The Commonality of Infertility and Why IVF Should be Funded

According to Resolve, the United States National Infertility Association, one in eight couples have trouble getting pregnant or sustaining a pregnancy (infertility = inability to get pregnant < 1 year).  The World Health Organization estimates global infertility rates at one in four, based on 2004 and 2012 data (infertility = inability to get pregnant <2 years). Within those couples, approximately one third of infertility issues are associated with the female partner, one third with the male partner, and one third remain ‘unexplained’. Derek and I were originally unexplained, but more and more evidence is pointing towards egg quality issues, with potential immunological issues on my part as well.


Because we are open with our infertility issues, others are often open with us as well. In my immediate family, I have one sister who is infertile due to teenage cancer treatments (early menopause), one fertile sister with two children, and a sister in law who has Poly-Cystic Ovarian Syndrome and is in the midst of fertility treatments with her husband. In addition, my mother and father took >2 years to become pregnant with my youngest sister (secondary infertility), and my mother in law had a still birth between my husband and sister in law. I have a handful of current and past coworkers with IF, and multiple friends and acquaintances from past and present who have reached out to share their stories. Infertility is all around me, and I’m sure it’s all around each of you reading this, though you likely don’t realize it.


An aspect of infertility that is gaining attention in the media recently is funding of infertility treatments. In November 2015, the Ontario provincial government announced that it would fund one cycle of IVF for qualified patients (note that funding is not fulsome, some costs are still paid by the patient). Conversely, Quebec’s publicly funded IVF program – paying for up to three IVF’s – was cut to one, and changed to a tax credit program (patients pay for the procedure up front and receive tax credits from the province). IVF is not funded by the public health care system elsewhere in Canada.


In 2013, the Government of Alberta commissioned a study through the University of Alberta’s School of Public Health to better understand the true costs of IVF. Currently, IVF is unregulated and unfunded in Alberta. Patients pay for IVF, and as a result, are driven to transfer multiple embryos – more bang for your tens of thousands of bucks. Multiple embryo transfers result in high rates of multiple pregnancies – the costs of which are borne by the public health care system. High risk prenatal care, preterm births and associated NICU hospital stays for the babies, and longer term health care associated with premie baby births result in $82 million dollars of societal costs over 18 years. Implementing a funded, but restricted, policy for IVF with single embryo transfers would save these costs, in addition to protecting the health and safety of mothers and children.


Infertility is common – more common than you think – and equitable access to infertility treatment not only reduces the long term burden on our health care system, but also provides more hope to your sister, brother, cousins, friends and coworkers in becoming parents themselves. Talk about it more to understand the issue better, and help us get the message out in support of funding for infertility treatments. It not only benefits us IFer's, but also you as the taxpayer.

And Then There Were None

Over the last week, I've gone through multiple scenarios regarding our two little embryos in my head, going through the what if's. What if one is genetically normal? We would be scared we only had one, but hopeful that it was the golden embryo leading to the last, greatest chapter in our story. What if we had two? Even better, with our plan to do a single embryo transfer we get two chances at success, a little bit of insurance.

But the scenario I avoided thinking about was what if we had none. It was hard to think about, hard to talk about. We avoided verbalizing it for fear of negative thinking, of course this was going to work! We are doing everything right this time!

But, unfortunately, the scenario we couldn't stand to think about during the wait is what ultimately happened. Both embryos are genetically abnormal. Abnormal to the point that a live birth, if it got that far, would result in severe mental retardation and physical deformities.

I suppose the silver lining is that we might have some sort of answer after all these years. We produce really crappy embryos. We suspect it's my eggs, and Dr. Hudson confirmed that during our call. We briefly discussed the option of doing multiple IVF's in the hope that we might end up with a normal embryo, but that is so far outside of what I am willing to put myself and us through I immediately rejected it.

Onward, I suppose, to whatever the next step will be and we know we have some options. I have to come to terms with the fact that I will never pass on my genetic material - I think I'm ok with that, but it's still really shitty. Regardless, we'll be taking some time to think and refocus, and explore this new world we've found ourselves in.

And Then There Were Two

After a couple of days of agony, we got the call from the lab this morning that we have two blastocysts, graded at a 17+ and an 18 (of 20), on ice. They were able to biopsy both and we should have the results in a week or so.


It will be interesting to see the entire lab report on all embryos to understand the day-by-day. Yesterday, on day five, I answered a call from the clinic and it was Dr. Hudson himself. I instantly felt a knot in my stomach certain that the news would be bad and all embryos had arrested. But we still had four, although the news wasn't exactly what I wanted to hear. As of yesterday, we had one hatching blast graded 17+ that was suitable for biopsy and vitrification (freezing), but only one other early blast graded at a 16, and two morulas. A morula is typically what is seen on day four, so they were a day behind. Not necessarily bad news, but not great either. The plan was to see what made it to blast and freeze with no biopsy - the concern was that they were of such low quality that attempting a biopsy would damage them to the point that they'd arrest.


Ending up with two, and having them graded higher than I expected, is great news!


The PGS results will tell the final story however. At my age, according to the research, we have about a 50/50 chance of a genetically normal embryo. Since we have two, we're looking at around a 66% chance of at least one genetically normal embryo. I am so thankful we made it this far - hopefully we have something to work with and we can move to the next stressful step in the process!

IVF #2 - Day Three Embryo Report and More

The day following the retrieval we decided to make our way back to Calgary early to give use some time to visit friends and family along the way. Long days of travel followed by evenings of visiting meant I had little time to provide an update. We arrived home last night and Derek's at work today, so I can sit down and write it all out.

After the retrieval, we ended up with seven mature eggs and three immature. We elected to use ICSI on all the mature eggs (we were originally going to do 50/50), and natural IVF on the immature ones to see what happens. The day after retrieval (day one), six of the seven mature eggs fertilized with ICSI had fertilized, and two of the three immature eggs matured overnight and fertilized with natural IVF. On day one we had eight! This was great news and a very good result.

Day two is the first day they can assign grades. VFC grades on a scale of 20, but really it's a scale of 15 - 20. A grade of 20 is perfect and very rare, where a 15 is very poor quality and generally is not transferred. On day two we had two grade 18's, three grade 17's, one 16 and one 15 - seven embryos still going, some better than others. The other piece however is that they were all 'fast cleaving' as most of them were six to seven cells. On day two they look for four cells; you'd think more is better, but growing too fast can lead to them using all their energy too early and petering out later on. It can also indicate chromosomal abnormalities. That said, some recent research has shown that fast cleaving embryos produce more robust blastocysts (day five embryos) if they make it to that stage.

By day three they look for six to nine cell embryos. Our day three embryos were a six cell grade 18, two grade 16+ embryos at five and eight cells, and a nine cell grade 15. We also had two grade 17's with six and seven cells, however they had not done much for about 24 hours so they may have arrested. The lab was going to let them keep going to see what happens.

Today, day four, is a critical day for embryo development and they don't disturb them. They "got a bath" yesterday (words of the lab director!) and went in the incubator, where they will stay until tomorrow. Our hope is that we have two or three blasts tomorrow to do PGD on. The more blasts we have the more likely we have at least one genetically normal embryo.


Keep those little embryos in your thoughts and will them to make it to day five!

IVF #2 - Retrieval Day

This'll be a fairly short update as there isn't a bunch to go over, and I'm still a bit loopy from the drugs and napping all day.


We arrived at the clinic at 7:30 this morning and were immediately shown to a room where we both changed in to more appropriate clothing - Derek in scrubs, me in a cotton nightgown. I climbed in to the bed and put the warm heating pad over my belly. Our nurse came in to go over a few things and provided me with Tylenol and Celebrex to keep my pain down all day, gravol for nausea, and Ativan to make sure I was relaxed going in. We waited for about 45 minutes for it all to take effect and during that time had a few visits from Dr. Hudson and the embryologist to go over the game plan. By 8:20, after emptying my bladder, we were lead to the retrieval room.


The nurse gave me a tiny bit of freezing in my wrist prior to inserting the IV. As the embryologist and Dr. H were getting prepped, she started loading me up with fentanyl and propofol. At this point things get really hazy and I don't remember much. I know Derek was in the room with us, and I did feel some minor pain. Dr. H had the nurse top me up with pain medication twice during the 10 minute procedure. Once done, I was carefully walked back to my recovery room for a nap. This is the point where Derek went and did his part, which I have no recollection of at all because I was still pretty drugged up.


We stayed in the recovery room for about an hour (according to Derek) where I napped on and off. I was finally able to wake up enough to get dressed and be escorted to the car. We stopped for a quick breakfast (no food prior to the procedure) and came back to the rental so I could nap some more - I was incredibly tired and still am 10 hours later! I crawled on to the couch and slept for about 2.5 or 3 hours, and laid around the rest of the afternoon.


In the end, we have ten eggs, seven of them mature. The embryologist is going to allow the three immature eggs develop overnight to see what happens. The seven mature eggs will have been ICSI'ed earlier this afternoon while the other three, if they mature, will be fertilized using natural IVF. We should get an update call from the embryologist some time tomorrow morning with how many survived the night.


The next five days are going to be very difficult - during our last IVF we started with 14 mature and ended with two that were transferred on day 3, two that made it to day five. My hope is that we have two or three for PGS testing, and at least one is normal. The wait continues....

Dum Spiro Spero V2

Dum Spiro Spero

While I breathe, I hope

I've been wearing this bracelet since I left Calgary and tend to fiddle with it during my appointments at the fertility clinic. I'll be wearing it tomorrow during the retrieval as well. It was a gift from a group of amazing ladies during our FET last year. I just wanted to acknowledge them for their ongoing support.

Today was a total down day. No injections, no early appointments, just a late sleep followed by a pedicure (so my feet look nice in the stirrups), lunch, and wandering around the city. I'm trying not to get my hopes up for tomorrow (and the days to follow while we wait to see what makes it to day five), but I can't help but want to compare to last time: 17 eggs, 14 mature.

So, let's have some fun and start guessing - how many eggs, how many mature do you think based on the following:

IVF #1: Long Lupron (Gonal-F and Luveris, started 150 IU and 75 IU respectively, increased to 375 IU Gonal-F by day 7)

Baseline E2: 72 pmol/L

Injection day 7: E2 501; seven follies right, four left

Injection day 10: E2 3879; eight follies right (lead at 16 mm), five left

Injection day 12: E2 6665; eleven follies right (lead at 19 mm), five left

Trigger day 13

ER day 15: 17 eggs, 14 mature

IVF #2: Femera/Antagonist (Gonal-F and Luveris, 450 IU and 150 IU steady)

Baseline E2: 24 pmol/L

Injection day 8: E2 890; eight follies right, five left

Injection day 10: E2 2024; seven+ follies right, three+ left (plus a few stragglers)

Injection day 11: E2 5388; seven+ strong follies right (lead at 21 mm), five+ left

Trigger day 11



IVF #2 - Trigger Day

After eleven days of stims, tonight is my last injection - the HCG trigger shot. The purpose of this injection is to essentially force me to ovulate and allow the eggs to be collected from the follicles. The trigger is very time specific and taken 35 hours prior to retrieval - I take it tonight at 9:30 pm.


At the ultrasound this morning we counted eight follicles over 17 mm with the lead at 21. There are also a couple of stragglers in the 14 - 16 mm range that will catch up by retrieval Wednesday morning. My estrogen continues to rise quickly (similar to last time) and was 5388 pmol/L (~1500 pg/mL) this morning. All good news!


In other good news, we received an email from Genesis Genetics this morning (this is where we are having our genetic testing done) and the cost is about half what we expected at $2,600 CAD. This covers up to eight embryos over a nine month timeframe. So, if something happens (i.e. we send our embryos and none are genetically normal), and we decide to try another IVF, we are covered in this respect cost-wise if we do another cycle right away. It's good to have that peace of mind.


Next stop, egg retrieval! I show up at the clinic Wednesday morning at 7:30 am with everything but my legs crossed.

IVF # 2 - Day Ten & we're almost there

This is an update from yesterday's ultrasound and blood work - for some reason the patient portal is not working for me so I had to get an update verbally during my appointment this morning.


Yesterday we had seven strong leaders on the right ovary, and three on the left, with the lead follicle at 17 mm. Estradiol was 2024 pmol/L (around 550 pg/mL in US units). For comparison, on day nine of IVF #1, we were at eight on the right, five on the left, with the lead follicle at 16 mm. My estradiol was at 3879 pmol/L.


I am on a Femara/Antagonist protocol, which suppresses estrogen in the early part of the stim cycle, so I'm not really surprised that my levels are slightly lower. The use of Femara (aka 'letrozole'), which is an aromatase inhibitor, acts to block the conversion of androgens to estrogens in the body. This results in less free estrogen in the blood stream. The benefit of Femara as part of the Antagonist protocol, and the subsequent reduction of estrogen, is that it makes my follicles more receptive to FSH, which is part of what makes the eggs grow. You can read a bit more here.


We went in for another ultrasound and blood work this morning with instructions to return again tomorrow. I will likely be stimming for one more night (tonight) and then trigger tomorrow night, for egg retrieval on Wednesday.


I think side effects are kicking in to high gear because I feel slightly nauseous all day, with a pretty serious aversion to coffee and espresso drinks of all things. Anyone who knows me knows this is serious! Luckily, it isn't so bad that I can't be out and about enjoying the beautiful weather all day, and we've had a lovely time touring Victoria with Derek's mom and aunt for the last four days.


Almost go time!

IVF #2 - Day Eight of Stims / First Ultrasound

This post is a day late because I spent most of the day yesterday in bed with food poisoning (thanks Salmon Wellington). Luckily, before it hit me too hard, we were able to make it to the clinic by 7:30 am for blood work and my first ultrasound. It looks like we're on track and things look similar to IVF number one, which resulted in 14 mature eggs. Here's my follicle report:

We are looking for follicles close to 17 mm for trigger. The more that are close to that number at trigger, the better. In some cases, they'll let me go an extra day or so, resulting in follicles upwards of 20 mm, to allow slightly smaller ones to catch up.


During our first IVF my right ovary looked much better than my left as well, however during retrieval they found a handful of hidden ones (my left ovary itself likes to hide). I'm hoping for the same result this time as well. Estradiol yesterday was 890 pmol/L, which is right where I need to be.


Next ultrasound and blood work is tomorrow morning.

IVF #2 - Day Four of Stims

I had forgotten how much nerve it takes to stab yourself in the abdomen with a needle. I started stims four days ago, and as I stood over the sink with my first of three daily injections, I almost started crying when I realized that I ACTUALLY had to put this needle in my stomach. Tears in my eyes, I looked at Derek sitting on the edge of the bathtub watching me, planted my feet, and jabbed it in. And it stung going in, but wasn't so horrible that it stopped me from preparing and taking shots two and three.

Now I've got my routine and I'm done in 20 minutes flat. 150 IU of Luveris (two 75 IU vials with multiple prep steps) and 450 IU Gonal-F. I'm also taking 7.5 mg Femera mid-morning (pills), and steroids in the evening (also pills). In a couple of days, I add a new injection mid-morning to prevent me from ovulating too early. I've added all of these reminders to my phone and check often to make sure I'm not missing anything. Good thing I'm organized by nature and enjoy routine!

When I was contemplating what I would write in this blog post as an update earlier today, I was reflecting on the fact that I've had very few symptoms so far. My abdomen is tender for sure, and I haven't been sleeping well (this is normal for me, so not sure if it's a symptom or not), but otherwise it's still early, so no major bloating. Then, this afternoon, I started getting irritable. And then, about an hour ago, I had a cry. For no reason. Yup, side effects are starting. Now the fun really starts!

This picture is worth $9,004.38

I picked up the last of my medication for our IVF this evening and had a sudden, shocking realization about how much this is going to cost us. It's one of those things people wonder, but never ask - how much does it cost? It depends on how much and what type of medication you need, how long you stim for, what your insurance covers, what types of intervention you need (i.e. genetic testing), and what your clinic fees are. In our case, my insurance covers zero IVF medications, but will cover things like antibiotics, steroids and even the letrozole (Femera). But the most costly medications, which in my case is Gonal-F, Luveris, and Cetrotide, are not covered. Luckily, we can coordinate benefits and hopefully upwards of 80% of the medications are covered by Derek's benefits and we will be reimbursed in a month or so.

In addition to this, the fee for our IVF with the Victoria Fertility Clinic is $9,500. This includes the egg retrieval and associated twilight medication/IVs, sperm collection, embryo culture, biopsy (for PGS - genetic testing of the embryos), vitrification of the embryos (freezing), our first year of cryostorage, and our first frozen embryo transfer. This does not include the PGS itself, which will be an additional $2,000 to $3,500 and is performed by a lab in the U.S. All ultrasounds and lab work is covered under our provincial health care, so no out of pocket costs. We also have travel costs to Victoria, as well as accommodations and food.

Known costs for this IVF: $20,500 -  $22,000 (not including travel and accommodations).

Pro Tip: All medical costs not covered under provincial health care or insurance in excess of around 3% of your total income can be claimed on your income taxes. In general, you should receive around 25 - 30% of your claimed expenses back.

It's a very, very expensive process, and we are lucky we can afford it as many can not. Regardless of the ability to pay, it's still a punch in the gut when you add it all up. Hopefully, in the end, it's all worth it.

Here we go again

Last Thursday we had our scheduled consult with Dr. Hudson with the Victoria Fertility Clinic. Originally, our plan was to cycle in October or November, in part so we could enjoy the summer, and I also had a few cycling goals, which I met (yay, upgrade!). During the call with Dr. H, he asked where I was in my cycle. I was expecting my period over the weekend and said as much, and also mentioned that my cycles were becoming irregular after two decades of almost textbook cycles. Based on that, as well as some of my blood work results, he thinks I might be treading in to diminished ovarian reserve and poor egg quality territory. Then he said 'You know, based on your medical history and what's going on with your cycles, you could and probably should start right away.' A little bit terrifying, but we're ready, so here we go.

Today is cycle day four, and I'm downregulating until the end of August. On September 1st, I start injections. I will be starting with a high dose of Gonal-F and Luveris, which I used for our first IVF. The difference this time is that I'm starting at a high dose, whereas during the first IVF we started low and ramped it up quickly due to poor response. I ended up stimming for longer than normal, which may have overcooked my eggs and resulted in poorer egg quality. This time we're starting with the big guns.

Interestingly, I will be taking Femera at the same time. Femera is also used for hyperovulation, but usually on it's own, and usually for timed intercourse or IUI. From the limited research I've read so far, this should do what I'm referring to as 'slow cooking' my eggs in a way that slightly counteracts the high dose of Gonal-F. This will hopefully result in many high quality, mature eggs.

Starting on September 6th I add Centrotide to stop my body from ovulating and keep things cooking. We head to Victoria to finish things off on September 7th with estimated egg retrieval somewhere between September 12th and 15th. Using a combination of natural fertilization and ICSI (where they take a single sperm and inject it in to the egg - see image below), they will culture the embryos until day five. Each embryo will be biopsied before being frozen and the biopsy cells will go to the U.S. for Pre-Genetic Screening (PGS). This will be done to determine which embryos are genetically normal and ready for transfer, which will take place, if everything works out, sometime before Christmas.

Fingers crossed it all goes smoothly - here we go again!

Hope and Fear

Our seven year wedding anniversary was earlier this week (July 18). Derek took a long time to get around to proposing, so we have been together for more then double that, 15 years. The first time I got pregnant (that I knew of) was in 2007, right around the time Derek started with the fire department. Up until that time, we had never used any type of contraceptive, and I'm honestly not sure why I didn't think my not getting pregnant wasn't a big deal - maybe my mind just wasn't there yet. The day I found out I was pregnant I was bleeding heavily with what a thought was a really long, really bad period. At some point I figured I should probably take a pregnancy test, which I did, mid-day and at work, and it was blaringly positive. I left work and went to the hospital, had the requisite blood work and ultrasound done, and found that I was in the midst of my first documented miscarriage.


It was shortly after that loss that I began to track my cycles, and we agreed that maybe we should just go ahead and start trying to conceive. At our wedding in 2009, I remember thinking to myself that it would be just perfect if I became pregnant right around the same time, but a week after our wedding I got my period. Finally, in 2010, we started TTC in earnest, including working with the fertility clinic.


Despite the time that has gone by, and the losses we've endured, I still, sometimes, hold out hope each month. But when I think of what might happen past that positive pregnancy test, it's a fuzzy, scary black hole. I think it's inherent for us IF survivors, whether we do finally carry to term or not, to be fearful. The joy has been taken away and it makes me sad. I will never get to 'surprise' Derek with a positive test in a cute little gift box, blissfully unaware of what could happen a few weeks down the road. I will never go for just one pee-on-a-stick pregnancy confirmation test at the doctor's office, nor get a single blood test to confirm. I will never go for that first ultrasound full of joy, I will only be full of worry that there will be no heartbeat, that there is nothing there. The first 25+ weeks will be full of fear that I will lose the baby before viability, and then the months leading up to the birth will be full of the same fears plus the fear of birth complications. It won't stop there - I will be a helicopter mom, so worried that our precious prize from our hard fought battle will be hurt, injured, might die in childhood.


As we approach our last IVF, with my renewed hope that this new protocol might be what we need to stay pregnant, I think of these sorts of things and wonder if we can handle it. It's hard to rationalize these conflicting feelings - hope and fear - and I can only hope that the feelings of joy and love can overcome it all.

Reflecting and Regrets

There will always be those songs that trigger strong feelings. For me, when it comes to our journey, it's Lindsey Stirling's Crystallize:

This is because we used this song as part of a video we made a number of years ago when we entered a contest to win an IVF in the US. We didn't win, but the emotional process of making the video and the loving and overwhelming response we had from family and friends will stick with me forever. I have this song on my playlist, and every time it plays (like right now as I'm writing this post) I retreat in to a reflective mood, thinking about where we've been and where we're going.

So where are we going? Well, we've decided to give it one more shot. A couple of months ago I started reflecting (yeah, I do this a lot) on how I really felt about pursuing a gestational surrogate. Derek and I have this philosophy that we try to live with as few regrets as possible, so when making decisions, especially big life decisions, we think about the potential for regret. And I came to the conclusion that I would regret not giving it one more try on our own, especially considering the protocol I'd be following.

I had a call with Dr. Hudson yesterday and we're getting everything in place for a fall cycle. We're targeting an October retrieval, with PGD (genetic testing) on the embryos, then transfer in December or January.

So here we go, one last try, no regrets.

Infertility can make or break your relationship

I originally posted this in a Reddit infertility subforum and had a good response, so wanted to share with some tweaks for this audience.

We have been TTC since early 2007, which means we are just about to start year nine. That is a very long time, almost a quarter of my life by the numbers. Over the years, and especially recently, I reflect on our journey and where it's taken us. This is one part of it that I wanted to share.

This journey has been HARD on our marriage. We have had screaming, throwing things, slamming doors fights about infertility and what our next steps should be. Over the past eight+ years, we have very rarely been on the exact same page about the path forward. Early on when I was pushing for multiple IVF cycles in a row because I was panicking about getting older and was desperate to have a baby, he wanted me to take time to let my body recover. It drove me crazy and I was very angry at him.

About a year ago I finally passed that point where I truly am ok with being child free and it's time to move on (and have posted as much in this blog), but he is adamant that he wants to give it one more go for a biological child with a gestational surrogate - still not on the exact same page.

But through all this struggle, we have remembered (sometimes with the help of the therapist we have been with for as long as we've been on this journey) that it starts with the two of us, and celebrating the highs, working together through the lows, and learning how to compromise, has made us immeasurably strong together. Ultimately, I am happy with my husband, I feel lucky to have him in my life, and if it ends up being just the two of us, that's all I need.

Over the years I have observed many IF couples go through marriage break downs and divorces. It happens in staggering numbers. While in some cases there could have been systemic issues in the marriage that would have resulted in the same outcome regardless, I've often wondered if it was in part because they were so focused on the goal of having a child that they forgot to focus on each other.

For all those who are still in the midst of this, remember to take care of each other through this journey - you're in this together.

Gestational Surrogacy

In one of my last posts, we had outlined an ambiguous long term plan involving multiple IVF's, genetic screening of the embryos, FET's and immune system suppression protocols in the hopes that I would be successful in carrying a baby to term. After some very long and heart wrenching discussions, we landed on pursuing the use of a gestational surrogate - a surrogate would (hopefully) eliminate the unknown that is my body, and the genetic screening and use of 'normal' embryos would at least give some sense of security in that respect. We are not totally eliminating my carrying a pregnancy myself, but it's no longer our focus.

We started our search last December and I slowly entered the new world of Canadian surrogacy via Facebook groups and websites offering matching services. What we've come to discover is that this is not going to be easy. There are limited surrogates publicly offering their services in Canada via matching services or informal online groups, and while surrogacy in our country is legally 'altruistic' (you pay for actual losses, but nothing more), fee-for-service money certainly changes hands in many cases. This brings ethics in to the equation. Is it ok to skirt the law in order to secure a surrogate who expects payment for the 'service' she is providing, and is that changing the ethical implications of surrogates in Canada? If most surrogates now expect payment, and you can afford to pay it, do you still wait until you find a legal surrogate, or do you skip the line?

For now, we are sticking to our sense of ethics and the law in Canada and continuing to search for a surrogate that meets our needs and is aligned with the ethical intent of surrogacy in Canada.

I would like to highlight here that I have had multiple offers of surrogacy in the past and declined because we were not ready to pursue it. I also know that I will have friends and family that read this that may be interested in being our gestational surrogate, so to minimize the risk of uncomfortable conversations, here is a list of non-negotiables (for now):

• Must be healthy - this means healthy weight, non-smoker, no heavy drinking, no drugs (including prescription medication)
• Located in Alberta or British Columbia (preferably near Vancouver or Victoria)
• At least one successful, uncomplicated pregnancy and birth
• If there is a spouse/partner, they must be fully on board
• Available for gestational surrogacy late 2016 and in to 2017

I'd also remind you to read my previous guest post on what surrogacy means for the surrogate: Guest Post: What it means to offer to be a surrogate