Gestational surrogacy is an arrangement whereby another person carries and gives birth to a baby for another couple or individual who is unable to get pregnant or carry a baby to term. In these cases, the gestational carrier (surrogate) is not genetically linked to the child. Intended parents use their own eggs and sperm, or donor eggs and sperm to make the embryo which is then transferred into a gestational carrier who carries the pregnancy and delivers the baby.

A gestational carrier can be a person you know, such as a friend or a sibling. Alternatively, a gestational carrier can be someone who has been matched to you through an agency that specializes in surrogacy arrangements.

In Canada, a gestational carrier cannot contribute their own eggs (gametes) to the embryo. This is called traditional surrogacy. For example, if your sister was your egg donor, she cannot also be she gestational carrier for that embryo. If this circumstance applies to you, speak to your clinical team and we will help you find a clinic that can support this cycle.

There are a number of surrogacy agencies in Canada that specialize in matching intended parents with volunteers interested in acting as a gestational carrier.  Surrogacy agencies recruit people who are willing to be surrogates on a volunteer basis as it is illegal to pay a surrogate in Canada. It is important to work with an agency that has a solid reputation and understands the laws with respect to surrogacy in Canada.  Your dedicated clinical team at Markham Fertility Centre can help guide you in the selection of an agency and will work closely with all parties to facilitate the process.

Markham Fertility Centre requires that intended parents obtain legal advice prior to engaging in a surrogacy arrangement.  It is best to consult a lawyer who is familiar with fertility and family law in Canada and who has experience in drafting agreements related to gestational surrogacy.  You will find that an initial consultation with reproductive or fertility lawyer will help you understand the legal implications of your journey.

We recommend getting started with a legal consultation so that you are well informed before starting the process.  Here are a few of the legal considerations that a reproductive or fertility lawyer will raise with you:

• Number of embryos to transfer into the gestational carrier (surrogate)
• What to do if you and your gestational carrier disagree on a treatment plan
• The process of assuming guardianship of your child(ren). Family law is governed at the provincial level so rules will vary depending on where the gestational carrier gives birth.
• Do you have to adopt them? Will the gestational carrier on the child's birth certificate?
• How will you handle a breakdown in your relationship with your gestational carrier?
• What if your gestational carrier backs out from the process? How much money might be lost? How will your agency support you?
• What are your agency's responsibilities? How do you hold them accountable?
• What are your clinics responsibilities? How do you hold them accountable?
• What happens if your gestational carrier moves or has another major life change while carrying your pregnancy?
• What if there is a breach in your legal agreement? What recourse do you have?

Being prepared for unexpected events and outlining how those circumstances will be managed will make the process smoother for all parties.  Our dedicated team is here to assist you through this journey.

Finding someone who is willing and able to carry a pregnancy for you can take some time.  It is important that you know what criteria are used when considering whether someone is an appropriate candidate to be a gestational carrier. Here are some considerations:

• Must be over 21 years of age and preferably under 40 years of age.
• Must have had at least one full term pregnancy.
• Must have had less than five natural births/deliveries and no more than three C-section deliveries.
• Must have no significant chronic illness.
• Must not use tobacco, illicit drugs, and agree to not drink any alcohol during pregnancy. Generally your legal agreement will stipulate these conditions.
• Must be in a stable home-life situation.
• Must complete a psychological assessment.

The risks are the same as with any pregnancy. Although a gestational carrier is chosen for their good health and past successful deliveries, negative outcomes can still occur such as failed transfers, pregnancy loss (miscarriage) or pregnancy complications. Your doctor can help you understand the unique risk profile for both the gestational carrier and the intended parent(s).

Gestational carrier cycles and pregnancies are complicated by the addition of the third party.  Gestational carriers and intended parents must juggle many people involved in their journey, such as each other, partners, extended family members, agencies, lawyers, counsellors, and clinics. All of this can feel overwhelming. This is why it is particularly important for intended parents and surrogates to choose agencies, clinics, lawyers, and counsellors that they trust and can rely on.

In Canada, the Assisted Human Reproduction Act prohibits payment to surrogate for her services. However, it is legal to reimburse a surrogate mother for her reasonable expenses incurred as a result of the surrogacy.  If looking for a surrogate internationally it is important to consider the motivation for offering services if being paid and how that might ethically impact your decision to match.

When a person is pregnant, all choices regarding the pregnancy and delivery are ultimately in their hands. This means your gestational carrier has the final say in matters such as termination, diagnostic testing, and how/where to deliver the baby. This can present ethical dilemmas for intended parents where conflict arises between surrogate and intended parent.  For example, if you were in a situation where medical termination of the pregnancy was a consideration how would you feel about that? How would your surrogate feel?

In Canada, it is not legal to pay a person to be a gestational carrier, but intended parent(s) do have a number of costs to consider, which can amount to between $50,000 and $70,000.  Some of the costs include:

• Legal fees: Both the intended parent and gestational carrier are required to have a legal agreement where each party has their own legal representation
• Agency Costs: This will vary agency to agency.
• Reimbursement of expenses incurred by the gestational carrier: Reimbursable expenses can include lost wages, childcare, travel and accommodation as it pertains to the cycle. These expenses will be outlined in the legal documents
• Treatment Fees: In order to transfer an embryo into a gestational carrier, you will undergo IVF so that we can combine sperm and egg to create embryos for transfer into the surrogate.

Our specialized Donor and Surrogacy team can assist you in understanding the costs using a gestational carrier to complete your family.