By Carrie Schram, Medical Director, Natural Conception Program

In March 2020, in response to COVID-19 and under the direction of the Canadian Fertility and Andrology Society, the fertility community in Canada paused. Any care that was not actively underway was put on hold, and patients and care providers held their breath.

Pausing active care was, in many ways, remarkably easy. We shifted to virtual care and were able to stay connected with patients, and each other, almost seamlessly. We adapted to telemedicine with Zoom and other platforms with relative ease.

Very soon, however, patients and care providers alike became eager to resume more active care. The challenge laid in how to do so safely and effectively in a pandemic environment.

The Natural Conception Program (NCP) also saw a silver lining: an opportunity to not just make our care safe, but also to innovate. We critically examined our previous care model, and looked to evidence-based medicine as a guide. We looked outward to how low-intervention fertility is practiced across Canada and globally, and reflected on how different models of care may work in our environment.

What emerged was a fundamental philosophical shift from a highly medicalized, paternalistic model of care to one that is more natural, and empowers people to better understand their natural fertility to make informed decisions.

We knew the model was pandemic safe, but how well would it work?

We were not surprised some people started to get pregnant. We were not surprised some people appreciated the opportunity to do testing closer to home and have fewer, less invasive, medical appointments.

When we looked at our first quarter statistics, however, we were surprised. More people were getting pregnant with the new model than the previous model.

Initially, we felt these results may be inaccurate. There were a lot of possible reasons, not related to our model, to explain the higher pregnancy rates. The good news was that the model was working. People were getting pregnant, and we were able to deliver safe care.

Over the past 10 months we have refined our model and continue to evaluate its effectiveness. We initiated “safety check” ultrasounds for insemination cycles and processes to do medically necessary blood work.

We are now caring for more patients than ever before, and our new processes mean we help people from a wider geographical range. We’ve added two new, fantastic, physicians to our team.

Our pregnancy rates remain higher than they were under our previous model, and access to high quality fertility care within the NCP has never been better.

So where are we going? Our new model is here to stay. We are working to improve our communication to empower people to understand and manage their fertility. We are working to expand our community-based model to help support people even more broadly. We are working to optimize the probability of success, while not subjecting people to medically unnecessary tests.

The past year has not always been easy, but there have been some silver linings, one of which is the opportunity to rebuild a program that we truly believe is stronger than ever before.


Dr. Carrie SchramAbout the Author

Carrie Schram MD CCFP MPH
The Medical Director of Hannam’s Natural Conception Program, Dr. Schram has fellowship training in Women’s Health and a Masters of Public Health from the University of Toronto, where she is an assistant professor.