Third party reproduction, also known as donor-assisted reproduction, is an alternative reproduction technique using eggs, sperm, or embryos that have been donated by a third party to enable an infertile individual or couple to become parents. Additionally, these methods can be used in 2SLGB2QI+ family planning. Third party reproduction may also utilize gestational carriers allowing all family types to start a family where the woman is unable to carry a pregnancy.

For patients interested in third party reproduction, a medical appointment with your preferred physician will determine if third party reproduction is the best option for you. Supporting the well-being of all parties involved through counselling aimed at identifying physical, psychological, and legal risks that result from donation is advised. Patients wishing to proceed will meet with their fertility care provider to establish a treatment plan to best achieve a pregnancy.

In cases where infertility is caused by either the female, male, or both due to anatomical or genetic problems, or lack of function in the gamete production system, third party reproduction allows for intended parents to bear a child. An individual or couple may opt for reproductive medicine and options due to common causes of infertility including, but not limited to:

• Poor egg and/ or sperm quality

• Advanced maternal age

• Severe male factor infertility or medical conditions such as abnormal sperm parameters or other urologic conditions

• Low ovarian reserve

• IVF failure with own gametes

• Recurrent implantation failure and/or miscarriages

• Surgical removal of the ovaries

• Severe endometriosis

• Medical conditions that would make pregnancy a risk to the life of the carrier or fetus

• Personal reasons

There are different types of third party reproduction arrangements, that also allow for combinations between them. A few types of third party reproduction options include:

Egg Donation – This fertility treatment option is for individuals who, for various reasons, are unable to become pregnant using their eggs or do not have eggs of their own to use. An egg from a fertile woman is donated to an infertile woman using an assisted reproductive technology procedure such as IVF. The eggs from the donor are fertilized and the resulting embryos are transferred to the recipient’s uterus.

Sperm Donation – Sperm donation requires no hormonal treatment and is often used in intrauterine insemination (IUI) and in vitro fertilization (IVF), as well as in combination with donor eggs. Typically, sperm samples are quarantined, and it is recommended to have sperm donors with excellent seminal quality.

Embryo Donation – When the gamete production system is damaged in both the male and female, using both donor eggs and donor sperm, also referred to as double-donor IVF, or receiving donated embryos can be a solution for future pregnancy.

Surrogacy – A gestational carrier, commonly known as a surrogate, is a third party fertility option in which a woman other than the intended mother provides a host uterus. There are two types of surrogacies, traditional surrogacy where the surrogate contributes the eggs and gestational surrogacy where the carrier does not contribute to the genetic material in the creation of the embryo. The surrogate carries the pregnancy to term and delivers the baby to the intended parents.

Egg Donation – Patient’s seeking pregnancy through an egg donor must first undergo preliminary tests to assess the likelihood of successfully becoming pregnant through a donor egg. The egg donor must undergo hormonal ovarian stimulation treatment prior to extracting the eggs. On the other hand, the recipient of the donor egg will undergo hormonal treatment for endometrial preparation. Once the egg is developed into embryos, the preferred physician will determine how many embryos to transfer based on factors such as age, medical history, and the number & quality of embryos available. The embryo transfer procedure is typically quick and painless.

Sperm Donation – Patient’s seeking pregnancy through donor sperm must first undergo preliminary tests to assess the likelihood of successfully becoming pregnant through donor sperm. Once a sperm donor is designated, the sperm sample is appropriately reviewed and processed before artificial insemination.

Embryo Donation – Prior to the embryo transfer procedure, cycle monitoring occurs, and the donated embryo will be thawed. The embryo transfer procedure is a typically quick procedure with minimal pain and slight discomfort. After a successful embryo transfer, a pregnancy test will be administered.

Surrogacy – When using surrogacy, or gestational surrogacy, the first step is to identify a potential carrier. The surrogate will undergo a complete history and physical examination to ensure there are no reasons to avoid pregnancy. The intended parent(s) may also undergo screening if they are contributing eggs, sperm, and/ or embryos to decrease risks of infectious diseases and ensure optimal chances for a successful pregnancy. The intended parent(s) will go through cycle monitoring such as IVF and once an embryo is formed, the embryo will be transferred to the surrogate and a pregnancy test will be administered a few weeks later. This process involves important legal and clinical requirements.

Each patient and/or couple has a unique situation and fertility journey. The cost of third-party reproduction is mainly dependent on the type of treatment choice. The cost will also vary due to a variety of additional factors including geographic location, the physician’s and clinic’s experience/technique, and medical factors such as appointments, screenings, medications, and cycle monitoring/ IUI & IVF cycles (if applicable).

Third party reproduction involves several legal matters, particularly with surrogates and known donors. Third party reproduction can result in parentage and other legal issues, which can arise during pregnancy, antenatal care, in the birth registration process, or after delivery. Once all parties have agreed to proceed, legal counsel, preferably specializing in third party reproduction, will create a legal contract obtaining written consent before any procedure. Lawyers providing advice to the parties involved in third party reproduction should be well-versed in the complexities of the matter and inter-provincial differences, if applicable.