In researching surrogacy, we found that it is something that is vastly different depending on where you live. In some places it’s completely illegal like in Italy. In other places, it is illegal to take part in commercial surrogacy- when you actually pay the surrogate for her services- like here in Canada. And in other places, both altruistic and commercial surrogacy is well within the law- like the USA and Israel.
So being in Canada, where commercial surrogacy is illegal, and altruistic surrogacy is ok, I was surprised to find out that dependent on your Province, different rules apply… More on that later.
However, this whole surrogacy thing is actually a lot more complicated than you could imagine. So I thought I’d do a quick (?!) run down on how it works for us, here in Ontario along with the costs.
Step 1: Be Barren. ($$$$- All the fertility costs up until now)
Step 2: Find a Surrogate (Free if you find one yourself… unknown fees if you use an agency)
There are actually three main types of surrogacy in Canada. A traditional surrogate is a person who would use their own egg, plus the intended parent’s sperm, and carry a baby to term. The second type involves donor eggs and/or sperm with the use of the surrogate’s uterus to carry the baby to term. The third, and most common type, is called a gestational carrier. This is where the baby would be biologically related to the intended parents, and use a surrogate’s uterus to carry to term. That’s us.
Now to finding a surrogate. ha… Well think for a moment, how many people do you have in your life that are willing to volunteer? I would hazard a guess that the number is fairly small. And wait a moment until you read the whole list below about what’s involved and then ask yourself again, would they still volunteer if they knew all of the below?
So in case you don’t have anyone jumping at the chance to put their life on hold, endure invasive testing and actually bare you child, well you do have options. There are surrogacy businesses in Canada that assist in linking you to a person who would be willing to be a surrogate. Now remember, these potential surrogates cannot be compensated for this (other than their expenses) so as you can guess, the number is quite small of people volunteering. However, these types of amazing strangers (angels!) do exist believe it or not.
So now you have yourself a volunteer…. (Insert Hunger Games joke here about volunteering to be a tribute)
Step 3: Get Approved for Surrogacy by your Clinic (covered by OHIP)
It apparently isn’t as easy as just asking. Because of the potential harm and risk to the surrogate, clinics in Canada aren’t jumping at signing anyone and everyone up to do surrogacy. In fact, many clinics do not facilitate surrogacy whatsoever.
We were lucky that our clinic did. Not something I looked into in my initial research for a clinic, but was very helpful in the end as we got to continue with the same doctors, medical team, and it was close (enough…) by.
I wrote previously about our clinic not being overly excited about approving us at first, however, we were approved at our next appointment and on we go. Read more about that part here: One Step Forward, Two Steps Back and Hoping for the best, Preparing for the worst: The Clinic’s Final Decision
Step 4: Get your Surrogate Medically Approved ($$- Every test and ultrasound is paid out of pocket ~$2000)
A logical next step. We need to ensure the surrogate is in good medical health and able to complete the process without any undue harm. However, I was surprised to find out how much testing they do.
The clinic requires the a whole pile of blood work that tests for anything and everything including STIs, HIV, mineral and vitamin deficiencies etc. Next up is the Day 3 blood work and ultrasound- tests done on the third day of the surrogate’s cycle to ensure that all the hormone levels are where they should be for Day 3. Next is essentially a full physical including a pap smear etc. With this appointment comes the longest and most invasive list of medical questions you could imagine. Lastly, if anything comes up in that, then she would need to follow up with specialists for clearance prior to proceeding.
Step 5: Get your Surrogate and Yourselves Psychologically Approved ($$ – ~$600-$1000)
Yep. Next step is for you and your partner to sit with a psychiatrist to determine if you are able to go through with this process. It isn’t easy for anyone, but there are also huge social, moral, and legal implications. Have we thought everything through?
Once that is passed, it’s your surrogates turn. She gets to sit on the hot seat and have a psych doc evaluate her mental capacity to ensure she is up for the task. One hour of answering tough questions about how, why, and what is about to happen. If your surrogate has a partner, the partner must also be included and pass the above testing.
Once you and the surrogate have the official ok that as separate parts you are sane enough to move forward, you then have the final appointment- An hour session with all included parties to discuss how we feel about moving forward, how it will work, ensuring we understand each others needs and clarify that yes, we are sane.
Step 6: Legal ($$$$- Two laywers btw $5000 – $10,000 total)
Next up- find a surrogacy lawyer who will draft a surrogacy contract. This is a necessary step required by the clinic prior to initiating any procedures. This contract will clarify a bunch of the detailed information such as the maximum amounts for expenses, what the medical agreements are, how many embryos, how many tries, when would we terminate the pregnancy, when would we selectively reduce, what tests and pre-natal care is expected, who will attend appointments, who will attend the birth… etc etc etc
We draft the initial agreement with our lawyers. The surrogate gets an independent lawyer to review the agreement with and amend as necessary.
We go back and forth until it is acceptable and protects both parties- then it is signed off. The lawyers then confirm with the clinic that it exists and is signed off. Giving the clinic the go ahead to move forward with any procedures.
Step 7: Get your Cycles Synced up and Review your Protocol ($$$- Admin fees NOT including medications here are about $2500)
In order to get your cycles synced up, the surrogate needs to start a birth control pill to allow the clinic to ‘control’ her cycle. The pill is the same dosage each day and she needs to continue on it until told otherwise. In the meantime, the intended mother (aka me) needs to get everything in order to start a new round of IVF to grow and get the eggs to fertilize. Signing off of medical consents with the clinic happens here.
Step 8: Start synchronized cycles ($$$$- This would be a round of IVF for me and a round similar to Frozen Embryo Transfer for our surrogate PLUS medications, so for us it would be anywhere from $20,000-$35,000)
A normal process would look something like this: Surrogate starts injections to put her cycle on hold (yep- she’s now stuck poking herself with needles too…), then incorporates estrogen pills (orally and/or vaginally) to try and get her lining to thicken up to receive the embryos. In the meantime, I’d get started with injections to stimulate the follicles, take a shot to mature them, have them extracted then fertilized. Wait between 3-5 days while the eggs grow and then transfer them into our surrogates uterus.
All well and good, but the timing has to be perfect. The surrogate’s lining has to be a perfect thickness in order to take the embryos… which means the intended mother’s IVF cycle has to be carefully planned to coincide with it. Which is going to be very interesting (to say the least) in our case.
Step 9: Pray it worked (Do I include the cost of anti-anxiety pills here??)
Wait for two weeks until beta day to find out of the embryos implanted… if not…
Do not pass Go. Do not collect $200. Begin again at step 7 and repeat.
If it works! Congrats!! Now you’re pregnant… well she is, with your kid.
Step 10: Realize that legally you have no say into anything during the pregnancy. (Cue anti-anxiety meds again)
In Ontario, once the surrogate is pregnant, the law considers it her child regardless of it’s biological origins. So if the surrogate decides to take up whiskey, pot smoking and moves to China… We have no say.
Now you’d ask why we spent thousands on a legal agreement if it means nothing? Well… because that’s the process. And the process sucks.
We have to have an agreement to start, but the agreement really doesn’t mean anything once she is pregnant (it wouldn’t hold up in court as the fetus is legally ‘hers’). The only thing it would mean is if the surrogate directly violated the contract, the intended parents could withhold the expense payments. Woop-di-dooo
So this means if the surrogate so chose, she could abort the pregnancy at any time or selectively reduce the pregnancy at any time (aborting one or more fetuses if there are many for medical reasons for the children or mother). You get the picture. This next 9 months is where it is incredibly important that in Step 2 you found a good surrogate who you completely and absolutely trust.
Step 11: Expenses ($$$$ For us, capped at a total of $21,000 plus any lost wages capped at $14,000)
Now is the part where you cover the surrogates expenses incurred during the pregnancy. And so you should. The basis of this legal principle allowed in Canada is based on the fact that this person, who is carrying you child for purely altruistic purposes, should not incur any expenses as a result.
Expenses can literally include almost anything if it related to the pregnancy. The easy ones to think of are maternity clothing, mileage to and from appointments and check ups, pre-natal vitamins, and covering babysitting costs if necessary to get to appointments. The ones you probably wouldn’t think of are covering life insurance premiums (at a minimum coverage rate), any lost wages if the surrogate becomes ill and/or if they go on bed rest and/or during the delivery and recovery, house keepers to assist with house work if tired/ill, healthy food, gym memberships, massage, chiropractor, and pretty much anything else you could possibly imagine that could somehow be tied to pregnancy.
As you can imagine, this portion can get extremely expensive. Interestingly enough, the average for expenses for surrogates that are close with their intended parents versus those who are strangers are drastically different. And I imagine so… I don’t think my best friend is going to go on a crazy shopping spree with my credit card for thousands of dollars of maternity clothes. She will go and get what she needs, plus I’ll push her to get a little more. Same with a house keeper etc. This is the part of the legal contract that is actually helpful as it stipulates the maximums allowed that the surrogate can charge.
All receipts and payments to the surrogate needs to be kept and tracked. Our lawyer and others have noted that we will most certainly be audited when it comes to tax time, so keep track of everything. To date, no one has yet been charged under this specific law so the boundaries around what are considered ‘expenses’ has yet to be decided in court. We don’t really want to be the first case… so we are following the rules precisely.
Step 12: Legal… again. ($$$- Around $5,000 – $10,000)
At around 24 weeks gestation, you get in contact with your lawyer again. When it comes time to give birth, it is important that the Hospital know the information surrounding this agreement as well as who the biological parents are. The lawyer starts correspondence with the Hospital to ensure they are aware and on board with our arrangement. Additionally, we need to ensure that all medical decision making for the baby, once born, is at our discretion. Legally, the baby is still considered to be the surrogate’s- so we need to ensure that the Hospital is ok with the surrogate having the authority to make decisions about herself and the baby while it is inside of her, but once born, all medical directives for the child would come from us. Complicated. But important.
Step 13: Have the baby. (OHIP covers the costs of the birth the same as any other in Ontario)
Suddenly the birth process sounds so easy, doesn’t it?
Here is the part where you surrogate actually endures labour and gives birth to your child. Yep, as I mentioned before. She’s an angel or a super hero. Or both.
Step 14: Who’s baby is it? ($$- Legal fess cover off some of the above but you also need to pay for DNA testing etc)
Legally, until proven otherwise, it is the surrogate’s baby. We would initiate DNA testing of the child, the intended parents, and the surrogate to get confirmation of the biological origin of the child. This takes a little bit of time to send off and then receive the results. In the meantime, you cannot register the child’s birth as registering him/her in the intended parents names isn’t allowed, and registering him/her in the surrogates name would be false. And so you wait…
Step 15: DNA Results are in! Now off to court…!? (Covered in the legal expenses referenced above)
Once the DNA results come in, the lawyer now has to prepare what is called a Declaration of Parentage. This is a formal procedure in which the lawyer presents our situation to the judge along with the surrogacy contract and DNA results and petitions the court to put the intended parents (us!) names on the birth certificate. This normally happens in a closed door session in front of a judge.
The second step to this is a Declaration of Non-Parentage. This is sort of the opposite procedure. In Ontario, believe it or not, it is legal to have more than two persons names on the birth certificate. So adding our names would mean that it would now be listed as the surrogate plus us. We then have to provide the court with the above declaration to get the surrogates name off the birth certificate so there is no further legal link to the child.
Congratulations! You now have a baby AND the law recognizes that s/he is yours!
Now time to register the birth and celebrate.
Oh… and explain to the world that even though you didn’t have a baby bump, the baby is actually yours biologically.
Step 16: Have the Gov’t Screw you Again ($$$$- Cost of my top-up benefit and EI for ‘maternity’ portion of your leave from work.
Because I didn’t actually give birth to the child, I am only entitled to receive gov’t assistance (read: Employment Insurance) for the parental leave portion of the year (37 weeks). I can choose to take a full year off work, however, I do not receive anything for the ‘maternity’ (15 weeks) leave portion.
This has actually gone to the uppers courts previously as it was challenged that this is discriminating against those who are unable to bare children (cause it sure is… Haven’t we been through enough? Since I can’t bare children, and you already won’t pay for me to try to have them, you then won’t give me the same benefits as a birth mother. Nice). The court rules that the maternity portion is specifically for recovering from childbirth, it is the parental section is for raising the child.
To add insult to injury, my job allows for maternity/parental leave ‘top-up” to top up my salary to a percentage during my leave. However, the language reads that it will top-up the difference between my EI and my wages (to a percentage) … So if I don’t get EI, I don’t get top-up.
But hey, I’ve got the child of our dreams- so I guess I’ll focus on the bigger picture.