SURROGACY IN CANADA
Consultants aim to help the curious
Wanted: women willing to give their time and their bodies to help other women become mothers — for purely altruistic reasons.
Ottawa’s Liz Ellwood and Lisa Casselman have opened up a new fertility consultancy to help infertile couples find egg donors and surrogates. Fertility Match is one of fewer than 10 such agencies across Canada. And they all face increasing demands for egg donors and surrogates in a seller’s market.
Ellwood, 34, and Casselman, 41, have seen both sides of the surrogacy equation. Ellwood was diagnosed with cervical cancer at 24. Despite freezing eggs at the McGill Reproductive Centre in Montreal, they were not viable. She eventually decided to find an egg donor and a surrogate mother. She now has a five-year-old daughter.
Ellwood met Casselman while looking for a surrogate. Casselman was already carrying a baby for another couple, but the two remained friends. Casselman is the mother of eight — she already had three children and a stepchild and became a surrogate twice after that, carrying two sets of twins for separate couples.
“We’re looking to find some amazing people and guide them through this journey,” Ellwood says.
There are few statistics, but demand for donors and surrogates in Canada is much higher than supply. Between 2014 and 2015, the number of embryo transfers made to a surrogate increased by 23 per cent from 413 cycles to 533, according to the Canadian Fertility and Andrology Society.
Egg donation and surrogacy are legal in Canada, but donors and surrogates can’t charge for their services, although they can be compensated for their expenses, such as medical costs and pregnancy-related expenses, such as clothing, food and exercise classes.
Under the Assisted Human Reproduction Act, agencies can’t charge for matching would-be parents with egg donors and surrogates. Federal law prohibits paying a woman to be a surrogate, or advertising such a payment. It also prohibits paying someone “to arrange for the services of a surrogate mother” or accepting such a payment, or advertising of arranging these kinds of services.
It’s in stark contrast to the U.S., where egg donors and surrogates are paid, though those amounts vary widely.
Under the law in this country, Canadian donors and surrogates are helping infertile couples for altruistic reasons.
“No one really understands what ‘arranging’ services means, as it is not defined under the act,” says fertility lawyer Sherry Levitan. “Most of the agencies interpret it as matching surrogates with intended parents, but that isn’t my view.”
At the same time, Canada is becoming an increasingly attractive place for foreign couples seeking a surrogate.
Around the world, doors are closing on couples seeking thirdparty reproduction, including in Thailand, Vietnam, India and Mexico, Levitan says.
In India, for example, surrogates protested after the government announced it would ban foreign couples from hiring Indian surrogates. The Indian government had argued that hiring out wombs for rent was exploiting poor women. Last year, India drafted a law that would permit only infertile couples who have been married for at least five years to seek a surrogate, who must be a close relative.
For couples around the world, the U.S. and Canada are still options. In fact, Canada is a destination for would-be foreign parents. Overseas agencies point out to clients that the costs of prenatal care and the birth are covered under Canada’s health-care system. The exchange rate makes it even more attractive to couples in western Europe, Asia and the U.S., Levitan says.
It is widely expected that Health Canada will soon change the regulations in the Assisted Human Reproduction Act that deal with paying egg donors and surrogates. But as it stands, for most intended parents, the first step is usually word of mouth. “You never know whose neighbour’s cousin might want to be a surrogate,” Levitan says.
She believes that agencies are necessary to protect all of the parties. “A new intended parent working independently without an agency is vulnerable to experienced surrogates who may be trying to avoid some of the regulations and safeguards put into place by agencies,” she says.
“There is so much information and support that is required, and it is perfectly legal to charge for — and advertise — those services.”
Ellwood and Casselman say what they’re offering isn’t matching-for-money, but rather help in navigating a complicated system to find a donor or a surrogate who best meets the needs of every intended family. The agency screens both would-be parents and wouldbe donors and surrogates rigorously, Ellwood says.
“We want people to feel valued. We don’t want them to feel alone.”
Carolynn Dubé, executive director of Fertility Matters Canada, which promotes awareness and equal access to fertility treatments, says about one in six couples experience infertility. In about 30 per cent of the cases, it is attributed to the man, in 40 per cent of the cases it’s the woman, and 20 per cent it is a mixture of both. The reason is unclear in 10 per cent of cases.
“Some people will get IVF and move on and live happily every after. Some people will have uterine cancer at 20 and never be able to carry a baby,” Dubé says. “There are people who are interested in donating because they have a gift they can give someone else. It’s an incredible gift.”
The total cost of having a baby through surrogacy is between $60,000 and $100,000, depending on whether there is a need for an egg donation and fertility clinic costs, Ellwood says. Couples suffering from infertility are often mourning their own inability to have a child. Often, fertility treatments have failed. Would-be parents want to have complete trust in the person who will carry their child.
And there are a lot of ways for trust to fail, before and during the pregnancy and after the birth. In one case reported in 2013, a Spanish couple took their premature twins home, leaving the surrogate to pay a $58,000 hospital bill.
When Ellwood first started looking for an egg donor, she went to a U.S. agency.
The first potential donor got pregnant with her own child, there were problems with the second donor’s hormone levels, and there were questions about the blood tests of the third donor. Ellwood started looking in Canada. The first potential egg donor simply disappeared. She was successful with the fifth donor.
“People wouldn’t call us. You never knew what was happening. No matter what you did, it was out of your hands. It was awful,” she says. “We really lucked out with our surrogate. She really hung in there for us.”
Casselman had her own woes as a surrogate. She says she had to go to court to recover some of her expenses from one set of intended parents. She and Ellwood say now they thought there had to be a better way to do it, to make sure both sides of the agreement know exactly what they’re in for.
“We said, ‘We should start an agency to help both parties have a better experience,’ ” Ellwood said. “It’s a bit like a courtship. It’s an important decision.”
There are a number of issues that both sides have to agree on, Casselman says: how many embryos will be transferred; whether there will be a “selective reduction” if the surrogate is carrying multiple embryos. They have to agree on whether amniocentesis (prenatal testing that can determine abnormalities as well as the sex of the fetus) will be done, and whether they agree to terminate the pregnancy if the results indicate a chromosome abnormality such as Down syndrome.
The parties also have to agree on what kind of relationship the donor and surrogate will have with the family after the birth — whether to stay in contact, have no contact, or allow contact if there are crucial questions about the baby’s medical profile.
Casselman has wanted to be a surrogate since she was eight and her aunt’s premature baby died. The idea was reinforced when she was a teenager and learned about surrogacy. It’s best for a woman considering surrogacy to complete her own family first, she says. Her entire family gathered around the table before she made the final decision to be a surrogate. Her children always knew that the baby would not be coming to their house to stay.
“I just wanted a great story to tell. We want every couple, every surrogate, to say this was a great experience. It’s very important to do this the right way, and do it with love and caring.”
Levitan likes what she has heard from Ellwood and Casselman so far. “They are aiming at the highest standard,” she says. “Not every agency is that accessible and transparent. If they keep to those ideals, I will be delighted.”
We said, ‘We should start an agency to help both parties have a better experience.’ It’s a bit like a courtship. It’s an important decision.