What is surrogacy?

Surrogacy refers to an arrangement whereby a woman agrees to become pregnant for the purpose of gestating and giving birth to a child for others to raise. She may be the child's genetic mother or not, depending on the type of arrangement agreed to.

What is third party reproduction?

Third party reproduction is any human reproduction in which DNA or gestation is provided by someone other than the intended parents of the child.  This includes gestational surrogacy, traditional surrogacy, egg donation, sperm donation, and embryo donation.

What other terms are used to describe a surrogate mother?

There are 2 types of surrogate mothers, "gestational surrogates" and "traditional surrogates". Gestational surrogates are also referred to as "gestational carriers" or "host surrogates" and traditional surrogates are also referred to as "straight surrogates" or "classic surrogates".

How many types of surrogacy arrangements are there?

There are 7 types of surrogacy arrangements and 2 types of surrogate mothers, "gestational surrogates" and "traditional surrogates". Gestational surrogates are also referred to as "gestational carriers" or "host surrogates" and traditional surrogates are also referred to as "straight surrogates" or "classic surrogates". Gestational Surrogacy is the most common type of surrogacy arrangements in Canada.

Gestational Surrogacy (GS):
When the intended mother is not be able to carry a baby to term (due to hysterectomy, diabetes, cancer, etc.) her egg and the intended father's sperm are used to create an embryo (via IVF) that is implanted into and carried by the surrogate mother. With this method, the child born is genetically related to its parents and the surrogate mother has no genetic relation.

Traditional Surrogacy (TS):
This involves artificially inseminating a surrogate mother with the intended father's sperm via IUI, IVF or home insemination. With this method, the child born is genetically related to its father and the surrogate mother.

Traditional Surrogacy & Donor Sperm (TS/DS):
This involves artificially inseminating a surrogate mother with donor sperm via IUI, IVF or home insemination. With this method, the child born is genetically related to sperm donor and the surrogate mother.

Gestational Surrogacy & Egg Donation (GS/ED):
If there is no intended mother or the intended mother is unable to produce eggs, the surrogate mother carries the embryo developed from a donor egg that has been fertilized by sperm from the intended father. With this method, the child born is genetically related to the intended father and the surrogate mother has no genetic relation.

Gestational Surrogacy & Donor Sperm (GS/DS):
If there is no intended father or the intended father is unable to produce sperm, the surrogate mother carries an embryo developed from the intended mother's egg (who is unable to carry a pregnancy herself) and donor sperm. With this method, the child born is genetically related to the intended mother and the surrogate mother has no genetic relation.

Gestational Surrogacy & Egg/Sperm Donation (GS/ED/DS):
When the intended parents are unable to produce either sperm, egg, or embryo, the surrogate mother can carry an embryo created from a donated egg/sperm. With this method, the child born is not genetically related to the intended parents and the surrogate mother also has no genetic relation.

Gestational Surrogacy & Donor Embryo (GS/DE):
When the intended parents are unable to produce either sperm, egg, or embryo, the surrogate mother can carry a donated embryo (often from other couples who have completed IVF that have leftover embryo's). With this method, the child born is not genetically related to the intended parents and the surrogate mother also has no genetic relation.

Who needs surrogacy?

As many as 1 out of every 4 couples are infertile in North America. Below are the many conditions/factors that warrant the use of surrogacy as an alternative to family building.

  • Women that are born without a uterus (Mayer-Rokitansky-Kuster-Hauser Syndrome).
  • Women that no longer produce eggs (ovarian failure/polycystic ovaries, maternal age, ovarian cancer, etc.)
  • Women that have had their uterus removed (due to fibroids, cancer, or accidents).
  • Women that have had several failed IVF procedures.
  • Women that have been diagnosed with a uterine abnormality (DES exposure, congenital abnormalities, Asherman's Syndrome, myomas/fibroids, polyps, insufficient endometrial linings...)
  • Women that suffer from high blood pressure (hypertension/pre-eclampsia/eclampsia).
  • Women that suffer from diabetes.
  • Women that suffer from a serious heart condition.
  • Women that have had recurrent miscarriages, stillbirths, and/or pre-term deliveries
  • Women that are on medications that are dangerous to take while pregnant.
  • Women that suffer from immune disorders.
  • Women that suffered with severe morning sickness (Hyperemesis Gravidarum) with a previous pregnancy.
  • Women that have suffered from any type of complication that could endanger their life or the life of their unborn child.
  • Men that suffer with problems with ejaculation or disorders affecting sperm production.
  • Men who are infertile from the side effects of treatment of testicular cancer.
  • Men who have had testicular damage either from injury or infection (such as mumps).
  • Men who have a rare genetic or hormone deficiency which causes infertility.
  • Couples with unexplained infertility.
  • Same Sex Couples
  • Single Intended Parents
  • Age

What conditions do not warrant surrogacy??

Surrogacy for social reasons such as the inconvenience of carrying a child, fear of pregnancy/pregnancy side effects or interrupting a career are generally not accepted where surrogacy is altruistic. However, there have been cases of surrogacy in Canada where the intended mother suffered from tokophobia (fear of pregnancy).

What are important considerations before matching/moving forward with surrogacy??

With every surrogacy arrangement, good communication is crucial. Both intended parents and the surrogate mother should agree on the following before proceeding together…

  • Time frame for beginning/completing surrogacy.
  • Number of transfers/time commitment.
  • Number of embryos to be transferred.
  • Disclosure (when to share with friends/family).
  • Religious/Spiritual/Moral Beliefs
  • Diet (food restrictions, if any).
  • Selective fetal reduction in the event of high order multiples (triplets+).
  • Prenatal testing for chromosomal abnormalities/neural tube defects.
  • Termination/continuation of pregnancy if there is an abnormality with the baby.
  • Life insurance policy & Will for the surrogate mother.
  • Expenses
  • Desired amount of contact during the pregnancy and after the birth.
  • Obstetrical care during pregnancy (Midwife/Obstetrician)
  • Hospital Birth/Home Birth/Birth Plan
  • Breastmilk

What is the difference between commercial surrogacy and altruistic surrogacy?

Commercial surrogacy refers to surrogate mothers who receive a fee, whereas altruistic surrogacy refers to surrogate mothers who do not receive any fees, only reimbursement for out-of-pocket expenses. Commercial surrogacy is prohibited in Canada but common throughout the United States.

How many Canadians are affected with infertility?

It is estimated that 650,000 Canadians of reproductive age (or 1 out of 6) are affected with some form of infertility.

How many surrogacy arrangements have there been in Canada?

There are no known statistics, but it is estimated that there are 400+ arrangements per year.

Has a gestational surrogate mother in Canada ever changed her mind in relinquishing custody of the baby?


Has a traditional surrogate mother in Canada ever changed her mind in relinquishing custody of the baby?


Why would a woman want to carry a baby for someone else, only to give it away?

Most surrogate mothers enjoy being pregnant, have children of their own and genuinely want to help a couple experience the joys of parenthood. They don't view giving the child to his or her parents as "giving away" but more as "giving back" to its parents (since they were the ones that conceived the child either through IVF treatment or with their "intent".) This is why it’s common to hear a surrogate mother say "I'm a 9 month babysitter!"

How do intended parents truly bond with their child if they do not experience the pregnancy and birth themselves?

Just like a child that is adopted or fostered, children born through surrogacy are wanted and loved. They may not have "grown under their mother's hearts... but they grew in it". Children need to know that they are wanted and loved and in a nurturing environment, they thrive. Children born through surrogacy have many people taking part in their creation with not only their parents, but a surrogate mother and her family, doctors, nurses, lawyers, and sometimes egg or sperm donors. It does not get more special than that!

Why don't surrogate mothers get "attached" to the baby?

Most women would never entertain the idea of being a surrogate mother let alone acting as one. This is because surrogate mothers often feel they have a "calling" to carry a child for someone else and they know immediately that they can do it. From the beginning a surrogate mother sees the hopes and dreams of a family through the intended parents and a strong friendship is often formed.

Intended Parents are usually with the surrogate mother during the IVF process and when the embryos are transferred (an emotional moment for those involved) the surrogate mother can witness the intended parents already bonding and yearning for their hopeful baby via ultrasound. It is at this point (before actual implantation in the womb) that surrogate mothers physically see that they are carrying someone else's baby and bond with the new family that they are helping to create. The intended parents often take part in ultrasound/doctor appointments, have a baby shower with the surrogate mother and her family and some even create audio tapes for their surrogate mother to play for the baby while pregnant (so that the baby can begin bonding with their voices). Intended Parents are involved with the birth and start caring for their child immediately.

There are some ethicists that believe that surrogate mothers are cold and uncaring because they are detached from the child they are carrying but this is a misconception. Surrogate mothers do attach and bond to the child they are carrying but in a different way.

Today, many surrogate mothers have an ongoing relationship with the children and families they help create and some are incorporated as an extension to the new family.

How come some individuals believe surrogacy is wrong?

Everyone is entitled to their opinion, but in many circumstances, those against surrogacy are often uneducated and/or misinformed about the surrogacy process. It's important to note as well that people are often against things they do not understand or if they feel it has nothing to do with themselves. Many people today in our fast paced and on-demand society place little value on children and family.

Is there a stigma attached to surrogacy and third party reproduction in Canada?

Unfortunately... yes. Just like there are still stigmas attached to mental health, AIDS, etc... As long as people stay misinformed and/or uneducated about a topic, the longer the stigma will remain.

Why do couples use surrogacy when they could just adopt?

Many couples that turn to surrogacy have already tried, or have adopted, a child. They may have adopted and never knew surrogacy was an option until afterwards, and/or they want to add on to their family. Some couples have been hurt through the adoption process since many birth mothers decide to keep the baby after birth, even after the intended couple has already bonded with the child during the pregnancy. A failed adoption is usually devastating and heart wrenching for a couple to endure, some will go through it numerous times before they refuse to attempt again for fear of getting hurt once more.

Adoption is more difficult in Canada today than it was in the past. Today there are government programs to help women with unplanned/unwanted pregnancies and there is no longer a social stigma placed on being an unwed mother. Couples looking to adopt have to go through a lengthy process to even qualify for adoption with applications, background checks, references and home studies. Adoption is also an expensive process and wait times can be 5-10 years. There is also the issue of children available for adoption often coming from severe neglect, malnutrition, abuse, and they can have physical/mental handicaps or serious medical problems. Most adoptions are now open adoptions and many couples strongly fear bonding with a child only for them to lose custody if the birth parents change their minds.

Why do some ethicists believe the only reason women do surrogacy is for the money?

It is very stereotypical and ignorant to view a woman’s motivations for surrogacy in this manner. If money was the true motivator there would be more women volunteering to act as surrogate mothers. Even where there is commercialized surrogacy, there is a shortage of surrogate mothers. Most individuals have a negative opinion of surrogacy because they either do not understand how the process works and/or have only heard the negative stories (such as the Baby M case in New Jersey in the 1980's). More often than not, the media will portray the negative and not the successful, positive stories.

How important are contracts/agreements? What exactly do they define in the arrangement?

Contracts/agreements show the "intent of the parties" and help as a guideline to a surrogate mother and the intended parents on many issues that occur (or could occur) during the relationship. These contracts/agreements set out the rights, responsibilities and intent of all parties, in advance of the embryo transfer. Surrogacy contracts/agreements deal with important considerations/issues including confidentiality, custody/parental rights, pre-natal obligations on the party of the surrogate mother and reimbursement of expenses.

How enforceable is a surrogacy contract (either gestational or traditional) in Canada if the surrogate changed her mind?

A contract in a traditional surrogacy arrangement would be unenforceable if the surrogate changed her mind. She would have to be proven unfit for the child to be removed from her. However, since there is no precedent in Canada (no surrogate mother has fought for custody in a Canadian court) it is difficult to speculate for sure as it would depend on the judge’s decision/circumstances. The intended father would most likely have legal rights to visitation if pursued since he would be the genetic father, but he could also be required to pay child support.

If a gestational surrogate mother changed her mind she would have all rights to the child at birth whether a contract was in place or not (since Canada does not have "pre-birth orders" like in California). The intended parents would have to pursue legally and hopefully the courts would recognize the contract intent and DNA tests proving genetic parentage. Since there are no precedent cases no one can answer with certainty if the intended parents would be able to claim full custody of their child.

Will provincial health plans cover IVF/surrogacy treatments, pregnancy and birth?

Except in Ontario (as of 2015), Canadian provinces do not subsidize IVF. A surrogate mother's pregnancy/birth is covered by her provincial health care. Canada's health care system is not the same as in the United States. Our health care system is paid for through federal and provincial tax systems. However, any medical treatment needed before the pregnancy (such as fertility drug blood works/endometrial lining checks via ultrasound/physicals/gynaecological exams/doctor visits) may not be covered. They are considered third party medical because they are for fertility treatment.

*UPDATE - OHIP will cover one cycle of IVF for residents of Ontario starting December 2015.

Why do I see terms online like "womb4you", "oven", "womb service" & "womb 4 rent" that are used to describe surrogate mothers?

These terms are somewhat degrading and derogatory towards surrogate mothers. Proper terminology in surrogacy is: surrogate mother, gestational surrogate and/or traditional/classic surrogate, fertility assistant, and host carrier. The other terms seem to imply some type of commercial service and are more commonly used by American surrogates where surrogacy is commercialized.

Why is surrogacy controversial in Canada?

Canada is divided on its views in regards to surrogacy. Those in support feel that women and intended parents should have the right to choose what they will or will not do with their own bodies and have full control over their reproductive rights (I can have an abortion so I can carry a baby as a surrogate right?) Those against surrogacy feel that it is degrading towards woman and can be grouped with prostitution and child trafficking. They believe it is against true family values, turns children into commodities and children that are "products of surrogacy" will have lasting psychological and social damage.

The government surveyed Canadians in 1993 and found the country was divided, but that the majority of Canadians felt third party reproduction and cloning were unethical (the government put third party reproduction and cloning into the same bill).

What is considered illegal activity under Canada's Assisted Reproduction Act?

  • Pay, offer to pay, or advertise payment, to a surrogate mother.
  • Accept payment for arranging for the services of a surrogate, offer to make such an arrangement for payment, or advertise the arranging of such services.
  • Counsel, induce, or perform any medical procedures to assist a woman to become a surrogate if she is under 21.
  • Reimburse a surrogate for an expenditure incurred by her in relation to her surrogacy, except in accordance with regulations and a licence, and where a receipt is provided.
  • Reimburse a surrogate for loss of work-related income incurred during her pregnancy, unless a qualified medical practitioner certifies, in writing, that continuing to work may pose a risk to her health or that of the embryo/fetus; and the reimbursement is made in accordance with the regulations and a licence, with a receipt is provided.

Criminal penalty: A fine of up to $500,000 and up to 10 years in jail. Reimbursing a surrogate for her expenditures during gestation has became a controlled act and now requires a licence and compliance with regulations that are still pending.