Who Does What in a Canadian Surrogacy Journey?

The agency, clinic, lawyers, counsellors, intended parents, and surrogate are all part of the journey, but they do not all do the same job.

At the beginning of a surrogacy journey, it is easy to imagine that one person or organization is managing everything.

In reality, Canadian surrogacy is a team process. Medical decisions belong with medical professionals. Legal advice belongs with each party's own lawyer. The surrogate makes decisions about her body and pregnancy care. Intended parents make decisions about their embryos and family-building plans. An agency or independent coordinator may help connect the pieces, but should not replace any of those roles.

Understanding these boundaries early makes it easier to know whom to call, what questions to ask, and what support you are actually receiving.

The surrogate

The surrogate is not simply one member of a professional team. She is the person undertaking the physical and emotional work of pregnancy.

She decides whether surrogacy is right for her, whether a proposed match feels right, and whether she gives informed consent to medical care. Once pregnant, she remains the patient and retains decision-making authority over her body and healthcare.

She also has responsibilities. These may include providing accurate information, completing screening, following medical guidance she has agreed to, communicating with the intended parents and team, keeping reimbursement records, and participating honestly in legal and counselling processes.

Support for a surrogate should not begin at transfer and end at delivery. She should know who is available before matching, during treatment, throughout pregnancy, after birth, and when something does not go as hoped.

The intended parents

Intended parents are responsible for understanding the path they are choosing and preparing for it emotionally, financially, legally, and practically.

Their role commonly includes:

• working with their fertility clinic on embryo creation, storage, and treatment planning;
• reviewing potential matches thoughtfully;
• obtaining their own legal advice;
• funding agreed fees, professional costs, and eligible reimbursements;
• respecting the surrogate's autonomy and medical privacy;
• communicating consistently and honestly;
• preparing for parentage, birth, travel, and post-birth requirements; and
• making decisions about their embryos with guidance from the clinic.

Intended parents are not expected to know everything at the start. They should, however, be given enough information to understand the major stages, likely costs, areas of uncertainty, and which professional is responsible for each answer.

The fertility clinic

The fertility clinic is responsible for medical care related to assisted reproduction.

Depending on the circumstances, the clinic may:

• review medical and pregnancy records;
• conduct or arrange screening and testing;
• determine whether a proposed surrogate meets its medical criteria;
• counsel patients about medical risks and treatment options;
• develop the medication and transfer protocol;
• perform monitoring and embryo transfer;
• order pregnancy bloodwork and early ultrasounds; and
• explain medical outcomes and possible next steps.

A clinic does not guarantee that a transfer will work. It also does not decide whether two people are a good relational match, provide independent legal advice, or manage the entire journey.

Clinic requirements vary. A surrogate accepted by one clinic may need different records or assessment at another. The treating clinic's instructions should guide the medical process.

The intended parents' lawyer

The intended parents' lawyer advises the intended parents about their legal rights, responsibilities, risks, and documents.

The lawyer may draft or review the surrogacy agreement, explain the legal framework that applies to the arrangement, coordinate with the surrogate's lawyer, and help plan the parentage process.

For international families, legal planning may also involve citizenship, immigration, travel documentation, and advice in more than one country. Those questions should be addressed by qualified lawyers familiar with the relevant jurisdictions.

The intended parents' lawyer represents the intended parents. That lawyer does not give independent advice to the surrogate.

The surrogate's lawyer

The surrogate should have her own independent lawyer.

That lawyer's responsibility is to advise her, not the agency and not the intended parents. The lawyer should give her space to ask questions privately, explain the proposed agreement, identify concerns, and make sure she understands the commitments and risks before signing.

Independent legal advice is meaningful only when the surrogate can speak freely and make her own decision. The fact that intended parents commonly fund the cost of that advice should not change whose interests the lawyer represents.

Provincial requirements and parentage processes differ, so everyone should rely on their own qualified legal counsel for their specific arrangement.

The counsellor or mental-health professional

Counselling in third-party reproduction is not simply a pass-or-fail test.

A qualified professional may help participants explore:

• motivations and expectations;
• communication styles;
• boundaries and privacy;
• support at home;
• pregnancy-related decision-making;
• relationships after birth;
• previous infertility, pregnancy, or reproductive trauma;
• possible loss, failed transfer, or changed plans; and
• how conflict will be handled.

Some professionals conduct assessments before a match or treatment. Others provide ongoing support. Those are different functions, and it is worth asking what is included.

The Canadian Fertility and Andrology Society publishes professional guidance for counselling in assisted reproduction. The treating clinic may also have its own requirements.

The agency or journey coordinator

The agency's role is coordination, education, preparation, and support.

Depending on the program and agreement, an agency may:

• educate intended parents and prospective surrogates;
• recruit and preliminarily screen potential surrogates;
• create profiles and facilitate introductions;
• help both sides explore compatibility before matching;
• coordinate records, appointments, and communication among professionals;
• track milestones and outstanding tasks;
• provide practical and emotional support;
• help administer or coordinate reimbursement processes;
• assist with birth planning and post-birth logistics; and
• respond when communication breaks down or a journey changes course.

An agency should be able to explain exactly which of those services it provides, who provides them, and whether there are limits or additional costs.

An agency is not the fertility clinic, the lawyer, or the surrogate's healthcare provider. It should not interpret medical results, give legal advice, or pressure either party to accept a match or proceed with treatment.

The best coordination does not blur professional boundaries. It makes them easier to navigate.

The financial or reimbursement administrator

Financial administration can be handled in different ways. A journey may use an escrow provider, a managed account, an agency process, another administrator, or an arrangement designed by the parties and their lawyers.

Whoever administers the funds should be able to explain:

• where funds are held;
• who controls and can access them;
• how requests are submitted;
• what documents are required;
• who reviews and approves requests;
• how quickly reimbursements are normally paid;
• what statements or records each party receives;
• how urgent expenses are handled;
• what happens if funds run low; and
• what happens to unused funds if the journey ends.

Health Canada's reimbursement rules apply regardless of whether a journey is agency-supported or independent. For more detail, read Surrogacy Reimbursements in Canada: Receipts, Expenses, and Escrow.

Obstetric and pregnancy-care providers

After early fertility treatment, pregnancy care usually transitions to a family physician, midwife, obstetrician, maternal-fetal medicine specialist, or another appropriate provider.

The surrogate is the patient. Her healthcare provider is responsible for her pregnancy care and medical recommendations. Intended parents may attend appointments when the surrogate agrees and the provider permits, but they do not become the patient.

A birth plan can help everyone discuss preferences, communication, hospital logistics, and time together after delivery. It cannot predict every medical event or override the surrogate's consent and the healthcare team's clinical responsibilities.

What changes in an independent journey?

An independent journey does not remove the need for medical care, separate legal advice, counselling, financial planning, documentation, or careful matching.

What changes is who coordinates the work.

Without an agency, the intended parents and surrogate usually take on more responsibility for:

• finding one another;
• evaluating compatibility;
• collecting and transferring records;
• finding experienced professionals;
• tracking deadlines and clearances;
• organizing reimbursements;
• resolving communication problems; and
• planning for unexpected events.

Some people are comfortable managing those responsibilities. Others want a coordinator to hold the overall map and help keep the journey moving. Neither path removes risk, and neither path guarantees an outcome.

The useful question is not simply, "Do we need an agency?" It is, "Who will perform each coordination and support function if we do not use one?"

Questions to ask before the journey begins

Ask the agency or coordinator:

• Which parts of the journey do you manage directly?
• Which services are provided by outside professionals?
• Who is the main contact for each party?
• What support is available after hours or during a crisis?
• How are disagreements or communication breakdowns handled?
• What continues after a failed transfer, miscarriage, or ended match?

Ask the clinic:

• What screening and records do you require?
• Who explains results and medical options?
• At what point does care transition to a pregnancy-care provider?

Ask each lawyer:

• Whom do you represent?
• Which jurisdiction's law applies?
• What does the agreement cover if plans or circumstances change?

Ask about money:

• Who holds the funds?
• Who authorizes payments?
• What records will each party receive?
• What happens to funds if the journey pauses or ends?

And ask one question of everyone:

If something goes wrong, who calls whom, and what happens next?

The bottom line

A well-supported journey is not one in which a single organization controls everything.

It is one in which everyone understands their own role, respects the roles of others, and knows where to turn when the path changes.

An agency can be the thread that helps connect the journey. It should never pretend to be the whole fabric.

Further reading

• Health Canada: Assisted human reproduction
• Canadian Fertility and Andrology Society: Counselling Practice Guidelines
• What You Should Know Before Starting a Surrogacy Journey in Canada
• Why Surrogacy Journeys Sometimes Stall

This article provides general educational information, not legal, medical, financial, or counselling advice. Professional roles, clinic requirements, and parentage processes vary by province and individual circumstances. Obtain advice from qualified professionals who understand your specific arrangement.