Hidden from view: Canadian gestational surrogacy practices and outcomes, 2001-2012

Abstract

This paper raises some troubling questions about the fertility treatments provided to Canadian gestational surrogates, women not genetically related to the child that they carry. Using information published between 2003 and 2012 by Canada's Assisted Reproduction Registry, the paper traces the growing incidence of births to gestational surrogates. The transfer of more than one embryo increases the chance of pregnancy and the incidence of multiple births, and while the incidence of multiple births has declined overall since 2010, gestational surrogates consistently experience a higher proportion of multiple births and experienced higher levels of multiple embryo transfers. In 2012, just 26% of gestational surrogates received a single embryo transfer compared to 47% of other in vitro fertilisation (IVF) patients. The paper suggests that renewed attention needs to be paid to the counselling provided to gestational surrogates and treatment consenting mechanisms used by IVF clinics and that review of the 2007 Canadian Medical Association surrogate treatment guidelines is warranted. Finally, the paper describes the difficulties in obtaining accurate data about Canadian assisted reproductive medicine. Without good data, it becomes far more difficult to identify the possibility of potentially harmful practices.

“One for Sorrow, Two for Joy?”: American embryo transfer guideline recommendations, practices, and outcomes for gestational surrogate patients

“…For a subset of IVF patients-gestational surrogates-multiple birth rates remain stubbornly higher [10][11][12].…”

“…It advises that most IVF programs will limit the number of embryos transferred to two when the ova donor is aged 21 to 34. The booklet does not mention that the practice of transferring two embryos runs counter to ASRM-SART guidelines which recommend that one embryo be transferred when the ova donor is younger than 35 [72]: the predominate situation for gestational surrogates [11,12].…”

“…It seeks to fill an important gap in existing health policy literature, as few studies have examined the incidence of and implications for surrogates giving birth to more than one baby at a time [9][10][11][12]. It might be assumed that this problem has been addressed by embryo transfer guidelines issued jointly by the Society for Assisted Reproductive Technology (SART) and the American Society for Reproductive Medicine (ASRM).…”

Does body mass index impact assisted reproductive technology treatment outcomes in gestational carriers

“…Gestational carriers (GCs) are generally healthy women with proven fertility and a good obstetric history, who choose to carry a baby not genetically related to them for intended parent(s) [1]. Third-party reproduction is on the rise; in Canada, between 2001 and 2012, the number of births to GCs has increased six fold, and the proportion of ART births that involved a GC during the same years, doubled from 0.9 to 1.7% [2]. In the US, 2.4% of all IVF cycles performed between 2010 and 2014 involved GCs, resulting in 10,009 infants born [3].…”

Analysis of gestational surrogates’ birthing experiences and relationships with intended parents during pregnancy and post‐birth

“…Thus, it is not known if Canadian surrogates’ experiences are comparable to surrogates from other countries. The underrepresentation of Canadian surrogacy data in the existing research literature is disconcerting since many IVF cycles involving surrogacy have already been carried out in Canada, yet limited empirical data are available to inform clinical practice for Canadian surrogate and intended parent care.…”