Fertility problems and infertility are likely more common than you might think, but many couples choose to keep their fertility issues private, so you may not realize that someone you know is having difficulty conceiving.
In Canada, it is estimated that between 11.5% and 15.7% (roughly 1 in 6) couples experience fertility problems, which is double what the rate was in the 1980s.
If you find yourself in this situation and you’ve tried making lifestyle changes and other fertility treatments such as intrauterine insemination (IUI) and in vitro fertilization (IVF), the next option you may wan to consider is enlisting the help of a surrogate mother to help you have a child. This option is more complex as there are strict laws surrounding surrogacy, but it is estimated that more than 400 arrangements are made in Canada every year.
What is surrogacy?
Surrogacy is an arrangement where a woman bears a child for another individual or couple, and agrees that they will become the child’s parents after it is born. There are 7 types of surrogacy arrangements.
Types of surrogacy
|Surrogacy Type||Bio Mother||Bio Father||When is it used?|
|Traditional||Surrogate mother||Intended father||When the intended mother is unable, or if there is no intended mother.|
|Traditional + Donor Sperm||Surrogate mother||Sperm donor||When the intended father is unable, or if there is no intended father.|
|Gestational||Intended mother||Intended father||When the intended mother is unable to get pregnant or doing so would cause harm to her or the fetus.|
|Gestational + Donor Sperm||Intended mother||Sperm donor||When the intended father is unable, or if there is no intended father.|
|Gestational + Donor Egg||Egg donor||Intended father||When the intended mother is unable, or if there is no intended mother.|
|Gestational + Donor Sperm & Egg||Egg donor||Sperm donor||When the intended parents are unable to provide sperm, egg, or embryo.|
|Gestational + Donor Embryo||Egg donor||Sperm donor||When others undergoing IVF have embryos left over, which they donate to others.|
Also referred to as a “straight surrogate” or “classic surrogate”, the traditional surrogate donates her own egg which is fertilized in vivo via artificial insemination with the intended father’s sperm, or sperm from a donor, and carries the baby to term. Since it is the surrogate mother’s egg that is used, she is the biological mother of the child.
More common than traditional surrogacy, both the egg and the sperm come from either the intended mother and father, or from donors. Pregnancy is achieved through IVF and the surrogate mother has no biological relationship with the child.
Gestational surrogates may be used when the intended mother is unable to become pregnant or carry a baby to term or doing so may cause harm to to her or the fetus due to hysterectomy, diabetes, cancer, etc., the intended mother/father is unable to provide sperm, egg or embryo and/or there is no intended mother or father, as is the case with individuals or same-sex couples.
Surrogacy alternatives if you are having fertility problems
If you and your partner are having difficulty conceiving, there are many ways a doctor can help you. Before offering any treatment, they will most likely work with you to address any lifestyle factors that may be hindering your chances of becoming pregnant.
If making lifestyle changes (such as improving your diet, losing excess weight, etc.) doesn’t help, it may be time to look at fertility treatments, as well as alternative ways to have a child.
Artificial insemination is usually the first option taken to increase the chance of pregnancy. A doctor inserts sperm directly into a woman’s cervix (Intracervical Insemination), uterus (Intrauterine Insemination or fallopian tubes.
This makes the trip shorter if there is a low sperm count, the sperm are not strong swimmers and bypasses obstructions such as irregular reproductive organs or endometriosis. or using an egg donor, which will allow an infertile woman to carry a child and give birth.
In Vitro Fertilization
One of the more common infertility treatments is IVF. This procedure involves combining eggs and sperm outside the body in a laboratory. Once one or more embryos form, they are placed inside the uterus.
IVF is a complicated and expensive procedure. In Canada, the average cost of IVF treatment is $10,000 to $15,000 per cycle, the medications add around $5,000 and genetic testing (to see if the embryo is likely to be successful) can add another $5,000 to $10,000. There are currently four provinces that offer financial assistance to residents undergoing fertility treatment, including Ontario, Manitoba, New Brunswick, and Quebec.
In the past five years there has been a more than 30 percent increase in the number of IVF cycles initiated in Canada and 36 clinics initiated 33,092 cycles in 2017. In Ontario, 1% to 2% of live births are the result of infertility treatments.
Who should consider surrogacy?
If you are an individual or couple who has not able to become pregnant through other means such as IVF or artificial insemination, surrogacy may be an option for you. You also might also want to consider surrogacy if you are unable to adopt a child because of your age or your marital status.
If you are a woman who has a medical condition that makes pregnancy impossible or risky for you such as endometriosis, heart disease, diabetes, cancer or a hysterectomy, opting to use a surrogate might be your best choice.
Surrogacy is also a potential option for same-sex couples who could either use the surrogate’s egg, as with traditional surrogacy, or a donor egg, as with gestational surrogacy.
Parents who are considering surrogacy should be:
- in a stable living arrangement
- financially stable
- free of problematic substance use
- capable of affording the costs associated with the surrogacy process
- choosing surrogacy for the purpose raising a child, not vanity
- prepared to support the surrogate mother both emotionally and physically, including travelling to visit her and attending the birth
- committed to building a respectful relationship with the surrogate mother
- prepared to have open and honest conversations throughout the entire process
It is also important that the parents or parent have a general understanding of the surrogacy process, and are willing to follow the necessary protocols, including criminal background checks, psychological and medical examinations, and consultations with a lawyer.
How to find a surrogate?
Once you have determined that you want to use surrogacy to help you have a child, the next step is finding a surrogate mother. Since it is illegal to pay for, or advertise to pay for a surrogate mother in Canada, finding one can be time-consuming and difficult.
In the majority of cases, the surrogate mother may be a friend or relative of the couple who volunteers to carry the child, or she may be unknown to the couple and is introduced through a third party. There are surrogacy consulting companies that assist couples with finding a surrogate, including Surrogacy in Canada Online and Proud Fertility.
Intended parents should be aware that the law states that no one shall advertise the payment of, offer to pay, pay or accept consideration for the arrangement of services of a surrogate mother.
A surrogate mother legally must be over the age of 21. The ideal candidate should:
- be between the ages of 21 and 49
- have had at least one prior pregnancy without complications or premature birth
- be in good physical, emotional and mental health
- not have underlying conditions such as diabetes or high blood pressure
- have a healthy BMI (eg. under 35)
- regular cycles
- not abuse drugs or alcohol and be willing to abstain during pregnancy
- not smoke and be willing to abstain during pregnancy
- be able and willing to take time away from work and family to travel to appointments, rest and give birth
- not have a serious criminal history
She should also be willing to undergo any necessary medical procedures, such as:
- Repeated bloodwork
- Taking IVF medications (including hormone injections)
- Undergoing invasive medical procedures such as
- Sonohysterograms (ultrasound to look at the inside of your uterus)
- Hysterosalpingograms (special x-ray using dye to look at the womb and fallopian tubes)
- Endometrial biopsies (removing tissue from the uterus examine it for cancer or any other cell abnormalities)
- IVF transfers
- Amniocentesis (sampling fluid the amniotic sac surrounding a developing fetus to analyze for abnormalities)
What happens once you’ve found a surrogate?
There are three main areas that need to be addressed before starting the actual surrogacy, but the order in which they are done depends on the circumstances. They are:
Both the commissioning couple and the surrogate need to undergo a preliminary medical consultation in order to begin testing prior to treatment to ensure they are suitable candidates.
Intended couples, as well as potential surrogate mothers, should have an initial consultation with a lawyer to ensure that they understand the legalities involved with third-party reproduction. This is a fairly new field for family law, so it is important that you look for a lawyer who has experience and has completed a number of surrogacy arrangements.
This is particularly important for the surrogate. She should speak with a counsellor independently to talk about issues such as her relationship with the intended parents, feelings of attachment to the unborn child, and the impact surrogacy could have on her relationship with her own children, if she has any, as well as her family, friends, and even her employer.
As with the legal counsel, it is beneficial to speak with a therapist who has experience with third party reproduction.
How much does surrogacy cost in Canada?
A couple that does not need donor eggs should expect to spend between $60,000 and $80,000 by the time the arrangement is completed. If donor eggs are needed, the costs range from $70,000 to $100,000. The costs involved with surrogacy are high, and can often be prohibitive for many couples.
Gestational surrogacy cost
The cost of gestational surrogacy in Canada ranges from $35,000 to $85,000 and consists of the following fees:
|Psychological evaluation & implication counselling||$0 to $1,000|
|Legal fees||$5,000 to $8,000|
|Medical evaluation||$0 to $1,000|
|Life insurance policy||$300 to $500|
|Surrogate mother’s expenses – pre-pregnancy||$1,500 to $3,000|
|Surrogate mother’s expenses – pregnancy & post-partum||$18,000 to $25,000|
|(possible) C-section||$0 to $3,000|
|(possible) Multiple birth||$0 to $3,000|
|(possible) Bedrest (1 to 20 weeks)||$0 to $10,000|
|Fertility treatment cycle (IVF, IUI, etc.)||$10,000 to $20,000|
|Consultant/agency fee||$5,000 to $20,000 Typical: $8,500|
What is included
Legal fees: Including independent legal advice for both parties, and the creation of a legal contract (surrogacy contracts aren’t recognized in Quebec, and can be in somewhat of a grey zone in other provinces)
Surrogate mother’s expenses:
- Pre-pregnancy – travelling to an IVF clinic such as gas, mileage, parking, childcare, lost wages, food, airfare/accommodations, medications, legal, life insurance policy, will, communication (phone, internet, printing)
- Pregnancy & post-partum – maternity clothing, childcare, travel costs, vitamins, groceries, health supplements or treatment (like acupuncture or reflexology), lost wages, medications, health & fitness, pregnancy supplies, feminine hygiene
Should the surrogate require more than one IVF treatment, this could drive up the costs of the arrangement significantly.
Traditional surrogacy cost
The cost of traditional surrogacy in Canada ranges from $25,000 to $80,000 and consists of almost all of the same fees as gestational surrogacy apply (see table above). The biggest difference is that cost of the fertility treatment ranges from $0 to $20,000 and depends on insemination method used (home insemination, IUI, IVF). Traditional surrogacy is not as common and currently represents less than 2% of surrogacy arrangements in Canada.
Intrauterine insemination (IUI) cost
The total cost of IUI with a partner’s provided sperm is $600 to $1050, while using a donor’s pre-washed sperm costs $1,000 to $1,500.
|Donor sperm||$700 to $1000 per unit|
|Handling of pre-washed donor sperm||$100 to $300 per unit|
|Sperm washing (separating individual sperms from the semen)||$500 to $850|
In Ontario, there is no limit on the number of cycles of artificial insemination (including IUI) that can be covered by the government as long as you have a valid health card. However, this does not cover additional fees incurred such as the storage fee for cryopreserved eggs or embryos ($500) or specialized procedures such as PESA and TESE.
In vitro fertilization cost
The average cost of IVF treatment in Canada is $10,000 to $15,000 per cycle, but the addition of fertility drugs, genetic testing and donor eggs cost can sharply increase the the cost to over $20,000.
|Single cycle||$8500 to $9,000|
|IVF + ICSI Cycle||$10,000 to $11,000|
|Conversion from IUI||$7,500|
|Known egg donor or gestational carrier||$12,100|
|Frozen embryo transfer (FET)||$2,000 to $2,500|
|Fertilization and embryo transfer (frozen eggs)||$8,000|
|Frozen donor eggs from the US||$2200 USD to $4000 USD per egg|
|(possible) Medications||$3,000 to $7,000|
|Annual storage||$400 to $500|
In Ontario, individuals with a medical reason can have one treatment cycle of fertility preservation (freezing sperm or egg samples to be used later) covered.
Cost to collect, freeze and store embryos and sperm (fertility preservation)
- The cost to collect sperm ranges from $700 to $5,500 depending on the method used.
- The cost to freeze sperm is $700 to $800, including the first year of storage.
- The cost to monitor, stimulate, retrieve and freeze eggs is $7,600 to $9,000, including the first year of storage.
- The cost to store an egg, embryo or sperm is $400 to $500 per year.
|PESA sperm retrieval (fluid is pulled up with a needle)||$700|
|TESE sperm retrieval (surgical testicular sperm extraction)||$2,350 to $3,000|
|microTESE sperm retrieval||$3,500 to $5,500|
|Embryo freezing (includes 1st year of storage)||$1,000|
|Egg freezing (non-medical) (includes monitoring, stimulation, egg retrieval, 1st year of storage)||$7,600 to $9,000|
|Sperm freezing (includes 1st year of storage)||$700 to $800|
|Annual embryo or sperm storage||$400 to $500|
|ICSI (single sperm is injected into an egg)||$2,000|
|ICSI with surgically retrieved sperm (SRS)||$2,500|
|Computer assisted semen analysis (CASA)||$65 to $150|
|Kruger semen analysis||$300|
|Embryo biopsy for PGD/PGS||$1,800|
|PGS/PGT-A (pre-implantation genetic testing for aneuploidy)||$600/embryo, $2,000|
|PGD/PGT-M (pre-implantation genetic testing for mutation)||TBD|
|Vasectomy reversal surgery||$8,000|
|Tubal ligation reversal surgery||$6,000|
The above costs are based on prices listed by Ottawa Fertility Centre in Ottawa, ON, Pacific Centre for Reproductive Medicine in Vancouver, BC and Olive Fertility Centre in Vancouver, BC.
Surrogacy law in Canada
Surrogacy is legal in Canada, however the Assisted Human Reproduction (AHR) Act prohibits an intended couple from paying a surrogate mother for her services. In lieu of direct payment, the commissioning couple is allowed to reimburse the surrogate for reasonable expenses incurred as a result of the pregnancy.
Unlike the United States, federal law in Canada gives parental rights to the surrogate mother upon the birth of the baby. This means that if a gestational surrogate changes her mind, she has the legal right to keep the child, whether or not there was a contract in place beforehand.
In the event that this happens, the intended parents would be forced to sue for custody, and hope that the courts would recognise the intent of the contract as well as the DNA tests to prove the child’s genetic parents.
Canada does not have “pre-birth” orders, like some U.S. states, so typically a post-birth parental order is filed in the weeks following the child’s birth. Only then can legal parentage be established.
The intended parents are also legally allowed to change their minds, since their obligations as parents cannot be forced by law. In the event that the intended parents choose to abandon the child at any point during the pregnancy, they would be leaving the surrogate without payment, and with a child that is not hers. In most cases, the child would then be put up for adoption.
Any surrogacy agreement in Canada must comply with the AHR Act, as well as the provincial and territorial laws, which means that the arrangement could differ significantly depending on where the surrogate and the intended parents live.
The law is very explicit, and places several constraints on surrogacy arrangements.
To summarize, a surrogate mother can only be paid for out-of-pocket expenses, and usually a receipt is required in order to abide by the law. It is also illegal to pay for a professional service to help manage the surrogacy or recruit a woman to become your surrogate.
If a couple is caught not abiding by the surrogacy laws in Canada, they could be fined $500,000, or be sentenced to 10 years in jail.
Surrogacy helps create families
If you are considering surrogacy, it is crucial that you develop an intricate knowledge of how the process works, as well as your rights as an intended parent and the rights of your surrogate mother, in order to avoid potentially disastrous emotional, financial and legal complications.
Surrogacy can be a very complicated and expensive process, with many legal, emotional, and moral implications. It is, however, a viable option for Canadians who are unable to get pregnant by other means, and can provide them with the chance to have the family they so desperately desire.
What is infertility?
In general, infertility is defined as when a woman of reproductive age is unable to become pregnant while not using any form of birth control. More specifically, it is defined as not being able to get pregnant after at least a year of regular, unprotected intercourse. If the woman is over the age of 35, she is considered infertile after 6 months of unprotected sex.
What causes infertility?
Fertility is influenced by many factors, but the most common causes of infertility are:
- Age: Women are starting to have children later in life, and fertility decreases after age 35.
- Obesity: Increasing rates of obesity which can cause hormone imbalances and irregular menstrual cycles.
- STIs: Increasing rates of sexually transmitted infections (STIs) like Chlamydia which can cause blockages in the fallopian tubes
- Hormonal imbalances
- Early menopause
- Chemotherapy or radiation from cancer treatment
- Blocked fallopian tubes
- Varicocele (enlarged scrotal veins)
- 3 times out of 10, the cause is in men.
- 4 times out of 10, the cause is in women.
- 2 times out of 10, the cause is a mix of factors from both male and female.
- 1 time out of 10, at first, no specific cause can be found.
What to read next
- Assisted Human Reproduction Act
- Fertility – Government of Canada
- Study: Estimating the prevalence of infertility in Canada
- Fertility: Overview, 2012 to 2016 – Statistics Canada
- Report on sexually transmitted infections in Canada, 2017
- Tackling Obesity in Canada: Obesity and Excess Weight Rates in Canadian Adults
- Prohibitions related to Surrogacy – Health Canada
- Who Uses Surrogates? – WebMD
- In Vitro Fertilization – WebMD
- Infertility and Artificial Insemination – WebMD
- Genetic testing and screening – Health Canada
Over to you
We’re interested to know – are you considering surrogacy? What type are you leaning toward and have you found a surrogate? Let us know in the comments below!