertility Bridge and the host of Inside Reproductive Health, Griffin Jones.

GRIFFIN JONES: Today on Inside Reproductive Health, I'm joined by Liz Ellwood. Liz was diagnosed with cancer at age 24 that left her infertile from multiple surgeries, chemotherapy, and radiation. She knew she would survive and she knew she would find a way to become a mother which eventually led her to founding the national charity, Fertile Future. The organization has funded fertility preservation for over 600 cancer patients and eventually led her to meet Lisa Casselman, a two-time retired gestational carrier, who bonded together over their unique experiences and co-founded Fertility Match. Fertility Match is an agency to help people meet their third-party reproduction needs and to be supported equally, but in different ways. Ten years later, Liz is now the mother of a beautiful seven-year-old daughter and a successful businesswoman helping intended parents build their families through egg donation. Liz Ellwood, welcome to Inside Reproductive Health.

LIZ ELLWOOD: Thanks, Griffin. Thanks for having me!

JONES: I usually start with Ms. Ellwood, instead of Liz, so don't let me deprive you of that introduction. Ms. Ellwood!

ELLWOOD: Did you notice I crossed out Ms. Ellwood in the bio you wrote and wrote Liz?

JONES: I thought that we’d get it in there just to be formal! So you and I have spoken a lot about marketing because you had done some marketing. You are now more active on this agency side, so talk to us about that transition.

ELLWOOD: So I guess when we met initially a few years back, I was sort of in between the two organizations--so in between my work with Fertile Future, the cancer preservation charity, and of course, now Fertility Match, the agency. So for a while there I was doing a lot of marketing consulting based in fertility. For some fertility centers, the Canadian Fertility Associations, the nonprofit group for patient called Fertility Matters, and some work for CFAS as well, so there was a few different things--I sort of was getting to know the lay of the land in terms of marketing in fertility. And I was doing that for one, to pay the bills, but also I was trying to figure out what exactly I wanted to do next as my next business in fertility. Knowing I wanted to stay in this landscape, but also not being exactly sure where I wanted to do in terms of starting a private company in fertility. So did that for a bit, then finally decided it was time to start the agency in Canada because there were so many out there safely operating despite the Assisted Human Reproduction Act and some of the confines that existed with it when it was first introduced in 2004. And yeah, it kind of the agency idea presented itself and that was back all three years ago now and here we are! So it's been an amazing adventure.

JONES: Let’s give a little bit of background and what those constraints are because some clinics have relationships with Canadian clinics and they're fairly familiar, and others don't at all. So talk about the restrictions that you're referring to.

ELLWOOD: Right, so in 2004, the Assisted Human Reproduction Act was put into place by the government and what it did was it essentially put a banner prohibition on the payment of--I mean a lot of other regulations are in there--but the payment for egg donors, sperm donors, or surrogates in Canada. So what that meant was, where you could previously pay a surrogate or an egg donor $10,000 or $30,000 for being an egg donor or surrogate, that was no longer permitted. So what happened initially was first of all, agencies that were open, either moved to the States or they just shut down and clinics just started to not work with any Canadian agencies and saying to their patient, “You know what, if you need a surrogate, if you need an egg donor, go to the States, go somewhere else, because we just don't want to touch it now. It's such a small part of our business. We're just not going to go there.” Gradually, people sort of started to dip their toe in the pool a little bit more and it was around that time when I was trying to have my daughter, of course, so I kind of got into seeing what people were doing at that point. And really, you know, what the workaround was is we can't compensate a donor for her eggs, you can't compensate a surrogate for carrying for someone else, but we can give them reimbursable expenses. So reimbursable expenses that can be related to the surrogacy or their egg donation. So that means there are logs are filled out, receipts are submitted to the agency or to whoever is taking care of reimbursable expenses, and then the surrogate or the egg donor is reimbursed for those expenses that can be related to the egg donation. So it's sort of the work around in the law where we can't directly compensate, we can do this reimbursable expenses system. But, however, initially before that was found out, like I said, everyone just--this huge amount of cross-border reproductive tourism started in Canada where everyone was just going to the States for fertility treatment, especially we need the third party. Like, you were just going to go down there, you're going to pay probably a hundred two hundred thousand dollars, and that was how you're going to get your baby. But as these other agencies started launching in Canada people started to come in and move over to the fact that, hey we can still do this in Canada, we just have to do it in this really special workaround way to make sure we're following the law and we're not doing anything against the Assisted Human Reproduction Act. Essentially, that's how all the --I’d say there’s about 10 to 15 agencies now in operation in Canada and everyone's doing that. It's essentially a workaround with the reimbursable expenses. But there are—

JONES: But does it come anywhere close though? So if the average compensation in the United States is $6,000 for an egg donor, some are 5, some are $8,000, but let's say the average is $6,000. Does the reimbursable expenses come anywhere near that for an egg donor?

ELLWOOD: Well, yeah, it can because--and regularly we reimburse expenses at that level for an egg donor because there's things that--because the Assisted Human Reproduction Act never defined what the expenses could be that could be reimbursed, so we've been working in this whole gray area that has yet to be defined by Health Canada. So what that means is that all of these reimbursable expenses like groceries, prepared food, massage therapy, missed work, missed classes you can’t go to, child or pet care for appointment days, these are things that can be reimbursed to you as expenses incurred in relation to the donation. So were easily able to get to those numbers if women are in situations where they need those things, and many of them are. So that's sort of the workaround at this point and it does seem to be working and even now we see the draft regulations coming down from Health Canada in terms of what will be allowable reimbursable expenses, and we're already doing them. So, the regulations are coming down and they’re supposed to be put into power in I believe it's February 2020, and everyone's already doing what the regulations are saying, so I don't expect that a lot is going to change with the current landscape.

JONES: So you have an idea of what they’ll be? Do you speculate that maybe the reason why others didn't jump into the water more quickly or were slower to stick their toe in is because they're worried that Health Canada could come out and say, “Well, groceries aren't expensable or time off of work isn't reimbursable.” Do you think that's part of the reason is that Health Canada could come in with a tighter set of regulations that negate a lot of what you're able to do now?

ELLWOOD: Well, I think it's more that they didn't want to be doing anything illegal and they didn't want to be telling their patients to do anything illegal. And they couldn't get-- we haven't for the past, you know coming up on 16 years now since the act was put into place--we have had no additional legislation or clarity about the act and how we're supposed to interpret it and action it in Canada with the exception of you know, fertility lawyers looking at the act and telling us how they think it should be interpreted. So essentially, it was a piece of legislation that sort of scared everyone, but didn't give us any direction about how we can legally do things. And it was almost like the prohibition with alcohol in the States we saw decades ago. Like it literally got prohibited in Canada and it became an underground thing in a lot of cases. I've heard of situations where people just handed their surrogates cash, right? There's so many things that started happening that were so shady and that's exactly what happened with the alcohol prohibition as well, right? So it's not that, it's a very different situation, but you can see how the same thing actually, the same principle sort of applied when you prohibit something that is something that people want. So in any case, I think that doctors and clinics got very nervous, patients got very nervous, so a lot of people did go to the States. And then these agencies started to pop up in Canada saying, “Hey, wait! We know how to go around the Act so you can still use Canadian donors and surrogates,” and it started to catch on! And it caught on like crazy! And there's one woman who started an agency and then another woman started an agency, I think we have about 15 now, but one of the first agencies that started--there's only ever been one charge under the Assisted Human Reproduction Act and it was one woman who owns an agency and still owns it. She ended up taking a plea deal, I think, but there was definitely some things that were going on that she wasn't doing in accordance with the Act because of some of the charges didn't stick for sure. And I'm not sure what that is, I can't comment on her individual legal case, but I do know that after that arrest was made and everyone was trying to figure out what was going on, people got scared. People got really, really scared and that was right after my daughter had been born and it was really scary for me because I had used that agency. So it was like, we thought we were following the rules, we spoke to lawyers, and of course you got that call at 11 o'clock at night that your agency's been raided by the RCMP and there's clinics that are being questioned. It was everyone's worst fear and worst nightmare. And then nothing ended up happening. That woman had a small charge and then she went right back to doing what she was doing and that was the only charge ever made under the Act. And now, we have regulations coming out that essentially are just saying we can continue to do what we've been doing. So, yeah, I mean, I think that I would say there's probably about 5-10 clinics or something left in Canada who aren’t willing to work with Canadian agencies because it still makes them nervous. So what they’re saying to do instead is, with egg donation especially, is they're saying to their patients, go buy eggs from XY or Z Egg Bank in the United States who we have a partnership with, and bring them back here and we’ll thaw, you can make embryos, and then you can have a baby that way! So that's been a really big workaround solution. And I would say that, egg banks in the States have made hundreds of thousands, if not millions, of dollars working with Canadians in order to help build their family through egg donation.

JONES: Are Canadian clinics typically going through agencies for fresh donors? Do they also have their own fresh donor list? Because in the United States, there's some clinics that are still using more fresh donors, but some of them are using almost entirely frozen donors and using the egg banks. So are Canandian clinics--do they have their own lists? If they are using fresh donors, are they going through an agency?

ELLWOOD: Yeah. So, as it stands right now, there are no clinics in Canada who have their own donor bank or anything like that. There are clinics who will work with agencies and egg banks and then there’s clinics that will only work with egg banks. So there are clinics that you know, we still know that at the end of the day, no matter what, fresh is best when it comes to eggs. It doesn't matter with embryos, but with eggs, in any person, you can ask any fertility doctor out there and if they were good looking to build their family and they have the option of using eight eggs that were frozen and eight eggs that were fresh, they're always going to pick the fresh eggs to start with because you'll never--something about the cryopreservation still can cause some DNA damage, so we know that fresh is always better. So a lot of the clinics choose to just use agencies--there's a couple in Toronto, especially, that will just really push the fresh agency donor. And then there's a few that offer both--so you can use a frozen egg program or you can use an agency. And then there’s some, and some of the big ones--the ones that we’d love to be able to work with-- that are just you have the option of bringing in a known donor, like your sister or your cousin, or you can buy eggs from one of these banks in the States and ship them over. That’s kind of the lay of the land right now.

JONES: So are you also working with gestational carriers in your agency?

ELLWOOD: We actually closed our gestational surrogacy program about two weeks ago. And I was hoping we would get a chance to talk about that today because I think it's really, really important that we do. What’s happened in Canada is a bit of a unique situation right now. Because of our reimbursable expense system, you know, the average surrogate in the United States--I would assume that the average surrogate in the United States makes about $50-60,000 for carrying. I could be wrong. I'm assuming it's more though. In Canada, we typically see a surrogate getting $25-30,000 from reimbursable expenses that can be related to the surrogacy. So already, you have a lower number and it's in Canadian dollars. You know our Canadian dollar is not so high right now! So obviously a more attractive for surrogacy in terms of price point. Then you count the fact that we have Universal Healthcare. The surrogate prenatal care and their post care is taken care of by our Healthcare System. So they go to the--the baby's care all the way through the pregnancy, when they go to the hospital, they deliver--all of that stuff, that's covered by the Canadian Healthcare System. If you were using a surrogate and she had that additional cost in the States, that would be the responsibility of the intended parents. So right away, any surrogate her health care will be covered in Canada for the pregnancy. It's making it a very desirable location to find a surrogate from an international perspective, right? Why go to the States and maybe pay $200,000 when you can try to do the whole thing in Canada for around $100,000? So that's kind of the dynamic we’re looking at right now and not only does that look attractive to people in the States, that also looks attractive to people in a whole other lot of countries that needs surrogates, that aren't allowed to surrogates in those countries. So we're talking about aren't allowed to pay a surrogate in those countries, rather, so Australia, Spain, France. We hear from international couples all the time looking for surrogates. The bottom line is there's not that many surrogates in Canada because there's so many people trying to use the surrogates right now. So we decided to stop focusing on Thursday because it is such an over-diluted market, right now. And just try to really focus on egg donation and bringing that to new standard in Canada in terms of live donors and at some point, maybe frozen. I don't know, but right now we're just trying to make our donor program better and make it more protective of the donors.

JONES: So there's the demand for surrogates is so high and the supply is relatively low, probably—

ELLWOOD: Yeah, because of the cost. It's much less expensive, right? So Canadian couples, it is really difficult for--Canadians couples to keep saying that they’re very upset they can’t get a surrogate in their own country because so many people are coming over from other countries and using the surrogates. That is, you know, a complaint that we commonly hear and we feel for them. Like I would not want to be someone right now needing a surrogate in Canada because I think it will be very difficult to find one.

JONES: So where are Canadian intended parents going for surrogates? Are they going to the United States?

ELLWOOD: I mean, they're going to the agencies. They're getting on lists. The agencies, like Fertility Match for instance, but other agencies, they’re getting on their wait lists and hoping to be matched. They're doing things to market themselves on social media independently. Some of them who can afford it are going to agencies in the States. Yeah, but it's, again, it's a frustrating situation for Canadians who do pay into Healthcare System, right?

JONES: Yeah, and in the United States, there is also a lot of agencies have waitlists for their intended parents because GCs are really in demand here as well and it sounds like in Canada there is an even bigger delta.

ELLWOOD: Yeah, well, I think that I've heard of as long as two years at some of the agencies in Canada. So yeah, it’s pretty substantial.

JONES: You mentioned changes in more guidance coming down from Health Canada. Is there anything on the horizon for changes in law for third party? Whether it’s GCs or anything else going on in third party?

ELLWOOD: No, not really. The regulations are the big ones coming down and seeing how everyone responds to that and how judges start interpreting the contract and that sort of thing. We don’t really know how it’s all going to iron out. I was just at CFAS two weeks ago, I was in an Ethics and Law meeting about talking about the regulations and how they are going to affect everyone and it doesn’t sound like anything is going to change. I guess there are maybe four auditors in Canada that are going to go around and make sure everyone is following the act. I think it’s awesome, I think they should. I think everyone is following the act though, but that could be me being naive, but I know we’re following the act.

JONES: So, in the United States, donors are partly recruited by the offer of compensation. That you can early $7,000 from a cycle. How are donors recruited in Canada?

ELLWOOD: Essentially, in the same way up to X number of dollars in reimbursable expenses depending on the program. So donors understand that they’re not going to get--they’re not going to do their egg donation and say, “Here’s a check for $8,000,” but they understand that they’re going to submit their expenses and we’re going to review them and make sure that they are in accordance with the Assisted Human Reproduction Act and then we are going to reimburse them for those expenses.

JONES: It’s certainly a different method. One says you can make this much money and the other says you can go through something and then we will cover the expenses that you went through to go through it. So where do you find many of your egg donors coming from?

ELLWOOD: Well, they--I think you have to understand that these egg donors are motivated for for those reimbursable expenses. Right? Like that's a big motivator that they can have expenses reimbursed to them. So they're coming from the same places, like online marketing, event-based marketing, going to universities and campuses and talking about female reproductive health and saying egg donation is an option if you don't have your own eggs, and if you do have eggs, you know, you could become an egg donor for someone else. So I mean, I think it's just awareness in talking to women about it and normalizing it. I think that a lot of the young women who come into our program--I'm shocked because I think this generation I think they really--I can see how their way of thinking has even evolved since I was that age! And these young 20-somethings they really want to do something positive to make a difference for someone who's having a hard time having a family, or make a positive change in the world. I see that a lot in our donors who are like, “I was so lucky. I had kids, and I’m done having kids, why wouldn't I give something to someone?” It's a different way of doing it, for sure, but the benefits are there still.

JONES: And we see that a lot, that even when the financial messages can be useful, but the message of doing something for the intended parents, being able to provide something for the intended parents, is still paramount.

ELLWOOD: Yeah, I mean all of our donors like--I see these intended parents write these beautiful cards and send these amazing gifts to our office forward to donors and then back and forth communicate like a donor will maybe write a note saying how she hopes everything is wonderful for them and their future family. These people are just--on both sides--the best. They are just so grateful to one another and the donor’s happy to be able to do this great thing for someone. Because no matter what, whether you’re being compensated or reimbursed for expenses or whatever the case is, it takes an incredibly special person to be willing to give their eggs or to carry a child for someone. And whatever monetary factors are in it, whether it’s reimbursable expenses or direct compensation, it's not even worth--putting a number on it is just such a tough thing to do. It's priceless.

JONES: So there must be so much coordination going on on your end because how many clinics are in Canada? Around 40 or 50?

ELLWOOD: Yeah, I’d say around there. Yeah, for sure.

JONES: So let's say there's 50 and let's go with your estimate that there’s 10 that won’t use Canadian agencies, that are only using egg banks with their partners in the States. Let's say that there's 40 that are. That's a lot to--it's a lot of coordination.

ELLWOOD: Yeah, it's not that many though. You have to remember, there's some that maybe don't have an IVF Center, some might just be IUI, or some might just be you know--so like not every fertility center is a full fledged fertility center. So I would say we probably have more like--the number you're talking about this more like 20-25 right now.

JONES: Ok, even still, that's a lot!

ELLWOOD: Yeah, it is!

JONES: And is everyone you work with in your agency, are they local to the closest clinic? In other words, if you had someone that was a good fit in Halifax, you fly them to Vancouver, is that are reimbursable cost?

ELLWOOD: No, so travel is in addition to reimbursable expenses. So travel is something that we reimburse to donors outside of their reimbursable expense cap. So reimbursable expenses are expensive that a surrogate or an egg donor incur during the course of their pregnancy or their egg donation that they need to the reimbursement for because they paid out of pocket for it or it's an expense that they have incurred during the course of the process. Let's say there was a donor in Halifax needed to donate in Vancouver, we would take care of their travel and that would get billed directly to the intended parent when they select that donor. So the travel would be figured out in advance and we be able to give that information to the parents before they select that donor. They know exactly what that travel costs will look like because they travel costs, especially in that example journey that you just came up with, that's probably the most expensive travel cost you can have for a donor to take someone from Halifax and fly them and put them up in Vancouver. Like that would be a lot of money, right? So we always know those travel amounts in advance in addition to the reimbursable expenses.

JONES: If you had to ballpark the percentage, how many cycles are happening for people that leave their market, let's say more than a hundred miles?

ELLWOOD: A lot, a lot. Because we'll get a lot of donors who are not in the GTA, but around the GTA. And let’s face it, Toronto is really the mecca in Canada of fertility centers. There's over 15, maybe even 20 in the Toronto area. And the big third-party centers, the ones who have been doing it the longest, they’re in Toronto. That’s definitely where the pulse of fertility in Canada is. So we really do try to focus on recruiting donors in that area because we know that so many of the third-party programs are there as well and you can take a donor from around the GTA and she could pretty much be eligible to go to any of the major IVF centers to do a lot of third-party. So of course we work at really focusing in that area. But you know, typically, that's part of what we do is we say, Okay, couple 19253 really likes donor 19467 and 19284, let's get their travel estimate so we can e-mail this couple back and let them know what the cost would be for either one of these donors. It has all these moving pieces, but we want people to know what the true cost is going to be before they pick a donor. That's really important.

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JONES: So I could see the egg bank’s counter argument to your argument previously that fresh being better than frozen, that all sounds like a lot, and with the availability that one would have through the frozen bank, by the time you discount for uncertainty, you're on par or even they have the advantage.

ELLWOOD: Yeah, and I--absolutely, there's huge advantages of frozen egg banks. One being that the donor comes to the bank and she gets to cycle right away. She doesn't have to sit on a database and wait to be selected. Then they have the eggs, they're frozen, they take the eggs, usually they get at least 30 eggs out of the donor than they can divide it into lots. Let's say they got 32 eggs out of a donor, that’s 4 egg lots at least, right? They divide that off and that lot is full, which is great for the business because they've been able to divide up what was one donation into 4 sales. With a fresh egg donor, you cycle a fresh egg donor, there’s a lot more things that could go wrong or road bumps you can hit along the way, things can take longer than you want, you know different things like that. But at the end of the day, if you go that route, you're going to end up with, let’s say, the 32 fresh eggs. Those are all your yours when you use a fresh donor. So when you're looking at a situation where you want to have a family and you don't just want one child, you want two or three children, one becomes a much better option than the other. Because you're very likely going to be able to have your whole family with that one donation where with an egg lot, there's no way you're getting three or four children out of a 6-8 egg lot. You’re guaranteed one blastocyst or something, I know they have different levels of guarantees, and I don't know enough about them to really speak to them, but I do know it's a newer science versus an older science. And we do know that working with 32 fresh eggs is a lot better than working with 8 frozen eggs.

JONES: What do you feel like you're going to be able to grow this until? What are your growth plans for the next five years, long term, one year, short term?

ELLWOOD: That’s such a good question. Well, I mean, I think there's a couple things that we're looking at. I think we're really excited to see the regulations come out and see how those all come into play. And if anything does come up with how we have to adopt our businesses, we have to make sure that we could still function them and fulfill the purpose in Canada to help grow third-party families, while doing it legally. Our first big road bump or hurdle right now is to February 2020 when the regulations are put into place. Other things that I think are really important right now to be involved in for Fertility Match is we figure out something for a donor registry in Canada. So that is a huge issue for us. We hear so often, you know, it's like every day in the media we hear about some doctor that is used his sperm and a bunch of babies have been born with it or a donor who donates and that sperm ends up getting used to create 50 children or something like that. We have huge problems. We have no international registry. We have very few national registries. I think there's only one really good one in the States called Donor Sibling Registry. But again, that's more based for the siblings. We have no way of tracking donors or we don't know that a donor hasn't gotten around to every clinic and donated six times at this point. It's one of those things that we do need some sort of registry in place so that it's there for children one day and we don't have anything like that right now and that's a real concern for us at Fertility Match. So that’s sort of a side project thing that we're going to make absolutely no money on, but we just want to address because we think it's really important. Yeah, and I think just continuing to grow our egg donation program. We now have different tiers of donors. So we have a Proven Donor and a higher consulting rate for that, and then we have a Pre-Screened Donor and sort of a medium level consulting fee for that, and then we have New Donors where they haven't had their pre-screening done and an even lower consulting fee for that. So depending on the level of risk you sort of are taking on with your donor, your price is gonna fall more in accordance with that. We did do that and that was a big deal.

JONES: How often do you go back to your roots of why you got into this field in the first place? Maybe it’s why you got into the field, but now you’ve just been in it for so many years and you've been in different capacities, are you going more off of a base of knowledge that you have having been in it professionally? Or do you still go back to the reasons that you came into the field at your story with onco-fertilities? How often do you go back to it?

ELLWOOD: I think I go back to it a lot. I share my story a lot with clients because I think it's important, first of all, that they know that I have been through this. So when I--first there was my cancer, and initially when before I went through my cancer treatment--I don't know if I ever even told you this--but I went on the big mission to freeze my eggs. And I was like, okay, I'm gonna freeze my eggs and I'm going to figure this out later and I'm just gonna get some in the freezer and then I’m going to blast through my cancer treatment. I'm going to find a surrogate, they're going to carry my baby. I'm still going to have a biological child. It's all good. So I froze them. And at the time--this was 2007--so egg freezing was very new, it was still considered experimental, it's not considered standard like it is now. So I froze them, did my cancer treatment. In 2009, a relative actually offered to be my surrogate, so we went and we transferred, and both times when they thawed my eggs, they thawed them, and they fertilized them with my ex-husband’s sperm and each time, they were horrible embryos. The embryos just did not grow well at all. And so each time they did a transfer into my relative who had so graciously offered to be our surrogate, it didn't work. Then I was left completely infertile with no more eggs. So that's when I started looking for an egg donor. And unfortunately, at that point my relatives said, “You know what, I was really okay with the idea of doing this and carrying a baby that was biologically yours, but now carrying a baby that from some donor that I don't know, I don't feel comfortable with.” So I was left with no eggs and no surrogate, I was pretty much back at like first square, right? Nothing, like what am I going to do now? So I started looking at donor banks and I started looking at--not banks, rather, they were just all live agencies at that point and I started trying to find a surrogate. And I actually back then, what I did--and there were so, we didn't have this strain from other countries taking up our surrogates then because--not taking up our surrogates, that sounds like they shouldn’t be, I mean, they’re welcome to it, it’s just an issue that we’re having. But I actually put an ad on Kijiji and a surrogate answered it. And many surrogates answered it actually, and then I found an amazing surrogate and she ended up carrying my daughter for us. But finding a surrogate was actually incredibly easy, so kind of the opposite of now, it was finding an egg donor that was more difficult for me. So I started working with agencies and I picked my first donor waited for her agency to let you get in line. So it was like the first person could wait and then the second person could wait, and a third person could be in line. So one person uses her for a donation, then you wait three months, and then the next person uses her, and so we were waiting for like a year for this donor. And when it finally came our turn to use her, she got pregnant, and she kept it. So that was devastating because I was like, oh my God, I wanted this donor! It was like you were waiting for a year and then you find out she gets pregnant. So it was really hard to take. Then I picked another donor and she was before her hormone testing and she didn’t screen in to be an egg donor. And I picked another egg donor and she ended up testing positive for HIV. And then I picked another egg donor and she disappeared, And then I picked another egg donor and she was honestly my favorite of all the egg donors that I picked--and I'm not just saying that because she gave me my daughter--I'm saying that because she actually, she wrote this amazing, kind message in her profile and it said, “I'm so happy I can do this for you. Be good to each other and love each other and that’s all I ask in return for this.” And it just was like this beautiful message and I just thought, oh my God, I am so lucky that this woman is willing to donate her DNA and then I get to have my daughter with the help of this woman. And sure enough, two months later, she cycled, first transfer, we were pregnant. But it was a lot of ups and downs because I didn't actually--it was so hard to find the egg donor for me. And that’s part of the reason why when we started Fertility Match, we really wanted our program to be very different in the sense that we put an emphasis on pre-screening and making sure these donors are viable options. If you're going to pay for a donor and you know for sure that if you're selecting a proven, pre-screened donor, you know that that donor is very likely going to get to a donation. Where if you’re selecting a donor who isn't proven, that’s a little bit more risky and therefore, the cost is a bit lower on that. So it was just one of those situations where we kept having so many things go wrong and that's why when we started Fertility Match, I wanted to make sure people really understood the tier of risk there in when they're choosing a donor. And so that they really don't want to go through that trauma and go through those difficult journeys, or maybe they've been through already enough on their own, then they should be picking a proven, previous donor, because those are the most likely candidates to get to the donation and retrieval quickly.

JONES: I'm realizing now how stupid my question was that given your experience as it was that it would be--it is irrevocable from how you would run your your business now. I mean, there'd be just no way of forgetting all of that as you're building processes and growing the agency.

ELLWOOD: Yeah, it's very much so. And Lisa, who is the most amazing business partner and is like a very like--because I'm an entrepreneur, so I have a lot of ideas and not all of them are good and some of them, I’ll say them and she's like, “Yeah, no we can't do that.” We'll have really hilarious conversations. But you know, she's an incredibly ethical woman and she's an incredibly hard-working woman and she was very much--she was working with intended parents who were also going through these situations with an egg donor with the same agencies I was where I was having trouble to actually be one to see through to the donation. And so that's why she's been such a--we both really have a high standard for what we want to see in our egg donors and how we want this to work for the intended parents, but also for the egg donors, and I think that is a very important part of what we do. And you know, we are not the cheapest agency out there. If you're looking to compare based on price only, Fertility Match is probably not going to be the agency you're going to pick. But, if you want donors that are very committed to the process, have gone through the screening steps, have gone through an interview to make sure that we were both, you know, we felt--Lisa and I interview them one on one. It's one hour video interview, kind of similar to what we're doing now, and we have a conversation to make sure they really understand what they're volunteering to do. And we say to ourselves, if I needed an egg donor, would I want this woman to be my egg donor? That's our big, are we letting her into the program or not? And so that is very much so what we're looking for. So we're not necessarily looking to attract as many candidates as possible, we're looking to attract as many excellent candidates as possible.

JONES: And to give an idea to the American audience of what you both are working on, besides of what it's like in Canada, how many matches is the largest agency in Canada doing, you suppose?d How many fresh cycles a year are they facilitating?

ELLWOOD: Oh, it's so hard to say because--I could put numbers out there, but I don't know if they're true. Me and my business partner, Lisa, we were just talking about that last week because I was saying was this agency had said in an interview that they were doing 30 donor cycles a month at different fertility centers. The numbers just don’t make sense in terms of that kind—I mean, maybe they are! But the numbers that they’ve given in a few different places don't really add up. I honestly have no idea. I know that with us, we’re not high volume. We get a good number of donor cycles in every month, but we’re not aiming to pump--to try to get 100 donors a month or something crazy like that. We’re looking to literally be a tinier, high quality agency. So you want a donor who has post-secondary education and leads a healthy lifestyle and we spend the time bringing her through the program and we feel like she's a great candidate to be an egg donor, and you're going to have to pay a bit more for a program like that. We’re not going to worry about other agencies--they have more candidates, but are they the same demographic? Or commitment level? I don't know. Not from my experience with them.

JONES: Are you able to do a freeze-n-share with the compensation regulations as they’re written?

ELLWOOD: What do you mean a freeze-n-share? So like a donor could freeze her eggs and give part of them away?

JONES: Yeah.

ELLWOOD: Yeah, I think you probably could! And it’s definitely something we’ve thought about doing at some point, but right now we’re just sort of--because we just closed our surrogacy program. We just wanted to get everything with our egg donor program where we wanted it to be for our clients and then we're going to look at the different potential projects that we're going to expand to. There’s so much that needs to be done.

JONES: You’ve definitely educated the audience about what's going on with third-party reproduction in Canada. You've given us a really good insight on what it was like for you. How would you, whether about your journey or the landscape of third-party reproductive health in Canada, how would you want to conclude with our audience?

ELLWOOD: That’s a really good questions! I would just say that I think the biggest thing in the world is no matter if you're looking at donor conception, there's a few things you need to consider when you're thinking about it in terms of not having the baby and bringing the baby home from the hospital or anything like that, but the life you will lead with this new member of your family. So what are their needs going to be? A huge issue for me is that with a lot of these egg banks and even some agencies still, at the idea of anonymity with donor conception. Anonymity is gone with being DNA testing and everything else is something that went out the window a few years ago. So we can't say anonymous donation is something that's happening anymore. All of the donors in our program are open ID, so they're committed to meeting a child after age 18 if the child wishes to do that. But when you get into anonymous donation, which is what most of the frozen egg banks in the States still are offering, is back child doesn't have any way to find out who the donor is except for tracking them down through DNA ancestry or something like that one day. And so is that really the best for the child? Probably not right? It’s probably having donors that are willing to meet them one day so they can have a better understanding of the biological makeup and how they became who they are in this world. I think the problem is with the egg banks right now is that they have all this anonymous inventory, so they haven't moved toward the trend that we're seeing so strongly now of intended parents wanting open ID egg donors. So I would say the biggest message I would want to give to people who work in third-party or who are considering building their families through third-party, or donor conception more specifically, is what is that child going to need one day? Because that child is going to ask you why they can't meet their donor or could very well ask you why they can't meet that donor and that could become an issue with the child and the parent oen day, the fact that that door was closed from them the beginning.

JONES: Liz, Ms. Ellwood, thank you so much for coming on Inside Reproductive Health.

ELLWOOD: Griffin, it was my pleasure. Thank you for having me. It was lovely to catch up with you.

You’ve been listening to the Inside Reproductive Health Podcast with Griffin Jones. If you're ready to take action to make sure that your practice drives beyond the revolutionary changes that are happening in our field and in society, visit fertiltybridge.com to begin the first piece of the Fertility Marketing System, the Goal and Competitive Diagnostic. Thank you for listening to Inside Reproductive Health.