What is third-party reproduction?

Third-party reproduction, or conception, refers to the use of donor sperm, donor eggs, donor embryos or gestational carriers to help an individual or couple become parents. The donors may be known or anonymous. Before proceeding, patients should be fully aware of the social, psychological, legal and ethical issues associated with such options. Implications counselling with a licensed counsellor is mandatory. All participants in this process require infectious disease screening; in many cases, legal counsel is also required.

Third Party

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When to consider third-party reproduction

There are a number of circumstances when patients may consider third-party reproduction, which include but are not limited to the following:

  • Same-sex couples
  • Single parents by choice
  • Individuals who are unable to produce sperm
  • Individuals who have had damage to ovaries or may have had their ovaries removed
  • Individuals who are unable to carry a pregnancy

What are the steps involved?

For patients interested in third-party reproduction, we suggest they begin by consulting with their primary care provider and ask for a referral to Mount Sinai Fertility. The initial phase of a  third-party reproduction process typically follows the following 3 steps:

Preliminary Testing

All patients and partners (if applicable) will undergo baseline testing prior to starting a treatment to determine the best fertility care plan.

Implications Counselling

All patients and partners (if applicable) who are considering third-party reproduction must meet with a counsellor. Counselling involves balancing medical issues with the possible psychological effects. Counselling may help people consider the potential implications that might arise through third party assisted reproduction.

Establishing a Treatment Plan

After baseline testing has been completed, the patient and their fertility care team will meet to discuss the best plan to achieve a pregnancy. Click below to learn more about each type of third-party reproduction treatment option offered at Mount Sinai Fertility.

Donor Sperm

Some patients may require donor sperm in order to achieve a pregnancy. Mount Sinai Fertility accepts donor sperm from select national certified sperm banks where donors are appropriately screened and the sperm is quarantined. Donor sperm can be used for both intrauterine insemination (IUI) and in vitro fertilization (IVF), as well as in combination with donor eggs.

When to consider donor sperm

Donor sperm is commonly required for patients who

  • are single by choice
  • biologically do not produce sperm
  • have severe male factor infertility (includes patients who do not identify as male but who have conditions such as abnormal sperm parameters or other urologic conditions)

What are the steps involved?

Our first step is to perform preliminary testing to assess the likelihood of successfully becoming pregnant through donor sperm. If you have made the decision to move forward with a sperm donor to achieve their reproductive goals, donor recipients meet with a counsellor in order to do implications counselling. You will select a known or anonymous sperm donor.

Known Sperm Donor

If the patient has a known or designated donor (such as a friend or family member), certain requirements are mandatory before the donated sperm can be used, in accordance with Health Canada and the Processing and Distribution of Semen for Assisted Conception Regulations. These requirements include an infertility work-up, as well as a 6-month quarantine of the sperm to screen for infectious diseases. Mount Sinai Fertility also requires a counselling session for all individuals undertaking third-party reproduction, and independent legal advice for the donor and donor recipient(s). Known sperm donation is done in partnership with a local sperm bank.

Unknown Sperm Donor

Unknown sperm donors are selected and screened according to each sperm bank’s quality assurance, operational procedures and policies. This process includes a medical questionnaire, interview, and blood and urine testing; plus screening for infectious diseases, medical problems, psychological issues, and diseases that can run in families (e.g. genetic disorders). Sperm banks provide information on the sperm donor's race, height, weight, personal history, academic performance, and many other demographic details.

At present, MSF currently uses only two sperm banks (Repromed and CanAm) Both are Canadian compliant.

Repromed link https://www.repromed.ca/
CanAm Link https://www.canamcryo.com/en

When choosing a donor you many also wan tot consider whether you would prefer a donor who has chosen to remain closed or open to identity release.

  • Closed: information will not be released to the offspring in the future
  • Identity release: information can be released to the offspring in the future

Things to take into consideration when ordering sperm

How many straws/vials are needed?

We recommend the following:

For IUI: 1 straw/vial is sufficient for 1 cycle, but you may require more than 1 cycle to conceive. To minimize ordering, patients are asked to consider ordering 3 units at once. Storage fees apply for any stored units.

For IVF with or without ICSI (intracytoplasmic sperm injection): 1 straw/vial is sufficient.

 

If pregnancy results from IUI or IVF, you may choose to purchase more units from your selected donor to ensure there is a possibility for siblings with the same genetics. Storage fees apply for any stored units.

Wash or unwashed sperm

We recommend you purchase an unwashed sample (if available) because this is the most economical option given that our andrology lab will wash the sample regardless prior to use in the clinic. Please note that samples that have been washed more than once may result in sperm with lower motility (the ability of the sperm to move well).

Delivery of sample to the clinic

After the donor is selected and/or the quarantine period for a known donor has passed, the cryobank sends the frozen sperm sample(s) directly to Mount Sinai Fertility, and we will thaw the sperm and analyze it in our andrology lab. Donor sperm samples must arrive at the clinic at least 2 weeks before your cycle begins. This time is needed to ensure the samples are appropriately reviewed and processed before your treatment.

Any additional vials will be stored at Mount Sinai Fertility until we instructed to dispose of them. We are happy to offer a 6-month grace period for donor sperm storage fees. If there are any vials in storage after 6 months, the patient will be billed for 1 year of storage ($480). If the remaining vials are used before the end of the year, the patient will be refunded the cost of the unused months.

CMV status

Cytomegalovirus (CMV) is a common virus that can be transmitted to a developing fetus. For this reason, patients who are CMV negative should consider choosing sperm from a CMV negative donor.

Donor Egg

Egg donation is a fertility treatment option for people who, for various reasons, are unable to become pregnant using their own eggs or do not have eggs of their own to use. The use of donor eggs has become much more common, particularly in those over 40 years of age. The use of donor eggs gives many people the ability to carry and deliver a child, or have a child when they otherwise would have been unable to do so.

When to consider donor egg

A common cause of infertility is low egg count or quality. Patients might consider utilizing donor eggs in the following cases:

  • Have a low egg number (also known as a low ovarian reserve)
  • Have had cancer treatment that has damaged the ovaries
  • Have premature ovarian insufficiency
  • Have severe endometriosis
  • Biologically require donor eggs
  • Are over the age of 43

 

When selecting an egg donor, patients can choose to use a known egg donor or get eggs through an egg bank (anonymous egg donor). Before proceeding with egg donation, The donor recipient(s) will meet with a counsellor for implications counselling.

What are the steps involved?

Our first step is to perform preliminary testing to assess the likelihood of successfully becoming pregnant through donor egg. If you have made the decision to move forward with a egg donor to achieve their reproductive goals, the donor recipient(s) will meet with a counsellor for implications counselling.

Known Egg Donor

Currently Mount Sinai Fertility is not offering treatments involving a known egg donor.

Anonymous Egg Donor

Anonymous frozen donor eggs can be imported to Mount Sinai Fertility from a donor egg bank. We work exclusively with Donor Egg Bank USA one of the world’s largest and most respected egg donor banks.

To find the best match, egg banks provide information on the egg donor’s race, height, weight, personal history, academic performance, and many other demographic details. The donor recipient(s) can also request to see photos of the donor and read an essay they have written about themselves.

For more information please visit Donor Egg Bank with a link to https://donoreggbankusa.com/

Embryo Transfer

If you will be using frozen eggs, the eggs will be thawed and fertilized with sperm using intracytoplasmic sperm injection (ICSI). The fertilized eggs will be placed in an incubator to develop into embryos. Embryos will be transferred on either Day 3 of Day 5, your doctor will discuss with you the best option.

Prior to the patient’s cycle, the patient and their Mount Sinai Fertility doctor will have decided how many embryos to transfer at a time. This decision is based on a number of factors, including age, medical history, government regulations, and the number and quality of embryos. It is possible to create more embryos than are required for transfer; any embryos that develop to a certain stage can be frozen for long periods of time without reducing their ability to implant later on.

During the embryo transfer, we will insert a speculum so we can see the patient’s cervix and use an ultrasound placed on the abdomen to see the uterus. Next, we will place a thin catheter through the cervix into the uterus and the embryo(s) will be placed into the patient’s uterus using an even thinner catheter that fits through the first. The entire procedure takes about 15 minutes, is not painful and does not require pain medication.

To learn about the Frozen Embryo Transfer procedure, please click here.

What is a gestational carrier?

The journey a gestational carrier (GC) undertakes is both exciting and rewarding. This person has agreed to carry a baby through pregnancy for someone else. Also known as a gestational surrogate, the GC provides a host uterus but does not contribute any genetic material (eggs) towards the creation of the embryo. The embryo is created from eggs from one of the intended parents or an egg donor, and fertilized with sperm from one of the intended parents or a sperm donor. Understandably, the GC process involves important legal and clinical requirements.

 

The ideal GC is a healthy person between the ages of 21 and 42 who has had already experienced a successful full-term pregnancy. They will also ideally have a supportive family and/or social network to help them cope with the added potential stress of pregnancy. The carrier should have had no more than 5 previous vaginal deliveries or 2 previous cesarean deliveries. Prior to becoming pregnant, the GC should consult with their healthcare provider about any potential risks. Currently, Mount Sinai Fertility is only offering treatments involving a gestational carrier when embryos have already created for use by a gestational carrier.

 

Using a GC is an option when the intended parent(s) wish to have a child but are unable to do so because of:

  • Not having a uterus
  • Having a uterus that is abnormally shaped, has a thin endometrial lining, has been scarred, or other such conditions
  • Having medical conditions that would make pregnancy a risk to their life or the life of the fetus
  • Recurrent implantation failure
  • Biologic inability to conceive or bear a child

What to expect

When using a GC is appropriate for the intended parent(s) given situation, the first step is to identify a potential carrier. Next, both the intended parent(s) will meet separately with a Mount Sinai Fertility social worker and the GC will meet separately with a counsellor for an in-depth consultation. The GC will also be referred to a separate fertility physician at our clinic for medical screening.

 

Once the above steps have been completed and all parties have agreed to proceed the intended parent(s) and GC are required to meet with a lawyer in order to obtain independent legal advise and to ultimately create a legal agreement. It is preferable that this lawyer specializes in third party reproduction. We can provide a list of lawyers with experience in this speciality. Mount Sinai Fertility must receive a legal clearance letter confirming that a gestational carrier agreement has been completed prior to starting any cycles involving a gestational carrier.

What are the steps involved?

Preliminary Assessment

The GC should have a complete history and physical examination performed to ensure there are no reasons to avoid pregnancy. This examination will also identify GCs at risk for sexually transmitted diseases. The Canadian Fertility and Andology Society (CFAS) recommends that all carriers be tested for infectious diseases including HIV, hepatitis B and C, gonorrhea, chlamydia, syphilis, and cytomegalovirus. Once tested, the GC will undergo a medical assessment (which includes screening lab work, a transvaginal ultrasound, and a uterine cavity assessment). The intended parent(s) will also be screened for infectious diseases that can be passed to the GC. This screening is done by questionnaires, physical examination and blood tests. Testing is required by Health Canada within 30 days of the egg retrieval and within 7 days of the sperm collection.

Cycle Monitoring

If the intended parent(s) are contributing eggs through in vitro fertilization (IVF), the IVF cycle may be timed to the embryo transfer cycle. The GCs uterine lining will be monitored until it reaches an appropriate thickness. Sometimes, this is achieved without the use of any medication – the hormones produced as part of a normal menstrual cycle are adequate. Other times, medication is used to thicken the lining. Regardless, when the timing is right, progesterone medication is added and the date of the embryo transfer is scheduled accordingly.

Embryo Transfer

The embryo may be done using a fresh or frozen embryo, your fertility care team will discuss the best options with you. During the embryo transfer, we will insert a speculum so we can see the patient’s cervix and use an ultrasound placed on the abdomen to see the uterus. Next, we will place a thin catheter through the cervix into the uterus and the embryo(s) will be placed into the patient’s uterus using an even thinner catheter that fits through the first. The entire procedure takes about 15 minutes, and does not require pain medication.

Pregnancy Test

The GC will be asked to do a beta-hCG blood test to determine if they are pregnant approximately 1.5 weeks after the embryo transfer. The nurse will make an appointment for an in-clinic test, or provide a requisition if the GC wishes do the blood work at an outside lab.

*Please note: The Assisted Human Reproduction Act (AHR Act 2004) prohibits several surrogacy-related activities. Surrogacy itself is not banned, but payment of consideration or the offer of payment to a surrogate are prohibited acts. Therefore, Mount Sinai Fertility does not facilitate finding a GC and we do not work with surrogacy agencies