Who needs a surrogate?

When a couple is infertile, they naturally try to figure out the problem on their own. "Is it my uterus?" "Are my tubes blocked?" "Is it my eggs?" "Is it his sperm?" It seems that a fair number of women assume that their uterus is the problem and that finding a surrogate will cure their infertility. In fact, the uterus is quite uncommonly the problem. Just this past week, I had a women who is infertile because of low egg count/quality tell me she has found a surrogate willing to help her conceive. It's quite generous that someone has agreed to be a surrogate, but she does not need a surrogate, she needs help with her eggs and using a surrogate will not help her at all.

So who does need a surrogate? In Canada, surrogacy is done for medical reasons, not social reasons. This means our guidelines do not allow surrogacy just because a woman does not want to be pregnant herself; there needs to be a medical reason. These reasons can include an absent uterus (from birth or a previous hysterectomy), scarred or otherwise damaged uterus, abnormally-shaped uterus, severe fibroid disease, a medical condition that makes pregnancy risky to a woman's life, or a same-sex male couple. It is also done, in some cases, for women who have recurrent implantation failure in IVF or who have recurrent miscarriages.

Off the top of my head, the patients who I've helped have children through surrogacy in the last few years have included women with:

  • previous heart transplant
  • previous kidney transplant
  • severe lung disease
  • severe kidney disease
  • without a uterus (called Mullerian agenesis)
  • severe scarring from previous D&C's
  • recurrent miscarriages
  • severe psychological trauma from a previous pregnancy
  • cervical incompetence (so their uterus cannot hold onto a pregnancy)
  • absent cervix from previous cancer
  • so many fibroids that normal uterine cavity is not seen
  • unicornuate uterus

The list goes on. A real challenge for women needing surrogacy is finding a surrogate. Since surrogates in Canada cannot be paid beyond "reasonable expenses," surrogates really need to be acting out of the goodness of their hearts (aka altruistically). In contrast, countries such as the USA and India permit surrogates to be paid outright. This makes finding surrogates easier but it can get more complicated when surrogacy becomes commercialized. Surrogacy in the USA costs between $40,000 and $100,000 and in India $10,000 to $20,000. In Canada it costs around $20,000 (including legal) plus "reasonable expenses" to the surrogate.

I should mention that the word "surrogate" is used here and throughout the web, but technically I should be saying "gestational carrier" instead. There are two types of surrogates: (1) gestational carrier - someone who carries a baby not genetically related to her and (2) true surrogate - someone who carries a baby that was conceived with her egg so she is related to the baby. Gestational carrier surrogacy is, by far, the most common form of surrogacy.

Ask your doctor if you need a surrogate - it's worth a conversation.