According to Statistics Canada, roughly one in six couples in Canada experience infertility, but that doesn’t mean that they will never be parents. If you have experienced two failed rounds of in vitro fertilization (IVF) or intrauterine insemination (IUI), Ari Baratz, a fertility specialist at the Create Fertility Centre in Toronto, recommends seeking a second opinion. “Patients need to make sure that the lab and clinic are accredited and that the protocols and environment during IVF are appropriate to ensure that the IVF performance is up to its full potential,” says Baratz.
There are additional lab techniques that can be used to assess embryos at a higher level before they are transferred. While there is no formal limit to the number of times a patient can attempt IVF, if a patient hasn’t been able to generate an embryo after three rounds of IVF, they are generally discouraged from trying again with their own eggs and sperm. “That would be a sign that they should stop doing IVF and move on to other options, such as donor gametes,” says Baratz. Here are options to consider when IVF doesn't work.
Donor gametes Using donor gametes (egg or sperm) still involves IVF and is a great option for couples in which one partner is struggling with infertility, as well as for single parents and LGBTQ couples. Egg and sperm donation are both legal in Canada. It is, however, illegal to purchase ova or sperm from a donor or from a person acting on the donor’s behalf.
Intended parents (IPs) who are using donor gametes from a sister, cousin or friend would go through a fertility clinic and get legal advice from a fertility lawyer. You can’t buy gametes through a clinic. Anonymous donor gametes, however, can be assessed through both Canadian and non-Canadian agencies that assist in matching IPs with donors, and certain Canadian fertility clinics now offer the use of imported frozen ova.
Canada only has three sperm banks, but there are agencies outside of Canada that can assist with finding donor eggs and sperm. Gametes coming in from the U.S. are delivered directly to fertility clinic labs. According to Kelly D. Jordan, a fertility and family lawyer based in Toronto, many Canadians turn to U.S. agencies for gamete donation. “It’s unclear how far the law in Canada goes in prohibiting payments for egg and sperm donors from the U.S.,” says Jordan. “There have been no cases where the RCMP has charged anyone, because it’s perfectly legal in the U.S.”
Although only a few Canadian clinics offer embryo donation, it is another option for patients. Select fertility clinics in Canada facilitate connecting patients if there is a patient who is looking to donate her embryos. There is also an open embryo donation program in Ontario called Beginnings Family Services that provides counselling services, recipient reports and screenings similar to those in adoption.
Before embarking on using donor gametes, it’s important that patients consult with doctors and obtain independent legal advice to understand the laws in the Assisted Human Reproduction Act.
Gestational carriers and surrogacy There are two different kinds of surrogacy: gestational surrogacy and traditional surrogacy. A traditional surrogate allows herself to be inseminated with the intended father’s sperm. She is the genetic mother but has the intention of giving up the baby after delivery. In gestational surrogacy, an embryo made from egg and sperm from the IPs or from donor gametes is transferred to the uterus of the carrier.
The reasons why couples would use a gestational carrier vary. It’s an option for women when IVF doesn't work, who have undergone cancer treatment, were born without a uterus or have had it removed or have specific cases of diabetes or a heart condition, as well as LGBTQ couples and single parents. Women who are on certain medications that would prevent them from being able to carry a baby themselves may also opt for gestational surrogacy.
Surrogacy is legal in Canada, as long as the gestational carrier isn’t paid for her service. Under the Assisted Human Reproduction Act, a gestational carrier can only be reimbursed for out-of-pocket expenses that can include maternity clothes, vitamins, legal fees, medications, lost wages, mileage (for appointments), a partial amount of groceries (such as organic food) and childcare. Like egg donation, gestational carriers and surrogates are often people that the IPs know, such as a sister, cousin or friend, but there are agencies in Canada that facilitate the connection of IPs and surrogates, such as Surrogacy in Canada Online (SCO).
“Surrogacy is recommended by doctors, so IPs need to be at a point where surrogacy is warranted and they’ve exhausted all options or it’s the only option,” says Sally Rhoads-Heinrich, owner of Surrogacy in Canada Online. After the IPs have been referred by a fertility clinic, both male and female parties are assessed to see if they’re medically fit. Legal framework and counselling must also be put in place. Then, after the IPs are matched with a gestational surrogate, they’ll meet with a fertility lawyer a second time to write up the contracts. The contract will outline details such as what expenses will be paid, what medical steps will be taken, the birth order that states who the parents of the child are and what the surrogate’s medical obligations are. The contract varies from parent to parent, but it will always outline “everything governing the pregnancy process and the post-birth process,” says Jordan.
“You really want to ensure that all of the potential non-medical issues are evaluated,” says Baratz. “Remember that the fertility treatment happens today, but if there is a pregnancy that’s developed within a family, there may be issues five, 10 or 15 years down the road in terms of connecting with the offspring and disclosure to the offspring.”
As Rhoads-Heinrich says, surrogacy is like online dating: You’re going to want to build a meaningful relationship that’s built on trust.
Adoption Couples who are looking to start a family can also consider adoption when IVF doesn't work. Many individuals choose this route first, and it’s important to note that adoption should not be seen as a solution to infertility.
In Canada, there are five types of adoption: adopting within the welfare system (public), adopting through an agency (private), adopting a child from another country (international), adopting a stepchild and adopting a birth relative (kinship adoption). You can consult a lawyer to discuss which type of adoption is best for your family, but most of the process will happen between the IPs and the adoption licensee.
“Parents should consider that there is uncertainty in the process and need to be prepared for what the legal process looks like and the length of time it might take,” says Jordan.
The rules of adoption are different for every province in Canada, but no matter where you live, parents have to complete a home study done by a social worker. The adoption process can range from nine months to nine years, depending on the type of adoption you’re doing and the province you live in. According to the Adoption Council of Canada, the cost of adoption ranges anywhere from $0 (public adoption) to $30,000 (foreign adoption).