My Compulsion to Create on The Art of Infertility

It was during Resolve’s Washington DC Advocacy Day in May that I had the pleasure of meeting Maria Novotny and Elizabeth Walker. They had put out a call to Advocacy Day attendees to tell their infertility stories, and well as bring along one visual artifact from their journey to share as part of their experience.

I really enjoyed chatting with Maria and Elizabeth and learning more about their project called The Art of Infertility.  It’s an amazing and thought-provoking project that chronicles the journey of infertility through artwork, oral history, and photography, and includes a traveling exhibit as well. 

I had the good fortune of participating in their oral history portion, telling my own infertility and surrogacy stories, which was a very empowering experience and one I’m really grateful to have a role in.

After our interview, it occurred to me that while drafting stories for my surrogacy memoir, I had actually already written about this exact subject! Maria and Elizabeth were interested in that story and I was more than happy to share my piece called “The Compulsion to Create” with them.

I know you will enjoy their Art of Infertility site, it’s filled with incredible art and stories from many people’s journeys, both resolved and unresolved, and I’m eager to follow their project as it evolves.

Thank you so much Maria and Elizabeth for having me!

Read "The Compulsion to Create" here. 

How Being a Gestational Carrier Affected My Childbirth Pain Relief Choices

A woman’s choice for pain relief during childbirth is always a very personal one. There are many factors to take into consideration when deciding whether or not to use anesthetic and if so, which one. Some of those factors include a woman’s tolerance for pain, how her labor is proceeding, potential and known medical risk factors for her and the baby, and the type of labor and deliver experience she is hoping for, among other things.

When a woman opts for a birth center or homebirth experience (described in more detail in this post), she knows that her options for pharmaceutical pain relief are very limited. And on the flip side, some women know immediately that they want an epidural as soon as possible (in the parking lot, please?), while some women prefer to ride out the contraction pains as they come and make a decision while in labor.

All of these approaches are equally valid. In fact, I’ve personally taken each of these approaches myself (several times over!) in the 10 times I’ve given birth.  

It was in my last two surrogate births that I was in the “I’ll take the epidural in the parking lot, thank you very much” camp, and here’s why.

My first eight births resulted in a wide range of experiences. I’d had four unmedicated births, two c-sections, and two vaginal births with an epidural and although each of the different kinds of deliveries had its benefits, it was the deliveries with the epidural that I enjoyed the most.

It wasn’t so much that I enjoyed being free from the pain of labor and delivery (though undoubtedly that was a real bonus), it was that because of the relief the epidural offered, I was able to better enjoy the labor and delivery experience with my intended parents.

You see, the unmedicated births I’d had by then taught me that I’m a pretty antisocial and crabby person when I’m trying to manage the pain of labor and delivery. I don’t want anyone talking to me and I definitely don’t want anyone touching me.  Even though I knew that people were only trying to help me and make me comfortable, the stress of the pain causes me to snap easily and be angry and demanding.

Now of course all this is understandable when a woman is in labor or pushing out a baby – it’s absolutely understandable! However, once I’d experienced multiple drug-free births, I was looking for something else. I didn’t want the birth to be so much about my labor and delivery experience, I wanted it to be about an event that my intended parents and I went through together. And knowing that I needed solitude to cope with the pain of an unmedicated birth, I opted for an epidural so I was mentally, emotionally, and even physically in a frame of mind to share the experience with them.

And it worked. During my last two births, both of which I had an early epidural, I was able to relax and enjoy my intended parents’ company throughout my labor and the delivery. I was able to talk with them, observe them and their nervousness and excitement, and really soak in the experience from their perspectives, which was very memorable and a pleasure for me.  I never could have interacted with them in that way had I been trying to manage the pain of contractions and pushing.

Had I not already experienced natural childbirth and epidural births, I can’t say that my choice to opt for pain relief would have been so easy to make. But to me it boiled down to two very different experiences – one more about my own personal labor and delivery experience, and the other about fully sharing my labor and delivery in a positive way with my intended parents.

There is no right or wrong in childbirth, of course – a healthy mother and a healthy baby is the outcome that everyone wants and works toward. Whatever makes the woman in labor feel most comfortable, safe, and successful is almost always the most appropriate decision, and the same applies when a woman gives birth as a surrogate mother. Sometimes, though, what makes the intended parents feel comfortable, safe and successful turns out to be a good decision for their gestational carrier, too. 

Scenes from My Surrogacies: A Memoir in the Making

I turned my attention to the monitor as the nurse started the exam and engaged my intended mother in marveling at her twin boys. I knew she was upset about what had just happened and I wanted to help get her mind off of it.

“Look, there he is, he’s as adorable as ever!” I said, while watching the tiny boy wiggle and squirm on the screen. I could vaguely feel the movements inside, but not to the degree that we could see them on the screen because a lot of the time the baby was kicking his brother and not me. His activity was good.

The nurse positioned the ultrasound wand to pick up the baby’s heartbeat. His heart came into view and we could see it beating away but instead of even, smooth, rhythmic contractions of his heart muscle, the beating was very irregular. Boom. Boom boom boom. Pause. Boom. Boom. Boom boom.  Pause. There was no pattern to it whatsoever.

The nurse asked if the baby had had an irregular heartbeat before, and we said no, never. Everything, until today, had always looked and sounded perfectly normal.

She flipped a switch on the machine and the sound of Baby A’s heartbeat filled the room with swooshing. The result was the same – oddly staccato, very irregular swooshing. The technician looked concerned.

“I’m sure he’s fine,” I whispered to my intended mother, who was sitting close to my side. She nodded in silence, the rest of her body motionless, her eyes glued to the screen. 

Is Homebirth an Option in Surrogacy?

photo credit: eyeliam, Flickr Creative Commons

Homebirth – it’s a word that can be very polarizing. It seems there’s very little happy medium when it comes to the issue – either you’re a fan of it or you’re vehemently opposed to it.

The good thing is that unless a baby decides to come suddenly and unexpectedly, no one is forced into giving birth at home, where as the opposite isn’t necessarily true – many more women give birth in hospitals when they may have preferred to use a birthing center or a midwife-assisted homebirth. And really, for most people it works out – they’re able to give birth in a place that feels safe to them and meets their medical needs.

Although homebirth has its fervent supporters, it still accounts for less than 2% of all births in the United States (numbers are much higher across Europe – as much as 30% in some countries). And in surrogate births the number is much, much tinier. And yet, some surrogates, along with their intended parents, do elect to deliver their babies at home. Who would choose this option and why?

 In most cases, surrogates who have had successful homebirths with one or more of their own children offer that option to their intended parents, or their intended parents express interest in homebirth when they find out that their surrogate has delivered at home in the past. Whichever way the topic comes up, all parties must feel comfortable and confident in the option if they decide to pursue it.

In my own case, I had a midwife-assisted homebirth with my third child and I had a great experience. In both my first and second surrogacies, I carried twins so the question of where I would deliver never came up because a hospital delivery was a foregone conclusion. When it came to my third surrogacy, I was coming off of two c-sections in a row, so neither my intended parents nor I were terribly comfortable with the idea of delivering at home at that point.

I assumed this was the case as well with my fourth surrogacy, but about midway through my first trimester my intended parents shocked me by asking if I was interested in a homebirth. Initially I thought they must be joking (and if they were, it was a cruel joke because I really did want to have a homebirth!) but much to my surprise, they were serious. I was both surprised and delighted!

We stayed with traditional OB care until our 20 week ultrasound showed a healthy baby, and then we switched to the same homebirth midwife that I’d used with my own child. We discussed where I should give birth and ultimately decided on their house for several reasons

• My IP’s house was bigger and they had more room for a birthing pool, since I wanted a water birth
• We’d have more privacy in my IP’s house because my kids would be at my house, along with someone to care for my kids
• My intended parents’ young daughter would feel more comfortable and part of the birth experience if we were at their house
• My intended parents themselves could relax and better enjoy my labor, delivery, and the first few days with their new baby if they were in their own home
• My intended parents’ home was considerably closer for our midwife to get to
• The surrogacy legal procedures were easier for my intended parents if we gave birth where they lived (though we only lived about half an hour apart, we lived in different states and theirs was more surrogacy-friendly)

The rest of my pregnancy was healthy and comfortable and I went into labor on my due date. Once I felt active labor kicking in, my husband and I drove to my IP’s house where I labored for about six more hours. At that point I got into the birthing pool they’d set up for me and I delivered their baby about an hour later. My birth was calm, quiet (through quiet is a relative term – everyone else and the environment was quiet – I, however, was not quiet at all because well, you know, natural unmedicated birth and all…).

My IP’s daughter met her new sister minutes afterward, as did the baby’s grandma, and per my IP’s request, I nursed the baby on demand. I stayed for a few days at my IP’s house in their guest room where I rested and slept and nursed their baby to get her the most breastmilk possible in the first few days.  It was a beautiful and rewarding experience for all of us – very calm, family-centered and peaceful (which is pretty much the direct opposite of a hospital birth experience).

What made homebirth a good option for us was that I’d already had a successful homebirth before, so I knew I could do it and I was very comfortable with my midwife. And I’d had three unmedicated births by this point so I knew what I was in for in terms of pain. My intended mother was very comfortable with the idea of homebirth and had friends who had done it, and of course my pregnancy was very low risk, which made me an excellent candidate.

Homebirth most definitely isn’t for everyone, and maybe it’s not even for the majority of women giving birth. And this is understandable especially for women who’ve faced infertility and have had to trust an array of medical procedures in order to have a baby on the way – it’s natural that they might feel most comfortable and confident with a medically-managed hospital birth.  And the bottom line is that everyone should be where they’re most comfortable and confident because when all is said and done, a healthy baby and healthy surrogate mother is what matters most from the delivery.

But when the place that everyone is most comfortable and confident is at home, a midwife-assisted homebirth can be a wonderful option, one worth exploring if each of the parties in the surrogacy arrangement are open to it. There are risks and benefits to all forms of and places for childbirth, so it’s worth exploring all of the options if you’re considering something outside of the traditional hospital birth route. 

Scenes From My Surrogacies: A Memoir in the Making

Once I’d confirmed that I was in fact pregnant with her baby (we didn’t yet know that I was carrying twins), I asked the nurse to keep the results a secret for an extra day. That night I set about making a special gift for her that would announce to her that she was about to become a mother. Still into paper arts at the time, I used decorative paper, rubber stamps, clear plastic disks, and a metal jewelry form to fashion a bracelet for her that had our due date on it. I was proud of my work, of course, and she immediately dissolved into happy tears when I gave it to her. Mission accomplished.

What I didn’t bargain for, however, was a nine-month-long recurring repair job.

To say that she loved the bracelet is an understatement. She loved it so much in fact that she rarely took it off – only to shower, she said. She tried to move it out of the way every time she washed her hands, but more than once it ended up getting soaked, which weakened it. While my craftsmanship was fine enough for a souvenir gift, the bracelet was never meant for day-in, day-out wear. It was more of a decorative memento rather than a sturdy accessory meant to withstand daily use.

I told her this, but she would not be deterred. Despite me giving her my heartfelt permission to take it off from time to time, she refused. It was thoughtful and sweet, and most certainly gratifying to know how much the bracelet meant to her, and only slightly infuriating as well.

How Does a Gestational Carrier Choose her Obstetrician?

It’s common practice for a surrogacy agreement to include some language about where the gestational carrier receives her medical care once her pregnancy is confirmed by the fertility center.  In many cases the surrogate returns to the same medical practice that she used when she carried her own children because she already knows and trusts them. And again, in most cases, the intended parents want the surrogate mother to be comfortable and confident in her prenatal care, so this is a good arrangement for everyone.

But what if for some reason the surrogate mother isn’t able to use the practice she’s previously used? Perhaps she’s just moved to a new area, or maybe she wants to change to a new practice – what happens then? Who gets to decide which doctor she sees?

Generally speaking, it’s the gestational carrier’s right to choose the doctor she sees for her pregnancy and delivery.  But if she needs or wants to find a new doctor, what, if any, role should the intended parents play in the selection of the doctor? And what should she look for that’s unique to surrogacy?

At the start of my first surrogacy, I found myself in this position. I was 9 weeks pregnant with twins and I returned to the OB practice I’d used for my first two children (I’d had a midwife-assisted homebirth for my third child). While the practice was fine when I carried my own kids, I noticed a distinct difference in their approach toward my surrogate pregnancy.  This time around, the doctor was very conservative in how she managed the pregnancy – she wanted me to stop exercising, she said to expect an ultrasound at every visit, and she wanted me to refrain from having sex with my husband.

These precautions were all curious to me, mostly because I’d already had three successful pregnancies and deliveries and I didn’t have any complications with my current pregnancy. I got the feeling from the doctor that she viewed my surrogate pregnancy differently than she did a natural pregnancy – perhaps higher risk (needlessly in my case) and maybe more importantly, more high-stakes? I got the sense that she wanted to restrict my activities to cover her own legal bases and as you can imagine, that wasn’t an environment I, or my intended mother, was comfortable with.

So together we decided to pursue another practice. I talked to several friends and got suggestions and then based on geography, I narrowed it down to a few possibilities.  My intended mother and I both went to the interviews and got a feel for not only how they viewed a twin pregnancy, but even more importantly, how they viewed a pregnancy with two mothers – me and my intended mother.

Of the two practices we ultimately interviewed, one was similar to the doctor we’d started with – overly conservative in our eyes (e.g., the doctor didn’t want me using a recumbent stationary bicycle at the gym because he thought I’d fall off of it – clearly he’d never seen a recumbent stationary bike before because even the oldest of exercisers can manage that piece of equipment and I was a very healthy 32-year old and regular exerciser!). 

Luckily the second practice was a great fit for us – the doctor was an older man who had many, many years of practice behind him and looked at me as a low-risk patient, which was how I wanted to be treated (because I was, in fact, low-risk). And even better, he had worked with a few surrogate mothers in the past so he understood the dynamics of the process. Ultimately we were both happy with that office and had a good experience with them.

Some things that we took into account when we selected a practice were:

• Personality and experience of the doctor (obviously!)
• Experience working with gestational carriers (while it’s not essential, we wanted someone who wouldn’t be intimidated by the idea of surrogacy)
• Willingness to include the intended parents and their family in the prenatal visits
• How the doctor assessed my pregnancy and delivery history and my current pregnancy
• The doctor’s views on what constituted a low-risk pregnancy and a high-risk pregnancy, and how potential complications would be managed
• Location (the practice we chose was actually close to my IP’s house, but about 45 minutes away from mine – while I didn’t love having to travel that far, there were other advantages to the practice and hospital that I would deliver at that made the inconvenience worth it for us)
• Services offered (did the practice have ultrasounds and bloodwork on-site, or at least in the same building?)
• The hospital the doctor was affiliated with, which would be where we’d deliver

We were lucky that we found a great practice without too much trouble and we were all happy with the care we received there. Unfortunately though, the doctor retired after I completed my first surrogacy, so it was back to the drawing board the next time around.

When I was pregnant with my second surrogacy, I returned to that same practice and saw another doctor, one who unfortunately could not have been more opposite from the doctor I had loved there. Before my first appointment was up it was clear to me that I’d have to find yet another OB for this pregnancy and delivery.

My intended parents wanted me to choose the doctor myself – it’s not that they didn’t want to be involved, it’s just that they wanted me to be happy with my care and completely deferred to my judgment. So I interviewed a few doctors alone and selected a great one, one who I remained with for all of my future pregnancies and deliveries.

Hopefully your surrogate mother has a care provider that she likes and trusts and is one that helps make your surrogacy experience successful and memorable – that’s the ideal, of course. But if not, don’t fret, you have the chance to find someone who will be a great fit for all of you. Be sure that you talk about your expectations before lining up interviews so you’re all on the same page - that way you can make sure that everyone feels included as part of the interview and decision making process. 

When you go into the surrogacy with clear ideas and clear communication about what you need and what you hope for, you’re all much more likely to have a healthy and rewarding experience – which makes having a baby that much sweeter! 

Scenes From My Surrogacies: A Memoir in the Making

I’m not sure why we were gathered in this outer part of the church, rather than inside, but this was the first time I’d attended a service like this. And god help me, it would be the last.

I don’t remember a lot about it, other than the sight of the tiny pink urn in the center. I don’t remember what the priest said, or what the urn was sitting on, or who was there, other than my husband and my kids and my intended parents and their two living daughters. I know there were others there, but I can’t quite picture them anymore.

I do remember that no one there was crying. The mood was somber, to be sure, but somehow the presence of young children at a funeral helps keep the focus on the beauty in the world, rather than the crushing pain inside.

I distracted myself by watching my previous surrogate baby fidgeting in her father’s arms. At only 21 months old, she had no idea why we were there, but her older sister did. She was there in the exam room with us the day the doctor gave us the grave diagnosis. 

Fighting for Infertility Treatment Rights: Resolve's Advocacy Day

Surrogacy is a funny thing. A lot of people see it as a selfless act, which I’m not quite sure I agree with. Generous, compassionate, loving – yes. But selfless? I don’t see it that way. There is plenty that I gain from the surrogacy experience, so does that make it selfless? I’m not sure.

And if I’m really being honest, it’s hard for me to feel as virtuous as people make me out to be, especially when I’m only helping two people at a time. Granted, I’m helping them in a very profound way (perhaps, for them, the most profound way possible), but even still, all told I’ve impacted only 6 couples who needed help building their families.

That is, until this week.

This week I took part in Resolve’s Advocacy Day on Capitol Hill (Resolve is the national infertility association). The goal of Advocacy Day is to make many, many voices heard to our legislators and to ask them to support family-building bills that are currently before Congress. To say it was an amazing experience would be a vast understatement.

There were well over 200 people gathered for this year’s Advocacy Day and all of us worked on advancing the same bills:

S 469 and HR 3365 – Women Veterans and Families Health Services Act - these bills provide veterans wounded in the line of duty with access to reproductive treatments and adoption assistance

HR 4892 – Special Compensation to Certain Veterans With the Loss or Loss of Use of Creative Organs – this offers up to $20,000 extra compensation to use for family building initiatives

A Veterans’ Amendment to the Senate Appropriations Mil-Con Bill – this bill allows the Veteran Administration to offer IVF to veterans

S 950 and HR 2434 – The Adoption Tax Credit Refundability Act – this bill changes the Adoption Tax Credit to a refundable tax credit, especially useful for lower-income couples and families

Advancing the CDC National Action Plan for Infertility – While not a bill, this is an important initiative nonetheless. In 2014, the CDC issued a public health action plan that declared infertility a public health issue. The resulting pro-family plan identifies scientific and programmatic steps for the CDC, communities, doctors, and others to take to detect, prevent, and successfully manage infertility and our role on Advocacy Day was to ask our elected leaders to champion this plan.

As you might notice, the reproductive medicine bills are limited to veterans, not the public at large. This is because military- and veteran-specific bills are the only infertility-related issues currently before Congress. I’m told that in past Resolve Advocacy Days, the issues have included ones benefiting the civilian population as well. It was an honor to give back, even in this small way, to men and women who have served our country.

Did you know that the Veterans Administration currently bans IVF for wounded vets, even ones whose fertility-related injuries were suffered in the line of duty? It’s an archaic policy, dating back to the 1970s when IVF was still considered “experimental” (and we all know how that experiment panned out!).

It’s my hope that by speaking out this week to my Senators, my House Representative, as well as to another House Representative from a different part of the state, we can change this dated and unnecessary policy to one that not only recognizes the success of IVF treatment, but provides it as a vital solution to our wounded veterans.

And in service to the civilian population is the adoption tax refund, of course, which is great. But it’s also important to note that historically, the military has led the way in establishing new medical treatments and protocols. That means that any changes for the better in the military and Veterans Administration’s infertility policies and procedures benefit the armed forces in the short term, but all of us in the long term. And asking our elected leaders to support the CDC’s infertility action plan is clearly of benefit to us all.

It was a thrill and an honor to take part in Resolve’s Advocacy Day, but the fight is not over! There is plenty that you can do to help make these bills a reality – check Resolve’s site to find out how you can lend your voice to this important cause that ultimately benefits us all. 

Scenes From My Surrogacies: A Memoir in the Making

He eased the ultrasound probe in with a gentle hand and the screen turned from inky black to shades of grey and white lines and speckles dotted the monitor. Near the bottom of the screen appeared a small, white oval with a dark center, and he zoomed in.

“Here’s your baby!” the doctor said and his eyes lit up as a wide smile broke out across his face. He fiddled with the keyboard on the machine, zoomed in some more, and took a few measurements. It was then that we saw the very tiny white flickering speck of a beating heart.

“It’s measuring right on track, 6 weeks and 2 days, which is where it should be,” he added. “And the heart rate is 151 - perfect!”

My intended parents congratulated me and thanked me for a job well done on the embryo transfer, as I very gently propped myself up on my elbows, trying to raise my shoulders and head up so I didn’t have to speak to the ceiling all the while trying not to dislodge the ultrasound probe, which was still inside me.

“Oh, that’s great, I’m so happy it worked!” I said with a big smile on my face because I genuinely was ecstatic to be pregnant. But something else was on my mind. I pointed to the ultrasound screen – higher up and to the left of where the baby’s gestational sac could be seen.  

“What’s this spot on the screen?” I asked while glancing at my intended parents, wondering if they’d be annoyed at me for challenging the doctor.

“What’s what?” asked the doctor, not looking up from scribbling in the chart.

“This, over here,” I said, as I placed my finger on the monitor and circled it gently over the spot higher than our baby. “What’s this dark spot over here?”

“That’s nothing.  It’s just part of your lining,” he said. “You’ve got one good looking baby in there, congratulations! Come back in a week for another look to make sure everything’s growing fine,” and within minutes I was dressed again and we were making our way into the parking lot with fists full of first-issue glossy baby pictures in the form of print outs from the ultrasound machine.

We all excitedly hugged each other goodbye. “Are you disappointed it’s not twins?” my intended father asked. “Because we’re not. I mean, twins would be great, but one baby is really great too. We’re just so happy that it worked on the first try.”

“I’m still not exactly convinced it’s not twins,” I said. “There was something else on that screen.The doctor totally blew me off when I asked, but I know I saw something there.” Then I paused.

“But… maybe not…” My voice trailed off as I backtracked, realizing that I probably shouldn’t contradict their doctor’s findings. I didn’t want to come across as a know-it-all to them and critical of the doctor they chose.

And so I added “It was probably what he said, nothing, just a shadow.”

Talking About Gestational Surrogacy on the Beat Infertility Podcast

I recently had the pleasure of speaking with Heather Huhman, host of the Beat Infertility podcast. Heather is such a lovely host (and a new mom herself!) and brings a wide range of personal stories to life on her podcast, as well as helpful advice and input from fertility experts.

I am so pleased to have had the chance to talk about the ins-and-outs of surrogacy with her, and we covered a lot of ground! We talked a bit about my own infertility journey, and how that ultimately led me to become a surrogate mother myself.

We also talked quite a bit about birth itself, and the similarities and differences I’ve found between giving birth to my own children and the surrogate babies I’ve delivered.

I hope you’ll listen in, or share this episode with a friend who might want to learn more about surrogacy! You can find the podcast here on the Beat Infertility site. 

Enjoy!

Before I Was a Gestational Surrogate: My Infertility Story

This week is National Infertility Awareness Week. Did you know that one in eight people suffer from some form of infertility? That’s a shockingly high number. Shockingly high! And believe it or not, before I was a gestational surrogate mother and before I had my own three children, I was part of that one in eight statistic.

Hard to imagine, right? But infertility is a funny thing, you just don’t know who might be affected by it and in what way. My husband and I were quite young – in our mid-twenties at the time– so in no way were we the “typical” infertility patients (if there is such a thing!).

After plenty of testing on both of us (he was fine, I was not, but we didn’t know what was wrong with me except I wasn’t ovulating) we started several rounds of Clomid.  We had no luck– even the highest dose of Clomid could not coerce my stubborn ovaries to give up an egg or two to the cause.

It seems so long ago (well over twenty years now – so it really was long ago) but at the same time, I remember it like it was yesterday. I remember the longing I had to get pregnant, the desire I had to start a family, how badly I wanted to be a mother.  And I desperately wanted to see my husband become a father. I remember going to visit several different doctors and none of them having any answers for us.

I remember friends getting pregnant all the while we were trying.

I remember talking to our insurance agent one day about our health insurance policy and finding out we had zero coverage for infertility treatment. The agent (not so helpfully) suggested that we move to Maryland because they had recently passed a law mandating IVF health insurance coverage. I thought the agent was joking, but he definitely was not. Would we have to leave Virginia just to have a shot at having a family? We had already bought a house and my husband had recently started his own company in Virginia, so picking up and moving ourselves and a new business to a new state seemed just too complicated.

Life is known for throwing out curve balls when you least expect it and to make a very long story short (you’ll have to read my memoir when it comes out – the whole story is most definitely in there!), we put our infertility treatment plans on hold while we sorted out some other life issues – a big job change, two moves (though not to Maryland!), a home renovation, and more, not to mention attempting to figure out how we were going to swing the cost of IVF. And yes, as you might have guessed it, during this very chaotic, intense and distracting six months, we got pregnant. Surprise! (except it wasn’t really a surprise – like I said, you’ll have to read the book)

I have always had mixed feelings about this “beating infertility” story of mine. On one hand it has a happy ending – I got pregnant, loved it, was good at it, and decided to become a surrogate mother and help others. What’s not to love?

What bothers me about it is that it seems to buy into the old horrible advice of “Hey, just relax and have sex – don’t stress about it – you’re making it worse! It will happen when it’s supposed to happen!”

What a bunch of horseshit.  Not to mention rude. Rude!

No, I didn’t get pregnant because we stopped stressing about it. I got pregnant because I finally ovulated, knew it when it was happening, and had sex on that very day. There was no relaxation or luck involved - it was biological science, pure and simple. Although it might seem that we got pregnant when we stopped worrying about it and trying so hard, that had zero to do with it.

So when I went on to pursue surrogacy, I not only knew how much I loved pregnancy and childbirth, I also was keenly aware of what it felt like to desperately long for a baby and the frustration and devastation of not be able to conceive one. I knew firsthand what that pain felt like because I’d lived it for almost two years. But more importantly, I knew what it felt like to triumph over it.

And THAT’S what motivated me. I wanted other women and men to enjoy the thrill of laying eyes on their baby for the first time. I wanted them to be overcome with delirious joy. I wanted them to know for themselves the feeling of how love multiplies, not gets more scarce, as your family grows.

I wanted to help them remove themselves from the infertility statistics - I wanted them to no longer be part of the one in eight.

Not only am I proud to have brought nine surrogate children into the world for infertile couples, I am happy to have found my voice here on Surrogacy by Design. And this week, I’m honored to use it to speak up for infertility awareness, because everyone deserves a chance to be more than just a statistic. 

You can find out more about National Infertility Awareness Week on the Resolve website.

Scenes from my Surrogacies: A Memoir in the Making

It was the kind of machine with tape of some sort inside it, not the kind you could access by phone from afar. It was the kind of machine that created a monster that would follow me for years to come.

Checking that answering machine became more than just an ingrained habit, it became a mode of operation. I’d walk in the door, set down my things, settle the children, and check the answering machine, sometimes not even in that order. If I wasn’t alone with the kids, I would walk straight from the foyer up the stairs to my bedroom (which is where we kept the answering machine – there was no room for it in the kitchen and no jack for it in the living room) without even taking off my coat or turning on the light in the room.

As I’d cross the bedroom to the far wall, where the answering machine sat underneath the phone, my eyes would immediately lock on the display on the small white plastic box. It showed a number on it, a number that glowed in bright red. A scarlet number, that at the time, I took to assign value.

This obsession would stay with me for years, five or six years at least, until cell phones became more commonly used. And it wasn’t a mindless, unfounded obsession, like the kind that compels you to check all the window locks twice before bed every night, even though the windows haven’t been opened in months.

It was, in fact, a very intentional obsession, as I sought the answer to one question, besides the basic inquiry of did she call. What I really wanted to know - what I really wanted that goddamn answering machine to tell me - was does she actually care about me? 

How Many Embryos Should We Transfer to Our Gestational Surrogate?

It’s a question that comes up before almost every transfer. And that’s with good reason – there aren’t any hard-and-fast rules you can universally apply to IVF - each cycle is different, and each uterus that receives the embryos is different.  There are so many variables to consider that are not only physical, but emotional as well.

The most basic guideline is that you should transfer only as many embryos as babies you are willing to carry to term – no more.

But even this seemingly logical advice might be simplifying things a little too much.

Only in a perfect world would one embryo transferred result in one baby being born, making the decision of how many embryos to put back in an easy one. But as we know, not every embryo transferred grows into a baby, and on the flip side, once in a while an embryo will split from one into two. So how do intended parents decide how many embryos to transfer to their gestational carrier so they can maximize their chances of achieving a pregnancy while also minimizing the odds of high-order multiples? (defined as triplets or more, though some intended parents or even gestational carriers wish to minimize their chance of carrying twins)

Obviously the first step is listening to your embryologist and your reproductive endocrinologist. They’re the ones most familiar with your unique medical history and the quality of the embryos you’ve created. By considering all of the relevant medical factors, they can give you their professional opinion on what they feel is best in your particular case, based on the information they have at the time of the transfer.

However, you and your gestational carrier should also be on the same page with what you’d like in an ideal scenario, and that discussion should take place as you’re matching with one another and before you sign contracts. If you feel strongly about transferring two embryos and your surrogate only wants to transfer one, you could end up in an uncomfortable position at your transfer, one that could have been avoided had you discussed it with one another earlier.

Again the key here is “ideal scenario.” You should come to an agreement on what your ideal scenario is (for example, transferring two 5-day old blastocysts) as well as discuss other possibilities. While you can’t possibly make firm plans that cover every different potential embryo scenario you might encounter, you can talk through how you feel about variations that differ from your ideal. That way, when your transfer day arrives and you have the latest information about the quality of your embryos to consider, your decision making process will be much easier and less overwhelming.

In the rare but possible case that an embryo splits and your surrogate is pregnant with more babies than one or both of you are comfortable carrying, what happens next?  What’s in the best interest of you the intended parents, your gestational carrier, and your unborn babies? Although no one likes a high-risk pregnancy, few people are comfortable with selective reduction, either.  

While transferring only the amount of embryos that you would be like to be carried to term is the best way to avoid a difficult situation, that strategy does not always prevent it from happening (an embryo splits after transfer about 1% of the time – so the odds are slim, but not non-existent). You and your gestational carrier should discuss the issue of selective reduction in the case of not only grave birth defects, but also in the event that you end up with more babies growing than you intended.

The day of your embryo transfer is a very exciting one, for you as intended parents as well as for your gestational carrier. With good medical care and advice along with honest and open communication the months prior to your transfer, you can maximize your chances for a successful pregnancy while also minimizing the odds of complications. Just as in life, there are no guarantees in IVF, but careful planning and forethought along with an open-minded dialog between all parties can definitely put everyone in a position for success. 

Scenes from my Surrogacies: A Memoir in the Making

Friends of ours – the best man at our wedding and his fiancé – were visiting from out of town and we planned to spend the day together followed by a night out on the town. I’d made an early morning run to the grocery store to pick up supplies for a picnic lunch and on my way to the deli, I passed by the feminine hygiene section.

Something caught my eye and I doubled back. On the bottom shelf were ovulation predictor kits. I was familiar with them of course, I’d taken countless tests at home to plan exactly when we should have sex in order to conceive, but I had never seen a positive result on any test I took.  I scoffed at myself for wishful thinking and getting distracted from the mission at hand of packing lunch.

But seemingly against my will and better judgment, I grabbed the blue box of kits, tossed it in my basket and finished shopping.

I drove home, packed lunches for four, and went upstairs to change into my bathing suit, taking the box of ovulation predictor kits upstairs with me. Not knowing why I was doing it after years of failure, I peed on the stick.

These sticks work just the same as home pregnancy tests – you hold them in the stream of your urine, soak the tip, and wait a few minutes for the result. Except this time, I had results almost instantly – the stick showed that I was ovulating. There were two very clear parallel blue lines right before me.

I gasped and look incredulously at the stick, wondering what was happening. My heart was pounding. I hadn’t ovulated in over six years and today was the day. Most of the house was already packed in boxes in preparation for our move, but our bed was still at the ready and would be getting some use today.

And then the doorbell rang. Our friends were here. 

Talking About Infertility, Gestational Surrogacy, and Other Things

Gestational surrogacy is a team sport if ever there was one! Between the intended parents, the surrogate mother, the medical team and all the supporting staff (lawyers, psychologists, administrators, etc.), it really does take a village to have a baby through assisted reproduction.

And sometimes the team includes others as well – an egg donor, or a sperm donor, or possibly even both. I recently had the chance to be interviewed by The Donor Group, an agency that specializes in egg donation services, and I’m happy to share itwith you.

We had fun in the interview – talking about not only topics related to fertility and surrogacy, but what motivates me and gets me up in the morning (I bet that will surprise you!), my own journey toward parenthood, and where I draw inspiration from.

It’s a fun behind-the-scenes peek at Surrogacy by Design, and I hope you enjoy it - you can find it here on The Donor Group's site!

Announcing my Surrogacy Support Doula Services

I can’t even recall over the years how many people have said to me “Oh, you’re a surrogate mother? My neighbor/second cousin twice removed/daughter’s dance teacher’s sister is looking into surrogacy, would you talk to her?”

My best guess is that I got that request maybe 20 times, and of course I always said that yes, I’d be happy to talk with them.  The conversations actually materialized probably 15 times over the years and I had the last one with someone about a year ago.

And I was always genuinely happy to help these people, though I was never in a position to actually carry a baby for any of them (the timing was never right). These were strictly “information sessions” I gave them, going over all of the basics of gestational surrogacy, giving them a first-hand look into the process, and helping them decide if surrogacy was in fact a good choice for them.

For all of them, I was the first person they’d ever met or spoken with who actually was a gestational carrier herself, which was something they all seemed to enjoy and find valuable.  Because it’s not every day that your path crosses with a surrogate mother, right?

And because I had no stake in the meetings or conversations (because we knew at the outset that I wouldn’t be the one to carry for them), we were able to talk candidly and freely, which I think was very helpful to them.

Which led me to an idea.

If my time and experience was valuable to these people who crossed my path through random luck, there’s a good chance that my experience could also be valuable to many other people.

And given that I’m not going to carry a baby again, and I’m definitely not getting into the business of matching intended parents with surrogate mothers (i.e., I’m not starting a surrogacy agency), I can offer something uniquely valuable to potential intended parents – my objectivity.

And that’s the how the idea of a “Surrogacy Support Doula” was born.

My goal is to provide informative, compassionate, objective and flexible help for a range of people – those just exploring the idea of surrogacy, people who would like some support getting their surrogacy arrangements underway, as well as those who would like someone to coach them through their entire surrogacy experience.

Surrogacy, unless you’ve been through it yourself, is an experience full of unknowns. It’s a very personal and high-stakes time in your life and even when things are going well, it can be reassuring to have an objective confidante who knows the ins and outs of the process.

As a Surrogacy Support Doula, I can provide my expertise and support to people (couples or singles, men or women) looking for insight on what it’s really like to go through the surrogacy process and address all of their unique questions and concerns along the way. Just as every pregnancy and delivery is different, so is every surrogacy – maybe more so because you’ve got more people involved in the pregnancy from the start! Having good information and an objective, reliable source of support is the best way to enjoy a successful surrogacy.

Feeling confused, overwhelmed or anxious about using a gestational surrogate mother does not have to be part of your path to parenthood – there’s a helping hand ready to support you through this.

Want to learn more? I offer three different Surrogacy Support Doula packages – take a look! Or do you know someone who might benefit from a helpful voice of surrogacy experience? Please pass this link along! 

Wishing you a successful and rewarding surrogacy!

Scenes from my Surrogacies: A Memoir in the Making

And so it was set - my mother insisted that we throw a party. An “easy” party.

Which was easy for her to say. My kids were ages three, four and six and we were just coming out of the stage of life where every meal was a circus and the odds of them having a meltdown were just slightly less than the odds of them holding their shit together.  And although the kids had met my intended parents several times already and liked them, they were still shy by nature and easily overwhelmed. And I would naturally be the center of attention, the one person who drew two these three families together – families who otherwise never would have crossed paths. Given that, could I meet the needs of my young children, in a potentially overwhelming situation right in their own home, while also being a gracious hostess? 

Why You Should Always Meet Your Gestational Carrier In Person Before Signing a Contract

It almost sounds a little silly as I type out those words, and I’m the one writing them.  What gives? Who doesn’t meet their gestational carrier, you might wonder.

Believe it or not, it happens.

In my early days of surrogacy, I belonged to several online support groups with surrogates and intended mothers from across the country.  Although the majority of the experiences the women brought to the group were positive, there were a few hair-raising ones as well.

One particularly unfortunate story involved an experienced surrogate carrying for a couple that maintained homes in the United States and Europe. They had an independent agreement (meaning they didn’t use an agency to find one another or negotiate their contract) and they used a US fertility center. They used donor eggs and the intended father’s sperm, and the surrogate was pregnant with their baby girl.

Throughout the contract agreement phase and the entire pregnancy, the surrogate spoke only with the intended father by phone. He told her that his wife spoke little English and they were overseas, so she had no contact with her intended mother.

When she delivered the baby, the intended father didn’t come to the birth. Within a day or so of giving birth, he revealed to her that his wife was never aware of the pregnancy and did not want the child, and therefore he didn’t want the baby either.

Shocking, right?!?

All’s well that ends well (in theory, at least) – the surrogate was able to get temporary guardianship of the baby and placed her with adoptive parents, who no doubt were elated.   But the guy who orchestrated the pregnancy and his unsuspecting wife? Clearly all sorts of crazy.

It turns out that the surrogate never met either of the parents (and this was long before the days of Facetime or video conference calls). She’d only spoken with the intended father on the phone, and nothing more. Granted, in no way, shape or form did she deserve this to happen to her, but I have to wonder if the situation could have been avoided had she insisted on meeting both parents prior to agreeing to carry for them.

And if you follow the news, you probably already know about an unfortunate surrogacy case currently happening in California, where a gestational carrier is pregnant with triplets for a single father. He wanted to reduce the pregnancy, which she refused to do, and now it’s in question whether he wants any of the babies  at all (though they’re all his).

As it turns out, she agreed to carry for him and became pregnant with his children without ever meeting him, or ever speaking with him for that matter (he is deaf, but still, there are mechanisms for people who are hearing impaired to communicate by phone, and of course there’s email).

Now there’s no way to know for certain that these, or any other grave problems with surrogacy could have been avoided if the matching process required at least one face-to-face meeting. But it sure seems like it would help.

Critics of surrogacy say that the process is demeaning to women and reduces them to their most basic evolutionary function – breeding. Advocates of surrogacy (like me) maintain that when thoughtfully and carefully executed with free will and full information, surrogacy is a beautiful act of love that benefits all parties involved. 

What’s questionable, then, is whether anyone can consider themselves “fully informed” if they haven’t actually met their surrogate mother or their intended parents in person. Sure, phone calls and Skype can get the ball rolling when initially getting to know each other and are especially helpful when each party is a great distance apart – I’m not advocating that couples spend excessive amounts of money when initially screening potential gestational carriers.

I, am, however, suggesting that a face-to-face meeting is a required component of the matching process. We are, after all, human beings with emotions and body language and senses and intuition – all of which are enhanced when we share physical space with one another.

The vast majority of potential surrogate mothers and intended parents all have the best intentions – to embark on life-changing journey together. And what’s more profound than creating a new life together? Isn’t that experience worth the bit of extra time and expense to feel in the flesh, deep in your heart, that you’re the perfect team to pursue the goal of parenthood together?

It may seem like a lot of money to spend initially, but the outlay for travel prior to finalizing any surrogacy arrangement is priceless in the grand scheme of things. And while it might not eliminate all potential pitfalls, it’s a very significant start and can  help to minimize heartbreak down the road

Your peace of mind as an intended parent or a surrogate mother is worth it!

Scenes from my Surrogacies: A Memoir in the Making

Her words did not shock me. I knew even before laying down on the table in the warm, darkened room what today’s results would show. So when the ultrasound technician flipped on the monitor and studied the chalky white lines that appeared on the screen and her face clouded over, I waited for her to tell me what I already knew.

The baby had no heartbeat. 

Until today I’d had no proof that the baby had died, and there were no outward signs that anything was wrong, so I hadn’t said anything to my intended parents or the fertility doctor. What was there to say anyway? I don’t think this one is going to make it? Why would they believe me anyway? Or even if they did, why would they want to?

They had been down this road so many times before – they’d had many previous miscarriages themselves, their first surrogate miscarrying her initial pregnancy for them, and now this. Does having that history make it easier for them to cope, I wondered? I felt guilty for even considering that possibility.

Three Big Things I Look for When Choosing Intended Parents

Although there are some differences throughout various regions of the country, there are generally more couples looking for a surrogate mother to carry for them than there are qualified gestational carriers available (this is particularly true in larger cities).  So it’s natural for couples to wonder what factors a potential surrogate mother might consider when deciding whether or not work with a couple.

Whether couples and gestational carriers are looking to match up with one another through an agency or independently, there’s no question that the whole process feels like a courtship for everyone. Both parties put time and effort into getting to know one another so they each can make the best decision.

There are several factors that all surrogates and couples run through as part of the very basic, initial screening – the number of embryos each is willing to transfer, their views on selective reduction and pregnancy termination, their desire for a close relationship versus a professional transaction, religious views that could restrict behaviors on either party’s part (such as dietary restrictions), etc.

These requirements are somewhat easy to address. But what about other components of the surrogacy relationship – the basic personality match as well as the parts that are more difficult to discern? Aside from having personalities that “just click” (this is often described as the case for many intended parent-surrogate mother matches), what other factors might a potential surrogate mother take into consideration when deciding whether or not to work with a couple?

Naturally every woman has her own requirements that are based on her personality, preferences, and prior experiences. And having successfully matched with six different couples myself (while also not matching with several couples over the years, too), I’ve had the chance to really clarify what’s most important to me. These three factors may or may not be essential to other gestational carriers, of course, but they’re also not uncommon, either.

1. An openness from the beginning to developing a close, personal relationship

Feeling close to my intended parents was always important to me, and I wanted to work with a couple that felt the same way. And for the most part, I did, though some surrogacies went better than others. This is only natural, of course, because we’re talking about human relationships and a wide variation is expected. However, I found that those couples who initially expressed their desire to develop a close relationship were indeed the ones I ended up closest to throughout and after the pregnancy and delivery.

The first couple I carried for said, at the outset, that they wanted to see how things naturally developed between us – they didn’t want to commit to any preconceived expectations for the relationship. This felt like a red flag at the time and I raised my concerns with the agency, but they dismissed my worries as “first time jitters” on both of our parts.  Ultimately the experience did not go well for me, the relationship was very tense and they cut off all communication with me immediately after the birth. Looking back I could see the signs of their lack of desire to have a relationship with me from the very start. It was a hard lesson, but one that used to help me find better matches in the future.

2. Timely communication

By timely I don’t mean instant. There were plenty of times during my surrogacies that I just couldn’t respond as quickly as my intended parents could, merely because I was caring for my own young children while pregnant with their baby. So it’s very important to consider context and life situations when assessing how slow is too slow with communication. But some things are very time-sensitive (medical, legal) while in other situations it’s just polite to respond quickly. Responsiveness was definitely something I considered when deciding whether or not to work with a couple.

I was once matched (through an agency) with a sweet couple. We had one meeting and seemed to hit it off. In the meantime, I was introduced to a friend of a friend who was also interested in me carrying for them. I told them I was talking with a couple from my agency and I would let them know if that match fell through. A month went by before I heard anything from the agency couple and by then I’d already moved on to talking with the second couple. I told my agency that I just wasn’t comfortable proceeding with a couple that took that long to get back in touch with me.

3. Trust in my body

For couples who’ve struggled with infertility and have been through many procedures and possibly losses themselves, any pregnancy is likely to be a mix of anxiety and nervous anticipation.  And for any woman who would have loved to carry for herself (which describes all of the women I carried for), the loss of control that comes with having someone carry your baby is stressful, undoubtedly. Those are issues that I always took into consideration when talking with potential couples, because it surely can’t be easy to turn over all physical control (and enjoyment) to another women.

However, I also had a history of easy, healthy and uneventful pregnancies and births and I had a deep need for the couples I worked with to trust me and my body. I always felt good about the process and enjoyed my pregnancies and did not want that dampened by overbearing concern from my intended parents (I know some degree of concern is natural, of course – but too much would be hard for me to endure). My best relationships started with “You’re an expert at this and we’re lucky to have you carry our baby because we know you can do this successfully. This vote of confidence was essential to me.

I spoke with one couple for several months and we seemed to be very compatible. She had carried their first child, but because of her own physical issues, it was a complicated and difficult pregnancy and she was advised not to carry again. She was cared for by many high-risk doctors during her pregnancy and she expressed, many times, that she wanted me to see the same high-risk doctors to ensure I was getting good prenatal care. Despite my explanation that I didn’t need high-risk care, she felt strongly about it and I was forced to tell her I couldn’t carry for her. I tried to explain very gently that we had significant differences in how we viewed my medical care that could not be resolved, and neither of us would be happy with a compromise. She was very upset, understandably so, but I still think it was a good decision that was in both of our best interests.

These aren’t the only qualities I looked for when meeting and talking with potential intended parents, but they are some of the bigger issues I took into consideration. If you’re an intended parent, I’d love to hear your feedback on this. Or if you’re a surrogate mother, does this ring true for you as well? Or are there other factors you take into consideration when deciding whether or not to work with a couple? Leave a comment and let us know!