Tips For Easing the Pain of Fertility Injections

Even if you’re not afraid of needles, the thought of daily fertility medication injections can be overwhelming for intended mothers, egg donors, and gestational carriers alike. We’ve all seen those photos on social media – the ones where the newborn baby is surrounded by empty medical syringes – and anyone going through fertility treatment can certainly relate. Injections are a fact of IVF life for most people.

There are some doctors who offer an injection-free protocol for gestational carriers – they use birth control pills instead of Lupron, estrogen patches or pills, and progesterone suppositories. While I’ve never had an entirely injection-free protocol prescribed for me, over the years I have used estrogen patches and pills and progesterone suppositories. The estrogen pills worked fine – I took them orally – but some doctors prescribe them to be used vaginally. I will say that I’m very glad I didn’t have to do that because the pills are a bright shade of blue, and what goes up must come down…and well… you can imagine the rest.

Several times I was prescribed progesterone suppositories and in my opinion, they were no fun at all. As if injectable meds are fun? No, definitely not, but I still found them preferable to the suppositories. Why? Two words. THE MESS. They are seriously messy in your underpants, even if you’re wearing a panty liner.  One brand I used was very oily and another brand was very sticky. Yuck. Enough said!

Some women prefer to administer their own shots, some have their partner give them, and still others opt to have a visiting nurse administer them. During my first two surrogacies, my husband gave me all of my shots, which I know he didn’t love but I very much appreciated. By my third surrogacy I was ready to take over the process for myself and once I conquered my nerves, it was actually much moreconvenient to just do them myself (disclaimer: I’m a HUGE fan of Emla numbing cream – that was my secret weapon throughout my years of shots).

Over the course of seven surrogacies I had nine cycles, and got pregnant eight of those times (the other time the cycle was cancelled prior to transfer). I’m not going to do the math, but I know the number of injections I did is well into the hundreds and over the course of all those cycles and shots, I did manage to learn a few things and pick up a few tricks to ease the process that I hope will help ease your injection experience as well.

Subcutaneous Injections:

• Inject into an area that has a thicker layer of fat (such as the belly instead of the thigh)
• Pinch up the area where you’ll insert the needle in order to separate it from the muscle below
• Firmly squeeze your flesh between your fingers (not so much you bruise yourself, though!) to distract from the pinch of the needle jabbing into your belly
• Lightly poke the needle around the area to find a spot that’s less sensitive
• Use a cold pack on the skin to numb the area prior to the injection

Intramuscular Injections:

• Warm the medication slightly (such as in your bra or in a pocket) for several minutes before injecting
• Use a cold pack on the skin to numb the area prior to the injection
• Relax the muscle you’re injecting into by leaning over a counter or sink and taking weight off of the hip you’re going into, or lay face down on a bed if your partner is giving you the injection
• Pull the skin taught prior to inserting the needle
• Withdraw the needle smoothly and without wiggling it around
• Massage the area firmly for several minutes to disperse the medication into the muscle
• Apply a heat pack to the area after the injection

For all Injections:

• Always wait for the alcohol to dry completely before inserting the needle – otherwise it will sting!
• Try distraction! Use the tv, music, or a magazine to draw focus away from the injection.
• Try a topical numbing cream that contains lidocaine (over-the-counter) or Emla (available by prescription in the US and over-the-counter in Canada) – be sure to apply it according to the directions and give it a good 30 minutes to take effect.

In all honestly, even after doing hundreds of injections and getting my blood drawn countless times over seven surrogacies, every time was a bit of a challenge to me and even to this day needles are still somewhat challenging for me (I most definitely can’t look when I have my blood drawn!).  Yet I managed to get through them all and at times even chose injectable medications over other forms (I knew it worked and who wants to mess with success?).

Sometimes the key is taking the injections one by one, day by day and remembering that they won’t last forever, and if all goes well, the stress and hassle of them will be very well worth it! 

Scenes From My Surrogacies: A Memoir in the Making

Curiously, the album I had planned to record my second surrogacy never happened, despite how much I treasured the one I’d made after my first surrogacy.

Was it lack of time that prevented me from tackling it? Possibly, as I was finishing my own kids’ first-year photo albums around that same time and maybe I was feeling a little burned out. But I don’t think that was really it.

The truth is that I really had no reason to make an elaborate memory album for myself because I knew that our first year together – the time we spent as a team,  bringing the twin boys into the world – was not a finite journey as it had been in my first surrogacy. Instead, it was just the beginning of a shared lifetime together. 

What Is a Three-Person Embryo?

Even though in-vitro fertilization (IVF) is no longer considered the least bit experimental, there are still plenty of aspects to it that scientists continue to work on, namely in pursuit of increasing success rates given that it’s still a costly treatment. While improving the process of IVF is one avenue of research, a newer, more cutting-edge aspect is genetic modification using the DNA from a third party donor, which can increase success rates by correcting genetic abnormalities in the embryos a couple creates together.

This technology currently exists, and the first baby was born from it in 2016 -  an apparently healthy baby boy born to parents from Jordan, assisted by an American doctor who created the embryo in an American lab, with the embryo transfer performed in Mexico because implanting a genetically-modified embryo is currently illegal in the US. But what exactly is and why is it illegal?

Currently, the experimental work of creating three-person embryos is aimed at women who carry a genetic abnormality affecting the mitochondria of the cells – known as the “powerhouse” of the cells because they convert food into energy that’s usable by the human body. While not every type of mitochondrial disease is fatal, many forms are and women who carry the fatal gene in their DNA have no chance of conceiving a baby who can live past the age of two or three.

The most recent development in genetic modification looks to be able to eliminate the marker for mitochondrial disease through use of a third source of DNA used to replace the faulty genes the mother carries. When creating the embryos in the lab, the embryologist isolates the nucleus in the mother’s egg and removes it. The embryologist then implant’s the mother’s nucleus into a donor egg in which the nucleus has been removed, so the mother’s nucleus (which contains the majority of the cell’s genetic material) is now surrounded by healthy mitochondria. This modified egg is then fertilized with the father’s sperm and then implanted into the mother as with any other IVF treatment.

When initially performed, five embryos were created and only one of them was found to be healthy, but that one embryo resulted in a baby born nine months later. How likely is this technique to take off and become more widespread, essentially offering parents insurance against fatal forms of mitochondrial disease, and eventually, other fatal diseases?

The future success of these techniques is uncertain at this time, at least in the United States. The process has been reviewed and is protected by law in the United Kingdom (which, incidentally, led the world with the first IVF baby born – Louise Brown), but its future is less certain in the United States. Medical ethics advocacy groups have raised concerns that being able to affect control over genetic expression is a Pandora’s Box just waiting to explode open and can all-too-easily result in the pursuit of eugenics – or the quest to create “genetically superior” children. Since this technology has become publicly known, I’ve seen plenty of opinion pieces asking if scientists will seek to eliminate congenital conditions such as deafness, blindness, dwarfism, even autism, which some people see not asdisabilities, but as differences. It’s a valid point.

But I don’t think it’s a valid enough point to hold back further research on the life-saving aspects genetic modification may hold. Right now the technique is employed for mitochondrial defects, but in due time scientists may be able to locate and even eliminate genetic predispositions to other fatal conditions such as Tay-Sachs disease, Trisomy 13 or 18, Cystic Fibrosis, Canavan Disease, even some forms of cancer. Over the course of many generations, many of these fatal diseases may be able to be eradicated.

It’s hard to argue that it’s unethical to try to eliminate fatal diseases, but some people and/or groups attempt to make the case that humans should not intervene with the disease portion of natural selection. I would hazard a guess that it’s unlikely that these people have lost a child or loved one to a degenerative genetic disorder. But like any new development on the scientific and medical frontier, it takes time for significant changes to be widely accepted.

For certain, we are just on the very forefront of human genetic modification and more research needs to be done on both the techniques and the long-term implications on human health. But the possibilities of helping couples have children when they otherwise stood no chance are a bright spot, and one we should keep our eyes on for future developments. 

Scenes From My Surrogacies: A Memoir in the Making

I laid her down on top of my legs while I adjusted my bra and gown, pushing both aside so she could easily access my breast. It took us a few times to get a good latch, but within a couple of minutes I could hear the sound that brought a wide smile to my face – swallowing. She was nursing, and nursing successfully – even though this was only our second time at it, she knew exactly what to do.

She not only seemed very competent at what she was doing, she seemed very comfortable as well. Even at only a few hours old, I felt she had an innate sense of our relationship – her job was to latch and suck, and my job was to provide her food. It distilled the whole concept of breastfeeding down to its essence – a nutritional delivery device, not unlike a wet nurse from an earlier era. I knew our nursing couplehood would be brief, and perhaps that’s why I enjoyed it so much. There was no real stress, very little responsibility, and no worries – she could take a bottle at any time since she’d switch over to bottles as soon as she left the hospital. Since I wasn’t vested in bringing in a big milk supply anyway, I couldn’t fail at this, and that idea was one of the most liberating I’d felt yet in my years of childbearing and parenting. 

Sperm Shopping: One Woman's Experience Choosing a Sperm Donor

By Alice Crisci

My mom is the queen of catalogs. Her catalogs served as our first internet, really. Want to know why you need a “As seen on TV” watermelon slicer? Ask mom’s catalog. Do you need a funny, thoughtful or personalized gift? Check her catalogs. New dress? No problem. Something knitted, crocheted, double breasted, faux leather, bedazzled?

She has a catalog for that too.

In fact, I dare say, there is only one catalog in the US she has never and will never receive:

A sperm donor catalog.  

You have to be a certain kind of unique to receive this precious, multi-page, double-sided, stapled, full-color, printed display of the cream of the crop (pun intended, however bad) DNA- from-around-the-world catalog.

That was my one and only catalog from the year 2008.

I had just been diagnosed with cancer three weeks prior to that fateful day in the fertility clinic. And I learned that my fertility would be at risk from chemo a mere five days before the very moment I am writing about.

That moment.

That moment, when someone you don’t know hands you a catalog of statistics and you wonder if she needs your help recruiting her basketball team for one of those weird fantasy sports leagues you just don’t understand.

But instead, it’s for me. The catalog is for me. . . and I just keep staring at her and at the cover, wondering how the hell I just got here?

I am embarking on the biggest responsibility of my life: hand selecting, or rather, vial selecting, the very best possible sperm donor to fertilize my eggs with the hope of becoming someone’s mama someday.

Whoa. I think I eventually erupted into some maniacal laughter, especially when my friend Jen declared it would be so much fun!

As of the night before, I was a single, 31-year-old and given that vitrification (flash freezing) had not yet sprung on the scene, slow freezing my eggs had only a 2 -3% chance of success.  Hence, the sperm donor. Healthy frozen embryos had a better chance at success, so our hope was that I could split my cycle and freeze half unfertilized eggs and half fertilized.

But I only had five days to pick a donor so I could hand carry the tank to my egg retrieval appointment. Without the luxury of time on my side, I decided to approach the process like you do in basketball tryouts. Day one, you cut.

I crossed anyone off the list who didn’t have every available potential piece of information. If they didn’t have an essay, buh bye. No baby photo? No thanks.

Next I crossed off any ethnicity I had never, ever felt any attraction to. Sure, I may find them attractive to look at but if I didn’t want to bone a blue-eyed Swede in real life, why would I want to procreate with his DNA in a lab?

Believe it or not, those two steps alone narrowed down my list from 300 to 30!

Next I crossed off anyone who was an open donor, meaning they would be allowed contact with my child at 18 years of age. At the time, I could only see my side of that equation and felt that would be intrusive and unwelcome, like they would show up on my doorstep one day - “Hey we share DNA – you’ve got my nose!”

It felt threatening to my perfectly manicured life I was envisioning with that perfect DNA. But that was naïve, and today, I would choose open donor in a heartbeat.  

With the 30 profiles, I was still feeling pretty overwhelmed, so at this point, I got clinical:

Step 1: keep those with athleticism and music in their background

Step 2: discard profiles with cancer in their family (sure didn’t need a double whammy)

Step 3: read their written essays – bad grammar and you’re out, not to be confused with your out, ‘cause see, that would eliminate a profile fast

Step 4: listen to audio interviews and see if you feel something . . . anything

Step 5: GO WITH YOUR GUT.

So my clinical approach didn’t make it through all five steps, but those 30 profiles got down to twelve, which got cut to six, then cut again to two. One tall. One not so much. Both incredible-on-paper men.

In the end, one had a spotless health history and a very personal story of grit.

Even though they haven’t discovered (yet) a specific gene tied to resilience, determination and grit, I knew I had those qualities too. And I knew if my future child could know both sides of his DNA had it too, he would be ok in life, no matter what he faced.

Because after all, there is a human behind that donor vial, and he gave me the most amazing gift of life . . . my son Dante. 

About Alice

Alice Crisci is a cancer survivor, entrepreneur and activist. She founded MedAnswers to help infertile people in crisis connect with the specialist they need. Available on the iOS store, she has reproductive endocrinologists, urologists, embryologists, geneticists, genetic counselors, psychologists and reproductive attorneys answering unlimited, patient questions for free. She is raising capital to expand into genomics and oncology. She also founded the oncofertility charity, Fertile Action, three weeks into her breast cancer diagnosis at 31-years-old. She co-sponsored the first fertility preservation bill in the country and oversees the prospective regulatory changes across the country in reproductive medicine. She deployed an online oncofertility course for both men and women on the udemy.com platform with almost 2,000 students. She has regulatory relationships across multiple sectors and within both the US Congress and California Legislature. She is a strategic advisor to other start-ups in the health tech space including oncology companies, genomics ventures and educational institutions. She is the ecstatic mom of her fertility preservation miracle, Dante (3.5-years-old), a cat Dante named Josh, a Shih Tzu he named NayNay and a fish he named Sunny. She may or may not let Dante help name his baby brother someday. 

You can find Alice here:

www.medanswers.com

www.facebook.com/infertilityanswers

Twitter.com/medanswerer and Twitter.com/fertileaction

Linkedin.com/medanswers

Facebook.com/alicecrisci

https://www.startengine.com/startup/ovum-medical-inc/

Scenes From My Surrogacies: A Memoir in the Making

If my intended parents have been through a lot of pregnancy losses, I tend to think about those losses – picturing them in my mind. Not picturing them in graphic detail though, but rather in terms of how they must have felt while enduring failure after failure. I’m always cautiously optimistic that we will succeed in having their baby – and this is my job, to be cautiously optimistic. Not overly sunny and confident, because I know better. I know there’s too much at stake to approach the surrogacy process with anything more than guarded hope. It feels irresponsible to me to express anything more confident than that because there is always the very real chance that it won’t work. It’s impossible to say with each couple what our chances are of having a baby – there are seemingly too many variables that could stand between us and them finally bringing home a baby. 

Surrogacy and Breastfeeding: What Are the Options?

Breastfeeding, for some women, can seem like a natural and logical choice, while other feel ambivalent or even conflicted about it, while some at the outset know that nursing is not for them. Some women decide to wait until their baby is born to make a decision about how they want to feed. How to feed your baby is always a very personal decision.

When many, if not most, people hear about a surrogacy arrangement, they assume that the option of breastfeeding is off the table, which is understandable. If the intended mother isn’t giving birth herself, how can she breastfeed? And certainly a gestational carrier wouldn’t breastfeed the baby, would she?

Well, she might, just as an intended mother might choose to breastfeed the baby her gestational carrier has just delivered for her. Neither of the nursing arrangements is very common by any means, nor are they unheard of, either. And of course a third option is that both women nurse the baby, but this is rare.

An intended mother who hasn’t been pregnant can in fact breastfeed her baby, though it does take a fair amount of preparation and more than likely, herbal and/or pharmaceutical support, and most likely some supplementation with formula, at least immediately following the baby’s birth. An intended mother may be able to bring in a full supply of breast milk to feed her baby, though patience and diligence is required. In a future blog post I’ll offer more information on the specifics of induced lactation for intended mothers and how they can prepare to breastfeed their baby.

A gestational carrier, however, is able to nurse the baby she delivers from the moment of the birth, because her body has spent the last months and weeks of the pregnancy preparing for it. In fact, the milk that her body is getting ready to produce is formulated specifically for the baby she’s pregnant with, as is the colostrum that she produces for the first few days, before her milk supply comes in. The colostrum is particularly beneficial for babies because it’s full of antibodies, concentrated nutrients, laxative properties that help the baby pass its first stool, and it offers the baby immunity from viruses and bacteria.

Intended parents and gestational carriers should talk about their thoughts and feelings on nursing early in the pregnancy, so everyone can prepare accordingly.  If an intended mother wants to breastfeed her baby (which is a wonderful way to bond, since she didn’t get to carry the baby herself), she should prepare to feed the baby exclusively at her breast. In this case, it’s probably best that the baby not nurse from the gestational carrier, so the mother-baby pair can begin to establish their own breastfeeding rhythm and routine right away. In this situation, the gestational carrier can pump her milk and provide it to the intended parents to supplement the baby with, whether through at-the-breast supplementation or by bottle.

Pumping milk is by far the most common way gestational carriers provide breastmilk to their surrogate babies. Some see exclusively pumping (rather than putting the baby to breast) as a way for the gestational carrier to avoid feeling too attached to the baby (though surrogates themselves rarely report this being the case – they are chiefly motivated by helping the intended parents). The concern,  though perhaps mostly unfounded, is understandable from the intended parents’ perspective, and any responsible and sensitive surrogate mother wants to respect her intended parents’ wishes.

When a gestational carrier pumps milk for her surrogate baby, the intended parents should provide her with a hospital-grade breast pump, milk storage supplies, and reimbursement for any costs such as shipping.  She will pump her milk and store it in her freezer and then send (or deliver, if she lives close enough) the milk in batches. It’s important to note that if the surrogate is exclusively pumping, the amount of colostrum the baby will receive is minimal, because it’s produced in such limited amounts over the first few days. This should not discourage intended parents from accepting pumped milk from their gestational carrier though, it’s just something to keep in mind.

The last option (which I have done twice) is for the gestational carrier to nurse the baby upon birth and through the first day or few days, as long as they’re together in the hospital or birthing center (following this she may continue to pump for the baby). This arrangement is certainly not for everyone, and it takes a certain amount of trust and confidence on the part of the intended parents, because I imagine at a time they are most overjoyed with the arrival of their baby via surrogacy, it can stretch their feelings of hospitality (even if they’re in favor of it).

The benefit of the gestational carrier nursing for a few days is three-fold – first, the baby is able to get the colostrum that’s ready and waiting for him in the breasts, which is an extremely healthy way to begin life. Second, the suckling action of the baby at the breast helps the surrogate’s uterus clamp down and contract, which minimizes her post-birth bleeding. And third, the initial stimulation from the early nursing helps the surrogate’s milk supply, allowing her to pump more milk than she typically would be able do had she not nursed.

The benefits of breast milk, whether provided at the breast or by bottle through pumping, are significant to the baby and can also be beneficial to the gestational carrier. Many gestational carriers who provide milk after the birth say that the experience is very rewarding for them and they enjoy the continued connection with the baby and intended parents. If it’s the right fit for the intended parents and the surrogate, the arrangement can be win-win, with the baby receiving the benefits.

There is no one right or wrong way to approach feeding your baby once he or she has arrived. And if you decide that breastmilk is what you’d like to provide to your baby, there are many different arrangements available. The most important element in your decision making is communication between your partner and your gestational carrier, to come up with a plan that works for everyone. And once you do come up with a plan, keep the lines of communication open as everyone adapts to their new roles, and try to flexible as different needs arise.  Breastmilk is a priceless gift to help a baby get a good start in life, but it’s not the only way to success – thoughtful consideration and happy, healthy parents go a very long way too! 

Scenes From My Surrogacies: A Memoir in the Making

I was 37 weeks and not ready to let go. I loved being pregnant with these boys, I loved their parents, I loved their family, and I loved the experience of carrying for them. I loved being loved by them; I was living and breathing in the middle of the very love story I’d longed to write since before my first surrogacy. When it came to embracing surrogacy for its ability to bring two families together and create a whole greater than the sum of its parts and reveling in the love created between strangers, in this couple I had more than met my match. 

Does A Gestational Carrier Have Any Genetic Influence on the Child She Carries?

Gestational surrogacy is often joked about from the surrogate’s perspective as “it’s their bun in my oven!,” which really does sum up the process – an egg from the intended mother, sperm from the intended father, and a host uterus to grow and deliver the baby. The gestational carrier has no genetic link with the child she carries, which is seen as one of the chief benefit of the gestational surrogacy process.

Despite the fact that the embryo’s genetic material comes from its parents (or egg/sperm donor), there are ways that the gestational carrier does in fact influence the fetus she carries. Most obviously is in the way she eats, the physical demands of her job and/or lifestyle, the quality of the air she breathes, even the sounds that surround her while she carries the baby. And certainly all of these factors cross intended parents’ minds when they seek out a woman to serve as their carrier, along with her excellent health and good pregnancy and delivery history. Couples understandably want a healthy, stable environment for their child’s first nine months because we know that uterine exposure can have long term effects on a child.

But what about the gestational carrier’s own genetic history? Is that something intended parents should pay attention to?

Conventional wisdom says no, because the carrier isn’t contributing any genetic material to the child. And although that fact still stands, the issue may not be quite as simple as originally thought.

There has long been anecdotal evidence from the egg donor community that perhaps mothers (those who use donor eggs but carry the child themselves) have more genetic influence over their children than initially thought. Parents of children conceived through donor eggs have observed commonalities with some family members, even though the child shares no genetic link with them.

We know from the work of Dr. David Barker (who put forth “The Barker Hypothesis”) that what takes place in the uterus can sometimes be more important than what happens in the home after birth, in terms of genetic expression. He believed that everyday chronic illnesses like heart disease, diabetes, obesity, etc. aren’t always a result of purely genetics and/or lifestyle, but they are influenced by what takes place in the womb during a woman’s pregnancy.  This of course corroborates every intended parent’s goal of finding a woman with a very healthy lifestyle to act as their gestational carrier.

But additional research has since been conducted that sought to determine if the gestational carrier (or mother who carries an embryo created from donor eggs) has any influence on the fetus and their genetic expression. After all, her body is supporting the embryo and its development from a very early stage – in some cases, as early as an embryo that’s only eight cells big.

After first studying the embryonic and fetal development of mice, researchers then turned their attention to a group of 10 women, all of whom were carrying a child from a donor egg. The scientists measured the activity of the genetic material that was present in their uterine fluid, and what they found was fascinating.

Present in the endometrial fluid during the time of embryo implantation were multiple micro RNAs, which are the molecules that encode information for how the embryo’s (and ultimately the fetus’s and the child’s) genes will be expressed.

What this means is that it’s the gestational carrier’s DNA (because RNA is a portion of a person’s DNA) that effectively directs the embryo’s genetic development, because RNA affects genetic coding, decoding, regulation and expression. It’s the gestational carrier’s DNA, then, that influences the way the baby develops, because it’s her genetic material that helps determines which of the baby’s genes get turned on and off. The gestational carrier passes these micro RNAs to the embryo via chemical molecules in the endometrial fluid, and it’s thought that they can influence the activity levels of the baby’s genes throughout life.

When considering this impact for mothers who carry children from donor eggs, it can be reassuring and a source of pleasure and pride. Most women are pleased that even though the child is not genetically related to her, her own DNA does exert influence over how the child she carries develops and grows.

This same satisfaction may not be true for couples who use gestational carriers, because it disputes the common wisdom that the surrogate is merely the vessel, and not a contributor to the baby’s genetic expression. While more research is needed to understand the wider implications of DNA, RNA, and assisted reproduction, it’s an issue worth considering when couples choose a woman to carry their baby.

Do gestational carriers or donor egg recipients pass on their DNA to the child they carry? No, it does not seem so (at least as scientists currently understand it). But do these donor egg recipients and gestational carriers effect the expression of the genetics of the child they carry? Yes, reproductive scientists seem to be confirming that fact.

While the current understanding of reproduction and genetics does not yet call for a complete study of a potential gestational carrier’s genetic profile (and certainly the current state of understanding does not offer us any kind of screening mechanism that would be helpful, anyway), intended parents deserve to know the various influences that could impact their baby’s health.

This is definitely an issue worth keeping a close eye on for further developments! 

Scenes From My Surrogacies: A Memoir in the Making

I paid, and breakfast in hand, waited for her to make it through the checkout line. It was one of the only times, in all nine of my surrogate pregnancies, that I would pay for my own meal. The only other time was prior to the pregnancy when she and her husband went out for dinner with Doug and I after we met with the social worker.

In every other pregnancy when I ate with the baby’s parents, they insisted on paying. It was a kind, heartfelt gesture they all had extended to me and something I came to appreciate. At first it was awkward, after paying my own way through the first surrogacy, but then I realized that it was an important and intimate expression for the parents. When they nourished me, they nourished their baby, too.

Once I made that connection, I graciously accepted each meal.

Fertility Guarantee Programs and Surrogacy: Is It Worth the Cost?

If you aren’t one of the lucky ones who has health insurance that covers infertility treatment, you know firsthand how expensive it can be. Fertility centers know the same, and most offer different kinds of treatment and payment options to help ease the financial burden.

One of the more popular options being offered at fertility centers across the country is a kind of “guarantee” program in which you pay a fixed amount up front and they offer you a certain number of fresh and frozen embryo transfer cycles in exchange. You pay the same amount whether you get pregnant on the first cycle or the fifth (or more, depending on the program). Some programs even offer a money-back guarantee, refunding you as much as 100% of your fee if you don’t have a baby.

These programs can be just the reassurance nervous couples need if they’re feeling apprehensive about succeeding at IVF treatment. They can alleviate the pressure couple feel about mounting medical bills should multiple cycles be necessary, because the fees are fixed and paid up front. And should the couple not succeed at becoming or staying pregnant, their money (or most of it) is refunded to them so they can use it for other family-building options, like adoption.

It’s important to note that there is no one standard shared risk program – each fertility center establishes their own guidelines for how much they charge, what is included, how much is refunded, and in what cases refunds are issued (e.g., some fertility centers will refund your money if you don’t take a baby home from the hospital, while others will only refund your money prior to the twelfth week of pregnancy, or other various terms). If you’re considering a fertility guarantee program, it pays to thoroughly investigate all of the options offered at the different practices you’re considering using.

Fertility centers also carefully screen patients to determine if they’re eligible to participate in a shared risk program – it’s not an option open to every patient who walks in the door. Screening factors used to determine eligibility include (but may not be limited to) the age of the mother, the general health and risk factors of the mother, the results of physical exams and tests, along with blood test results, and what prior fertility treatment has been done already, as well as the health and test results of the father. Using an egg or sperm donor or a gestational carrier (if any of these are appropriate) is generally a factor that improves your chances of success, and thus, improves your chance of being accepted into a shared risk program.

But in the case of gestational surrogacy, is paying the higher upfront cost of a shared risk program a smart thing to do?

As with most anything related to fertility, the answer is that it depends.

People pursue surrogacy for basically one of three reasons: the couple or single parent is male; the woman has a uterine condition that precludes her from carrying (or she has no uterus); or the woman has a medical condition (unrelated to reproduction) that makes pregnancy too dangerous to attempt. To look at the issue of whether or not multiple cycles might be necessary to achieve a pregnancy (which is what makes a shared risk program a good deal for fertility patients), we have to examine the specific reason why someone is using a gestational surrogate.

In the case of an intended father (or fathers), an egg donor is used, so there shouldn’t be significant factors that would prohibit pregnancy, especially if they are using a proven gestational carrier. If they have concerns about the health and success rates of their potential embryos, it may be more cost effective to pay for preimplantation genetic testing to screen for potential abnormalities and know they’re transferring the ones with the best chance of success rather than pay for a shared risk program.

The same applies for a couple where the woman is unable to carry for herself because of a medical condition unrelated to fertility. As long as she’s in the ideal age range for ovarian health and can produce eggs successfully, this couple stands a good chance of getting pregnant with a proven (or at least well-screened) gestational carrier. Of course this doesn’t mean that they will get pregnant on the first cycle – it’s by no means unusual for seemingly healthy couples to need two or three IVF cycles to achieve a pregnancy that sticks. Again, preimplantation genetic testing may increase the odds of success, but that’s an added fee. Couples in this situation should compare the price of a shared risk program to how many cycles, if paid for individually, have a similar cost in order to assess which is potentially most cost effective.

If the couple has struggled with embryo health and uterine health issues (and is not using an egg or sperm donor) and is moving onto a gestational carrier, a shared risk program may be a good bet. By using a host uterus they can (mostly) eliminate that variable from consideration, leaving only the quality of the eggs and resulting embryos as the main factor to take into account when estimating their chances of a successful surrogate pregnancy. The same may apply if the mother is at the upper end of qualifying for the shared risk program, because age is one of the most significant factors in egg production and fertilization and embryo health. In this case, multiple egg retrievals, preimplantation genetic testing and fresh transfer cycles may quickly cost more than a shared risk program, making the latter the best deal.

As with anything fertility-related, there are rarely any clear-cut answers when considering the various options available to you. And certainly adding the element of financial risk to the already stressful process of IVF can make even the most confident couples question each of their decisions along the way. If you’ve selected a fertility center and are interested in a shared risk program, be sure you’re clear on exactly what is and is not included, and discuss the various potential scenarios with your financial counselor and your doctor. If you’re deciding between two or more fertility centers, be sure to discuss all of the various cycle and payment options available to you and get the information in writing, so you can compare the benefits and drawbacks of each. And if at all possible, find out the success rates for patients that most resemble your own age and medical circumstance to get the most accurate estimate of your own success.

Making the financial decisions that go along with fertility treatments is by no means an easy task, but the more information you have, the more confident you will feel, which puts you in a great position for the most exciting part – making a baby and becoming parents! 

Scenes From My Surrogacies: A Memoir in the Making

What was this intense pull of fate that she spoke of, this knowing feeling that this was all part of a grand plan, that our paths had crossed for a reason? What exactly was this reason? And what, or who, was making her feel so incredibly certain about this?

And if in fact this all was meant to be, all part of some divine plan and not a random coincidence, but a carefully controlled series of events, shouldn’t I be feeling the same way?

Finally it was time for her to make an appointment with the fertility specialist. She asked me which doctor I recommended she see at the best practice in town.

And it was then that she added “Susan, I know you like your OB, but I’d really be more comfortable if you saw my high-risk specialist for the pregnancy.”

She trusted fate to bring us together for this most intimate of undertakings, and she trusted my recommendation for a fertility specialist, but when it came down to it, she just couldn’t trust me enough to make good decisions about my own body and my own care. 

What Screenings Are Required for Gestational Surrogacy?

Any woman who wants to be a gestational carrier has a big heart, loves pregnancy (and is good at it), and enjoys giving birth. But is that enough? How else do agencies and fertility centers determine whether or not a woman is a good candidate to be a gestational carrier?

For intended parents looking for someone to carry a baby for them, a lot of attention is paid to who might be a perfect “match.” This is a critical step, of course – all parties must feel a genuine connection to one another and want to spend the next year or so working together in pursuit of a baby.  But beyond the basic personality match, a potential gestational carrier must pass many other screenings before being cleared to carry a baby.

If a woman is working through a surrogacy agency to find a couple to carry for, the agency will conduct their own initial screening process even before accepting her into their program to be considered for a match. Each agency is different (so there is no one universal screening process), but the screening process for most agencies include:

A written application form that covers topics including physical and mental health background, educational and work history, pregnancy history, family descriptions and living arrangements, motivations and expectations for surrogacy, and more. Many agencies request potential surrogates to submit photos of herself and her family, and some request photos of her home.

An extensive interview with a member of the agency, which may be done in person if feasible, or via telephone or video chat if distance is an issue. During this interview the agency will follow up on any questions from the application as well as go into more details about the surrogacy process, ensuring that the woman has a thorough understanding of the requirements and responsibilities for a gestational carrier.

A psychological screening with a licensed mental health professional. Some agencies do this as part of their initial screening process, while others wait until there’s a potential match with intended parents. In most cases a psychologist will administer a written tool that assesses various personality traits and evaluates basic mental health, and issue a report back to the surrogacy agency.

References and a background check.  Some agencies may conduct these as part of their own screening process, some wait until the gestational carrier and intended parents are matched, and some merely offer the intended parents the option for these screening if they wish for them to be performed.

Once a match is made between a gestational carrier and intended parents, the potential carrier must then undergo medical screenings by the fertility center they plan to use. This is important because the requirements between fertility centers vary, and sometimes they can even vary between individual doctors within a fertility center. If distance allows, the potential surrogate should meet with the doctor in person, but some consultations can be done over the phone with test results sent in for review. The doctor will expect the following tests to be completed prior to approving her to be a carrier:

• Height, weight, and BMI
• Blood tests measuring thyroid and other hormone levels, and possible blood sugar level
• Drug and alcohol use screening
• Sexually transmitted diseases
• Other blood-borne diseases such as Hepatitis or Zika
• HIV testing
• Pelvic ultrasound of the uterus, ovaries and cervix
• Hysterosalpingogram (or HSG -  a dye-contrast x-ray exam of the uterus and fallopian tubes)

Once the carrier has successfully completed these screenings, the doctor will approve her to move forward in the process. Some fertility centers require that the intended parents, gestational carrier, and her partner all meet together with a social worker to ensure that everyone's expectations align – though not all centers have this requirement.

The good news is that if your gestational carrier is cleared this far, it’s highly likely that she’ll be an excellent candidate to carry for you, There are just a few final steps left!

If your gestational carrier is married or in a serious relationship, her partner will need to have blood tests done to ensure there’s nothing communicable that she might be exposed to. And although some might consider it part of the cycling process and not the screening process, it’s worth mentioning the mock cycle, since it can disqualify a woman from being a gestational carrier (though that is not common, usually any irregularities can be fixed).

A mock cycle is just what it sounds like – it’s a chance for the gestational carrier to use all of the medications in her protocol to see how her body responds. The doctor will check on her hormone levels during the cycle and measure the thickness of her uterine lining to make sure the medications are doing their job. At the conclusion of the cycle, the doctor may perform what’s called a “mock transfer,” which allows the doctor to visualize the uterus and plan the best way to transfer the embryos during the real cycle. Once this is complete, everyone is on their way to the real cycle and the actual embryo transfer!

Should you decide to pursue an independent match rather than working through an agency, it’s important to note that much of the background and mental health screening will not be performed – it will be up to you to decide if there are any screenings you’d like a potential carrier to undergo. She’ll still have to complete all of the fertility center’s medical prerequisites, but the psychological screening requirements may be minimal, so that’s something to take into consideration.

It may seem like a lot of hoops to jump through for anyone to become a gestational carrier, but each of the screenings has a purpose – to protect the carrier, to protect you, or to protect you both. And once your carrier has successfully completed all the screenings, you can be assured that you have the best possibly chance of enjoying a successful surrogacy experience. 

Scenes From My Surrogacies: A Memoir in the Making

“Here she is!” he proclaimed. His wide smile was unusually reserved as he held her out toward me. I reached my hand under her head and cupped it in my palm, drawing her puckering face in toward my lips to kiss her.

I was barely able to graze her cheek before he barked “They need to take a look at her.” He turned his head toward the other doctor standing next to him and he abruptly shoved her into his hands, and holding her nearly upside down, that doctor ran the few steps toward the wall with her, over toward the mobile intensive care cart.

My eyes fixed on her and the swarm of two doctors and two nurses that engulfed her newborn body, still being held on an inclined angle with her head at the lowest point. One nurse was picking through a fistful of tubes while another fixed bands to the baby’s tiny wrist. I could see through the screen of scrub-clad bodies that the tubes were being threaded through the baby’s mouth and down her throat.

“What’s going on?” I asked Dr. Tchabo, who was now seated by my legs. My eyes darted from him to the guys, who were still standing to my right but were beaming with pride as they gazed over at their baby on the other side of the room.  Oh my god, I thought to myself, they have no idea that something’s wrong. What should I do? Should I tell them? But they look so happy, and I don’t want to frighten them. But Jesus, I’ve never had to push a baby out on demand like that. What time is it anyway?

I glanced up at the clock on the wall in front of me. 5:30am. It’s 5:30am, how is that possible, I thought to myself. I started pushing less than ten minutes ago. Good lord. The doctor said push and I pushed. And I pushed that baby out in under ten minutes. Holy hell.

Establishing a Post-Natal Communication Plan

When you are expecting a baby via surrogacy, there are an enormous amount of issues to consider and decisions to make throughout the pregnancy and birth. No doubt it can feel overwhelming at times – juggling your own preparations for parenthood, your experience with your gestational carrier, all the legal documentation to take care of – it’s a lot to balance. And of course the excitement of your baby’s birth is the pinnacle to the whole experience.

It’s likely that your gestational carrier feels the same way about the birth– she’s eager to see you become a parent or expand your family. She may be looking forward to the birth for the most practical reason (she’s ready to no longer be pregnant!), but there’s a good chance she’s also looking forward to the ways your relationship will change and grow.

Naturally there’s no way to completely control the way any relationship develops – it ebbs and flows and grows or recedes as life marches on and various circumstances intervene, and the same is true for the relationship between intended parents and their gestational carriers, even after the baby is born. In some cases, the surrogacy agreement may very explicitly spell out that there will no contact whatsoever after the birth (though these types of arrangements are rare) or that the intended parents will only provide a photo and brief update once a year (also uncommon, but not unheard of).

Most arrangements, though, assume that the relationship between intended parents and their carriers will be warm and welcoming and they operate on the assumption that there will be at least some contact after the birth, once everyone has left the hospital. Even if you’re close with your surrogate mother and assume this to be the case, it’s valuable to take some time to sort through what kind of relationship and contact you envision once your baby is born and you and your gestational carrier have gone your separate ways.

For some, this is an easy answer because they’re open to as much contact as is feasible and if you live reasonably close to one another, this might include frequent visits. Life has a way of filling up free time, so it’s natural for the frequency of visits to wane over time, even if you remain close.

Technology makes it easier than ever though to stay in touch, especially if it’s not practical to visit often. Emails, texts, Skype or Face Time can go a long way toward bridging the distance between you, your gestational carrier, and your baby that she’s eager to see grow. Some people appreciate the spontaneity of reaching out to one another on a whim, while others prefer to have a more set routine such as monthly calls or photos.

One thing to keep in mind, especially in the early days after your baby’s birth, is the fact that your gestational carrier is going through the process of physically separating from your baby. Even though she mentally and emotionally knows that the baby is yours and not hers, her body may not so readily agree! She’s undergoing a wave of hormones from the birth that she may feel powerless against, and the only thing she can do is ride it out until her body stabilizes as time goes by. Staying in contact with you and receiving frequent updates, especially in the early weeks, can go a long way toward keeping her spirits up and feeling like she’s on a steady, even keel.

While there is no right or wrong way to keep in touch after the birth of your baby, it is important that the method and frequency of your contact feels right to everyone. If you have set ideas on what you’d like, by all means bring them up with your gestational carrier as the pregnancy is winding down. Be open to a dialog and perhaps some negotiation if it turns out you’re not on the same page, and work toward a compromise that satisfies everyone.

With some forethought, empathy and open communication, your surrogacy experience will flow into a parenting experience that’s satisfying and a joy to all parties involved! 

Scenes From My Surrogacies: A Memoir in the Making

On the long, dark ride back home, I was thinking about my newly pregnant friend. In the flurry of activities associated with moving, a new job, and planning a road trip, it had slipped my mind that it had been a few weeks since Doug and I had our afternoon of oh-my-God-we’re-grateful-to-still-be-alive-sex. Which looking back on it, seems crazy that I wasn’t counting the days given that day’s positive ovulation predictor test, but we’d been having precisely timed sex for almost two years already and that fact overshadowed my optimism that we’d actually get pregnant this time.

But as Doug drove along through the night and we passed time by talking about all the changes happening in our lives at that time, I started counting days, pressing my fingers one by one into my leg so as not to lose track of the days that had gone by. Two weeks and a day had passed and if I took a pregnancy test when we got home it might show a positive result.

But it didn’t.

I went on with my week, juggling two jobs, driving between the house we were living in and the house we were renovating, and coordinating all the contractors who were doing the work. Not to mention spending plenty of time sitting hunched over on the bed, calculator in hand and running various sets of numbers to figure out how much we could spend on making the new house livable and how much we had to save for fertility treatments. 

The Unsung Hero of Surrogacy: The Gestational Carrier’s Partner

The gestational carrier might be known as the star of the surrogacy show, but in almost all surrogate pregnancies there’s someone who just might be her unsung hero – her partner.

While not every woman who’s a gestational carrier has a partner, most do (and for the sake of simplicity here I’ll use the terms “husband” and “he” though they could be unmarried or she could be in a same-sex relationship, of course). And her husband plays a key role even before things ever get started in surrogacy – he has to agree to the idea of her carrying a baby for someone else.

It takes a special kind of man, one who has a deep appreciation for his role as a parent, to support his wife carrying a baby for another couple. In fact, whenever a stranger found out about my many surrogacies, one of the first questions they would ask was “What does your husband think about it?” which I took to be an odd question. My reply was always “Well, clearly he thinks it’s great, or I wouldn’t have done it so many times!” which seemed to only further stun them.  “He’s a saint!” they’d declare and I have to agree that yes indeed, he is. Over time I came to expect their shocked candor and appreciate that it really did take an open, giving spirit on the part of my husband to support me through all of my surrogacy adventures.

Aside from understanding and supporting the compassionate nature of surrogacy and his partner’s desire to be a surrogate, a gestational carrier’s partner has other roles to play in the process long before they get to the embryo transfer where she might get pregnant.  The surrogate’s husband also must:

• Meet with the intended parents (along with her) so they can get to know one another and decide whether or not to proceed with the surrogacy
• Undergo medical screening for sexually transmitted or communicable diseases
• Meet with a social worker or other mental health professional
• Undergo a background or financial check (in some, but not all, arrangements)

Once the surrogate begins her cycling for an embryo transfer, her husband’s role changes to:

• Helping her, if necessary, with the shots and medications she has to take
• Abstaining from sex just prior to and up to two weeks after the embryo transfer

If the embryo transfer is successful and the surrogate becomes pregnant, her husband’s role will also include:

• Supporting her through the first trimester when she could be nauseous or vomiting and probably very tired
• Ensuring the safety and security of their living arrangements
• Maintaining good health as to not expose her to anything communicable
• Abstaining from sex should the doctor prescribe pelvic rest at any point during the pregnancy
• Providing emotional support to the surrogate should difficulties arise with her intended parents, as well as any pregnancy-related complications or frustrations
• Making any medical decisions in the best interest of the gestational carrier if she is somehow unable to do so for herself
• Being available to support her during labor and delivery
• Being supportive, patient and understanding during the post-partum time when her emotions and hormones can fluctuate wildly

Any man who supports his wife through gestational surrogacy has to not only be comfortable with the idea that his wife will be pregnant with another man’s child, he must also take in stride all the attention that comes along with it. There will most definitely be times when he questions what he agreed to – surrogacy can be a long and at times, grueling road. But if he’s truly supportive and an equal partner in the surrogacy process, he can see the value of not only what his wife is doing, but his contribution to the process as well.

Surrogacy is the ultimate team sport,  and a good, supportive partnership between a gestational carrier and her husband goes a long way toward success! 

Scenes from My Surrogacies: A Memoir in the Making

I tried closing my eyes in the hopes of coaxing myself back to sleep. Even though it was nighttime and the room was dark, keeping my eyes shut prevented me from looking around the room and jumpstarting my mind with thoughts about yesterday’s pants and shirt sitting in a wrinkled heap near the foot of my bed, or the clutter that was collecting on the mantle above my dresser. But keeping my eyes closed had a down side to it as well - without any other sensory distraction, I was focused on the contractions – how long they were, how intense they were, how far apart they were, and that only intensified the pain. By the mere fact that I was obsessed with discerning whether or not I was actually in labor, I should have known that I was. But logic and rational thought are not the hallmarks of labor and delivery, at least for me they’re not. 

National Infertility Awareness Week: The Importance of Self-Care

April 23-29 is National Infertility Awareness Week (NIAW), which was founded by Resolve: The National Infertility Association.  This year’s theme for NIAW is “Listen Up!” in an effort to bring public awareness to issues surrounding infertility and family building. As the week draws to a close, I wanted to slightly shift the focus away from the disease aspect of infertility and toward productive, helpful ways to keep not only your body healthy, but your mind and spirit healthy as well.

Infertility can be stressful, full of unknowns, all-consuming, frustrating, expensive, physically, mentally and emotionally taxing, along with a host of other things, not to mention fairly common. It’s estimated to affect ten percent of the population or one in eight couples – so whether you’re aware of it or not, chances are excellent there’s someone in your life who’s impacted by it.

Whether you’re pursuing infertility treatment to conceive yourself or you’re pursuing surrogacy to build your family, every part of your body and life is affected by the process. Sometimes these stressors are physical (such as side effects of fertility medications), sometimes they’re emotional (worry, financial pressure, even excitement takes its toll), but most of the time there’s a complex cocktail of the two.

While there’s little you can do to directly change the physical process of infertility treatment, you can commit to managing the mental and emotional effects through diligent self-care. Not only can you practice self-care, you should practice self-care. And rather than considering it a luxury, look at it as an essential part of your treatment plan. Tune into your body and listen to what its saying, and take action accordingly.

Finding ways to practice self-care has many benefits beyond stress relief and relaxation (which is reason enough for it – it just plain feels good!). But other benefits may include preventing additional diseases or illnesses from developing, feeling productive and satisfied, developing a greater sense of engagement with friends and your community, a sense of achievement, among many others.

There are many different ways to care for your body, mind and what works best for you may not be what works best for someone else. Also, your needs and wants can change over time, so it’s essential to check in with yourself frequently and ask “Is what I’m doing serving me well? What can I do differently to change the way I feel?” and adjust accordingly.

Here are some suggestions – consider them launching points for your own, personalized self-care plan:

• Join an infertility support group like Resolve or other groups local to you
• Develop a mediation practice (through a class or self-study)
• Commit to regular exercise or movement – it need not be over-the-top intense to have benefits – even a brisk stroll, if taken regularly, can be very beneficial
• Explore mind-body connection exercise such as yoga or tai chi
• Get regular massages or spa treatments
• Take a class in something you always wanted to learn, like a foreign language, a style of cooking, gardening, etc.
• Develop a writing practice, whether it’s a daily journal or creative writing (poetry, short stories, personal narratives, etc.)
• Volunteer with an organization or cause that’s important to you
• Learn to (or dedicate the time to) make things with your hands such as woodworking, needlework, drawing or painting, etc.

Pursuing infertility treatment can feel overwhelming at times, which is natural. And taking time for yourself to do something you enjoy and are interested in might even feel unnatural at times, like you’re “taking your eye off the ball” or getting distracted from your goal. Nothing could be further from the truth though – it’s important to remember that good health is more than merely following a prescribed treatment plan. It’s just as important to listen to your own body and your own thoughts, feelings and inclinations and meet your social and emotional needs.

The mind-body connection is strong, so use it to your best advantage, both in pursuing your goal of becoming a parent and keeping yourself healthy all along your path to parenthood!

Scenes From My Surrogacies: A Memoir in the Making

Until this pregnancy, at least one of my intended parents had always accompanied me to my doctors appointments. We’d meet in the waiting room and catch up while waiting for the doctor. If we hadn’t seen each other in the last month, they could see how my belly had grown and if we were lucky, the baby would kick and I could grab their hands and place them over the exact spot where their baby was moving. I never got bored of watching the excitement on their faces when this happened.

But the guys, they didn’t really want to come to my OB appointments, and something in me just let this be.  Was it the fact that they were two men that allowed me to let this small, but important piece of my surrogacy experience drop by the wayside? Maybe it was the fact that they, in essence, weren’t “missing out on anything” the way a woman who was unable to carry for herself might feel?  Or it may have been mostly petulance on my part, holding the opinion that I wasn’t going to coerce anyone who didn’t want to be there to hear their baby’s heartbeat to come to my appointments, if it wasn’t their natural inclination in the first place.