Picture of Sarah CurrieSarah Currie is a medical copy editor on CMAJ


Rhonda and Gerry Wile’s journey to creating their family is documented on their personal blog and in Leslie Morgan Steiner’s new book, The Baby Chase.

Rhonda and Gerry met and married in their late 20s. Like many women, Rhonda had dreamed of a future in which she would be a mother. Unfortunately, Rhonda discovered that she had an uncommon medical condition that resulted in infertility: although she had two vaginas and two uteruses, and could easily become pregnant, the small size of each uterus meant that all of her pregnancies would result in miscarriage. The Wiles could be included in the 16% of Canadian heterosexual couples affected by infertility.

Infertility is increasing in Canada, as it is elsewhere, and it can be a heartbreaking, isolating and depressing diagnosis. More and more couples who want to start their families are forced to make some very difficult choices as to how far they are willing to go to create a baby. For the Wiles, those choices took them thousands of kilometres from home.

Couples like the Wiles have four options for dealing with infertility: remaining child-free, seeking fertility treatment, pursuing adoption, and surrogacy. According to Morgan Steiner, about 50% of couples will choose to remain child-free and not seek other options. The remainder who choose to continue on the path to parenthood must navigate some very murky waters. Treatment can be expensive and invasive, is often not covered by medical insurance and has no guarantee of success. Adoption processes can also be expensive, opportunists can take advantage of desperate prospective adoptive parents and first families alike, and many prospective parents may be screened out of both domestic and international programs for disclosing the use of antidepressants.

Surrogacy, which Morgan Steiner proposes most closely matches natural procreation, is not without its own pitfalls. Despite being one of the oldest solutions to the problem of infertility, it is not widely embraced. The practice is opposed by many mainstream religions. The medical procedures involved may not be covered by insurance. Some feminists consider it exploitative of women.

Because its legality is not universal and its cost so prohibitive where it is allowed, it lends itself to medical tourism, and to the ethical and moral dilemmas that entails. Like many couples seeking the surrogacy option, the Wiles travelled abroad, to India, to find the women who would carry their children. The Wiles’ surrogate mothers received financial compensation, medical care and support from the surrogacy clinic. The cost to the Wiles was USD30 000, including travel to and from India, and about 1/10 the cost of pursuing the same option in the United States. The Wiles’ journey ended with three beautiful, healthy children; however, not all surrogacy stories result in a happy homecoming with a new baby. Recent high-profile cases in Thailand have caused the government to consider outlawing commercial surrogacy there, an unregulated industry that was reportedly worth hundreds of millions of dollars each year.

Morgan Steiner argues that, were the ethical and moral dilemmas surrounding it resolved, surrogacy has the potential to eradicate infertility and allow anyone to become a parent. And she puts the onus on us, citizens of countries like Canada and America, countries that pioneered the innovations that allow modern-day surrogacy to exist, to resolve those dilemmas. We shouldn’t avoid doing so simply to avoid the discomfort of hard decisions.