National Post, April 26, 2008

In this second of a two-part series on the business of babies, A nine-month partnership looks at the prohibitive costs of surrogacy.

Alison Beder Solway suffered congestive heart failure in her eighth month of pregnancy and went into premature labour. Luckily, her daughter was born healthy. But then came the devastating news: A genetic heart condition prohibited her from carrying more children. Ms. Solway’s dreams of a big, happy family began to slip away. Ms. Solway and her husband, Kenny Solway, took desperate measures. The Toronto couple raided their nest egg and paid hundreds of thousands of dollars for surrogacy as an alternative method for having more genetic children.

“We’re still feeling the effects,” says Ms. Solway. Their costly venture resulted in three sons from a “carrier” in the United States, including a set of twins. Canadian couples with fertility or health issues who want their own genetic child have limited options. The 2004 Assisted Human Reproduction Act outlawed commercial surrogacy in Canada, prompted by concerns about “trade in the reproductive capabilities of women.” But while the Act clearly prohibits compensation to carriers, “who most commonly use a fertilized embryo from the prospective parents,” there have been no specific regulations forthcoming to outline how medical and other pregnancy-related expenses can be reimbursed. Couples can try to enlist a family member, friend or stranger to carry their baby for purely altruistic reasons. They can offer illicit compensation and cross their fingers that they don’t end up in jail or with a $500,000 fine. Or they can leave the country, usually going to the United States, and try their luck with an expensive commercial system.

That is what the Solways were eventually forced to do, but not before they spent between $75,000 and $150,000 on surrogacy-related fees and treatments in Canada. Over a three-year period, they underwent seven in-vitro fertilization (IVF) cycles and implantations with two surrogates, none of which resulted in a viable pregnancy. Their costs were only beginning. The financial burden for some families can be overwhelming. Couples rely on life savings, loans and donations from family and friends. Even when carriers are not compensated, there can be significant expenses related to IVF, pregnancy and delivery, particularly if there are complications. The law stipulates that direct medical expenses can be reimbursed, so if a doctor orders months of bed rest for a carrier with a complication, the prospective parents could wind up paying for lost wages.

Sherry Levitan is a Toronto lawyer who has been working on surrogacy-related files since 1996. She says before the 2004 Act, surrogacy was well run and self-regulated by the small number of professionals in the field. She says trying to work within the current legislation is like walking through a fog.

“I want to see some reality in the law,” Ms. Levitan says. “One of the [reimbursable expenses] is that if the surrogate needed to go to a doctor’s appointment, you could reimburse her mileage. So, what if she needs to go to a counsellor’s appointment or she needs to see her lawyer or she needs to buy organic food because that’s what the couple has asked her to eat? The categories and the examples they gave were so restrictive, it was as if it had been written by men who had never even been pregnant.” At Toronto’s IVF Canada, clinic manager Carole Craig says she sees five or six surrogacy cases each year. She also says some professionals refer to the 2004 Act as abusive for suggesting that someone should carry a pregnancy for absolutely nothing. “A maid gets paid for cleaning your oven. And this is a nine-month commitment that does have side effects and discomfort and a whole bunch of things that go with it.”

When the prospective parents’ embryo is implanted in the carrier, it may take several IVF cycles to accomplish a pregnancy — if accomplished at all. Each IVF cycle where a number of eggs (usually five to 10) are generated costs between $10,000 and $15,000, explains Dr. Daniel Reilly, an obstetrician-gynecologist. The eggs are fertilized and one or two of the embryos are implanted in the womb of the carrier. The remaining embryos are frozen and additional embryos can be implanted if the initial effort doesn’t work. The fertility medication required for each additional implantation generally costs $2,000 to $3,500.

But finding willing surrogates can be the tough. On the Web site IVF.ca, moderators sometimes find pleas from desperate couples, such as this recent post: “We are a Chinese couple looking for egg donation. We will provide considerable compensation.”

Dr. Kerry Bowman, a bioethicist with the University of Toronto and Mount Sinai Hospital, says underground arrangements can easily reach $50,000, including compensation for the carrier and payment for IVF. IVF.ca administrator Rick Bissonette says Canadians have little luck trying to find someone who will carry their baby for free. “There’s not a lot of people who are willing to take that risk for a stranger out of the goodness of their heart. So, that’s where a lot of people end up going down south.”

Surrogacy laws in the United States vary from state to state, though private services abound.Melissa Brisman, a lawyer in New Jersey, has built a practice out of facilitating carriers for intended parents. She says that of the 300 couples she sees every year, 20 to 30 are Canadian.

Ms. Brisman estimates that the total cost of having a baby carried in the United States is between US$65,000 and US$80,000, and the fees break down as follows: US$20,000 for the carrier, US$25,000 for the IVF cycle, US$10,000 in lawyer fees and US$10,000 to US$20,000 in miscellaneous costs, such as maternity clothes, child care, lawyer fees and medical expenses. If the carrier does not already have health insurance, Ms. Brisman recommends buying it for a total of 15 months to cover three months prior and three months post-pregnancy. That can add another $300 to $600 for each month of coverage.

In frustration, the Solways turned to Ms. Brisman in 2002. The first surrogate they were introduced to failed the psychological evaluation, and the second suffered muscle damage while delivering another couple’s twins. Ms. Brisman then introduced the Solways to Michele, who ultimately carried three sons for the couple– “a single birth followed by twins.”

IVF and implantation, sundry expenses for the carrier and travel expenses to meet Ms. Brisman, attend doctor’s appointments and then to pick up their sons cost US$100,000 to US$150,000 for each of the Solways’ pregnancies. “And the dollar wasn’t on par then,” reminds Ms. Beder Solway.

Despite the costs or the ethical objections, Dr. Bowman suspects that surrogacy is here to stay. “The commercialization of childbearing is quite offensive to some people. [But] infertility is a reality, and with surrogacy you can have a child who has a full genetic relationship to one and one’s partner at — if you can afford it — a fairly reasonable cost without risking the life or well-being of other people.”

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