Gestational Surrogacy is an arrangement in which a woman carries and delivers a child she is not genetically related to for a commissioning couple or person. Surrogacy arrangements can be complex undertakings for both the commissioning couple and the gestational surrogate. Therefore, it is important that patients are well informed about the steps involved. Here, we try to outline some of the key issues and steps required when pursuing a surrogacy arrangement.

 

What You Need To Know Before You Get Started

 

Gestational Surrogacy

• Women with congenital absence of the uterus or prior hysterectomy.
• Women with untreatable intra-uterine scar tissue.
• Women with untreatable recurrent pregnancy loss.
• Women with a contraindication for pregnancy (e.g. heart disease, cystic fibrosis).
• Women who have received pelvic or abdominal radiation for cancer.
• Same sex male couples who want to conceive.

 

Finding A Gestational Surrogate

A gestational surrogate may be known to the commissioning couple (typically relatives or friends who volunteer to carry the pregnancy) or unknown to the commissioning couple (usually introduced through a third party).

Since it is illegal to pay for surrogacy services or to advertise to pay for surrogacy services in Canada, finding a gestational surrogate can be time consuming and difficult. While there are agencies and consultants that assist in making connections between gestational surrogates and recipient couples, patients should be aware that current law also prohibits these companies and consultants from charging for this service. In a majority of cases, gestational surrogates are already known to the commissioning couple. We highly recommend that intended parents review the laws in Canada with respect to compensating surrogates and egg donors.

 

Guidelines for identifying a gestational surrogate

• Must be over 21 years of age and under 41 years of age.
• It is highly recommended that the surrogate have completed her family or have had at least one child previously.
• Ethically, the relationship between the commissioning couple and the surrogate should not be one where there is a power imbalance. (For example, where a commissioning couple is the employer of the surrogate).
• When searching for a surrogate, patients must also consider ethical, medical, psychosocial and legal issues.

 

What You Need To Know, Now That You Have Found A Surrogate

There are a number of different scenarios wherein a surrogate may be used, but in all cases there are three main areas that must be addressed prior to starting the actual surrogacy. The order in which these tasks are done will vary depending in the circumstances.

Medical Consultation

Patients should undergo preliminary medical consultations with their fertility specialist and start some of the testing required before treatment. Both the commissioning couple and the surrogate need to undergo testing prior to the start of treatment to ensure that they are suitable candidates.

Legal Counsel

Patients should have an initial consultation with a lawyer so that they can start to learn about the legal issues involved in surrogacy arrangements as well as the costs to set up legal contracts between all parties. Third Party reproduction is a new and emerging field for family law. Therefore, it is highly recommended that patients utilize a lawyer who has previous experience in third party reproduction and who has successfully completed a number of surrogacy arrangements. The Ottawa Fertility Centre can refer you to a lawyer, but we do not specifically endorse them.

Counselling

Counselling is an essential part of the process whenever a third party is involved in reproduction. The surrogate and her partner (if applicable) will talk with a counselor independently. The surrogate and her partner will explore issues such as managing a relationship with the intended parents, coping with attachment issues to the fetus, and the impact of a surrogacy arrangement on her children and her relationships with her partner, friends, and employers.
The commissioning couple is also required to talk with an experienced counselor. The counselor may explore such issues as the commissioning couple’s relationship with the surrogate and the relationship between the child and the surrogate.

Working with a counselor or psychologist who has experience in third party reproduction is highly recommended given the complexity of the arrangements. Dr. Patricia Gervaize is one of the most experienced reproductive psychologists in the country and is available to talk with intended parents and surrogates at the Ottawa Fertility Centre.

 

Checklist For Couples Considering Surrogacy

Commissioning Couple

• Have a fertility consultation with a fertility specialist at the Ottawa Fertility Centre.
• Completed fertility testing and infections disease screening done on woman and/or man.
• A clear medical indication or requirement for a surrogacy and egg donor (if applicable) has been identified.
• Receive counseling from a reproductive counselor prior to the start of treatment.
• Obtain written evidence that a legal agreements covering all expected contingencies does exist between the commissioning couple and the surrogate as well as the commissioning couple and the egg donor (if applicable).
• Sign all appropriate consent forms at the Ottawa Fertility Centre.
• Surrogates and egg donors may not be paid for this service other than reimbursement for out-of-pocket and medical expenses.

Surrogate

• Must be over 21 but under 41.
• Has completed her family or have had at least one child previously.
• Complete a history and medical examination and all appropriate testing to the satisfaction of the fertility specialist at the Ottawa Fertility Centre.
• Attend a counseling session with a health psychologist.
• Obtain separate legal counsel and sign a legal agreement with the commissioning couple.
• Sign all appropriate consent forms at the Ottawa Fertility Centre.
• The relationship between the commissioning couple and the surrogate does not raise any concerns.