Gestational Surrogacy

Surrogacy can be of two forms, one is traditional surrogacy in which the surrogate not only gestates the pregnancy but also provides the egg. This form of surrogacy is not practiced at the Regional Fertility Program. The only form of surrogacy that is practiced is that of gestational surrogacy. In this situation the genetic mother undergoes an in vitro fertilization cycle, her eggs are fertilized and the resulting embryos are replaced into the uterus of the third party. This woman carries the pregnancy to term. At the birth of the child the gestational surrogate relinquishes all rights and responsibilities of the infant and those rights and responsibilities are transferred to the genetic parents. After appropriate ethical and medical review the Regional Fertility Program was given approval to develop a surrogacy program in 1994.

Gestational surrogacy can only be performed in our program when it is medically indicated. Surrogacy may be medically indicated if a woman has an absent uterus or has a uterus which has been determined to be unable to sustain a pregnancy. There are some medical conditions in which a woman’s life would be significantly threatened should she carry a pregnancy. This recommendation must be made by a specialist in the area in which she has her disability. A pregnancy is not a risk free event to individuals undertaking it. IVF can occasionally have rare but serious consequences.

Before a gestational surrogacy arrangement can be considered all parties including the surrogate, her partner and the commissioning couple must attend an information session outlining the process of IVF and the potential short and long term risks of an IVF cycle as well as that of pregnancy for the surrogate. They will then have a medical consultation at the Regional Fertility Program which involves the genetic parents as well as the surrogate mother and her partner. If there is clear medical indications to proceed appropriate information will be given and a preliminary counselling process undertaken.

A gestational surrogate must have an assessment of her uterus both with an ultrasound examination as well as a hysterosalpingogram or hysteroscopy to ensure she can carry a pregnancy. She must also have screening appropriate to ensure that her health is adequate prior to pregnancy. We will require a letter from her family physician stating that he or she feels there are no medical contraindications to pregnancy. She must undergo a mock cycle to ensure that she is capable of producing an appropriate uterine response for embryo transfer. Within three months of the IVF cycle both her and her partner must undergo blood testing to screen for viral illnesses which are spread through body fluids such as HIV and Hepatitis and a repeat testing for these diseases are undertaken six months following the IVF cycle if a pregnancy has occurred or three months following the cycle if a frozen embryo transfer is to be performed.

The commissioning male must provide a semen sample to ensure there is adequate quality and quantity to undergo an IVF cycle and the female partner must have a pelvic ultrasound as well as testing to look at her ovarian reserve to ensure that adequate numbers of eggs will be produced. Within three months of completing IVF the commissioning couple must undergo blood testing to screen for viral illnesses such as HIV and Hepatitis and this screening is repeated six months after the IVF cycle if a pregnancy has occurred or three months if a frozen embryo transfer is being considered.

After the above process has taken place the genetic parents as well as the surrogate and her partner must seek out separate legal counsel. A contractual agreement between the gestational surrogate and her husband and the genetic parents must be effected after appropriate consultation and before treatment can be initiated. This legal agreement is undertaken independent of the Regional Fertility Program. Before treatment can be started the clinic requires either a copy of the agreement or a letter from each of the participating lawyers to confirm the agreement has been executed. An outline of issues that should be considered in the agreement will be provided by the Regional Fertility Program. It is recognized that in Canada there is no case law directly applying to surrogacy or surrogacy arrangement. The courts may find surrogacy contracts invalid and therefore not enforceable and rule in “the best interest of the child”.

Gestational surrogacy arrangements are obviously controversial. There are strong opinions and arguments for and against such arrangements. This is one of the many emotional and psychological issues that needs to be dealt with before, during and after such agreements are executed. The psychologists, nurses and physicians at the Regional Fertility Program undertake to provide such counselling to help all members of the consenting agreement to be aware of the relevant issues and to help work through them. It is important that there not be any coercion in this process and that each member enters into it voluntarily with full informed consent. After completion of the initial psychological counselling it may be deemed inappropriate to proceed further. The Regional Fertility Program physicians and psychologists do reserve the right to refuse treatment if the requirements of the program are not met. The counselling process will require meeting with the couples individually and as a group and the issues of genetic surrogacy will be explored in depth. Ongoing counselling may be required during and even after the pregnancy as there is limited experience with surrogate gestational motherhood at present.