Scenes From My Surrogacies: A Memoir in the Making

Doug was splitting his time that day between work and visiting me, so my mom brought my two oldest kids to the hospital to visit me and to see the twins. Once they’d arrived, Grace brought the babies, tightly swaddled and bundled together in one rolling plastic bassinette, up to my hospital room, located one floor above the nursery.  Although the babies were a good size when they were born – 6lbs and 6 lbs, 9 oz, - they could easily have passed for a little girl’s toy dolls laid lovingly in a plastic shoebox.

The kids peeked into the bassinette and their eyes grew wide as I grew nervous. Would Grace let them hold the babies? Would she even let them touch them? I had never felt so much like I was in uncharted territory as I did now that we were both finally mothers. 

Should You Try to Find a Gestational Carrier Who Lives Close to You?

When I was a gestational carrier, I had one initial screening criteria for intended parents before I asked any other questions:  I wanted to know how close they lived to me. For me, the closer the better.

I carried babies for six different couples in three different states, and since giving birth, many of them have moved away. However, when I was actually pregnant with their children, all of the couples were local to me. The closest one was 20 minutes away, and the farthest one was just over an hour away. This was entirely by design on my part.

In addition to really enjoying pregnancy and childbirth, what I wanted most out of surrogacy was to bond with my intended parents and enjoy sharing the pregnancy with them. I wanted them to come to all of my doctor’s appointments, I wanted them to see with their own eyes how my belly grew, and I wanted them to be able to feel with their own hands when their baby kicked, rolled, and hiccupped. 

So by only working with couples who lived near me, did I get all this? Mostly, but not entirely. But I did get enough of it to be satisfied by the experience.

Given that I live in a big metropolitan area with a highly educated population and high cost of living, it wasn’t hard for me to match with intended parents that lived near me (gestational surrogacy is much more common in these areas and there is a higher concentration of fertility centers). But being able to work with someone locally is by far the exception rather than the rule – and I knew I was lucky in that respect.

Had I lived in a more rural area, chances are I would have had to compromise on something – either the suitability of my match (which is never a good idea to compromise on) or my location requirements. In retrospect it’s easy for me to see that while living away from my intended parents might have been disappointing, distance is a far easier hurdle to overcome than a bad match.

Not to mention that technology makes it easier than ever to stay connected. As it turned out, I grew closer to my intended parents through our phone conversations, emails and texts than I did during the times we actually spent together. Sure, it was nice to be able to see them in person each month, but it wasn’t really the hustle and bustle of our doctor’s appointments that helped us grow close. Instead, it was all the seemingly mundane, day-to-day contact by phone, text or email throughout the pregnancies that allowed our relationships to really grow and develop.

If you’re mulling over the issue of physical distance in your surrogacy arrangement, here are some things to consider. There are no right or wrong answers to any of the questions, merely preferences to take into consideration:

• Would you prefer to be able to see your gestational carrier frequently, or are you a very private person who might do better with less frequent in-person visits?
• Are you eager to attend each doctor’s appointment with your gestational carrier, or are you satisfied getting a summary after the fact?
• How much free time do you have to devote to getting together with your gestational carrier during the pregnancy, outside of doctors’ visits?
• How comfortable are you with technology beyond emailing and texting? Are you open to using video conferencing programs like Skype or Facetime?
• What is your budget for travel? If you choose a surrogate who lives far from you, how often will you be able to visit, if at all, prior to the birth?
• Given the area that you live, how likely is it that you’ll find a gestational carrier near you?
• If given the choice between working with someone near you but waiting longer for the match, or working with a carrier many hours away but matching and starting a cycle sooner, which would you choose?

By thinking through these questions and discussing them with your partner, you can hone in on what’s most important to you in your surrogacy experience and plan accordingly. But by having a clear picture of what you’re hoping to get out of the experience, your efforts will be much more efficient and successful. Even if it takes a little more time than you hoped, the right match is almost always worth the wait!

Scenes From My Surrogacies: A Memoir in the Making

I’d reached 39 weeks with these little girls and I was still enjoying every day of my pregnancy. Despite that, I was even more excited to finally reach this last stage of my surrogacy, the point where I’d give birth and watch her hold her children for the very first time. She would see them; she would hear them; she would smell them; she would touch them. She would finally come to know them in the carnal way that only I had the privilege of experiencing up until this day.

It’s the vision that I, and every other surrogate mother that I knew of, held so dearly. It’s the vision that inspires us to become gestational carriers in the first place and it’s the motivation that keeps us going through the challenging and inconvenient aspects of the pregnancy, of which there are always many.  We keep our eyes on this prize because to us, it’s not taking the babies home that we want – it’s seeing our intended parents take their babies home that deeply satisfies us. It’s what closes the circle of life for us – the life we started within our own and pass over to someone else to complete. There’s nothing else on this earth quite like it, to grow a human for someone else. 

What is the Ideal Age for a Gestational Carrier?

There’s a very short and sweet answer to this question that can be stated in just one sentence:  Follow the guidelines your fertility center gives you.

But like everything else in life, the issue does not have to be quite so black and white, which is probably a good thing (this coming from a woman who gave birth to her last surrogate baby at the age of 45).

If you are looking for a gestational carrier through an agency, the agency will have applied its own screening requirements to any potential surrogate candidates that you meet. In general, agencies accept women between the ages of 21 and 40, though some more conservative programs cap the age for women they’ll work with at 35, while some will allow a carrier to be 41 or even 42.  Because a gestational carrier is not using her own eggs for the process, her age does not have an impact on your baby in terms of chromosomal and genetic health.

It’s easier to make a case for the minimum age guideline than it is for the upper threshold. Most agencies and fertility centers require a woman to be at least 21 years old because it’s an enormous responsibility- both physically and emotionally – to carry a baby for someone else. While a woman does not have to be married to be a surrogate mother, she does have to have given birth to at least one child already, be in a stable, secure living situation, and not be on any form of public assistance.

Upper limits on a gestational carrier’s age have a much wider range of variability. While the emotional maturity and life stability issues generally aren’t as much of a factor for a woman in her late thirties or early forties, physical considerations take the primary focus. The older a woman is during pregnancy, the higher the risk she has for gestational diabetes, preeclampsia, placental abruption, and placenta previa (where the placenta is positioned low in the uterus, partially or entirely covering the cervix). There’s also the consideration that a pregnancy – even an easy one – is physically taxing, and generally speaking, a 23-year old will find it physically easier to endure than a 43-year old.

Even so, that doesn’t mean that a woman in her late thirties or even early-to-mid forties isn’t an ideal choice for a gestational carrier, because the experience is about much more then the physical aspects of the pregnancy.  And in many cases, age can offer some benefits, as well.

A potential gestational carrier who is a bit older is less likely to be caring for young children herself, which can be a benefit for scheduling appointments, or even if she just needs a little extra rest.  If she has a career, she may be more established, which may allow for more scheduling flexibility with her work hours.

A woman on the older end of the surrogacy spectrum is also likely to have a more mature outlook on the surrogacy process itself, and have a fuller understanding of the intricacies of the medical, physical, social and emotional aspects of the process, as well as all of the responsibilities. And although not universally true, the older a woman is, the better she knows her body, which can be a big benefit during pregnancy, labor and delivery.

No matter what the age of your potential gestational carrier, she will have to undergo a wide range of medical testing to determine that she’s a good candidate to carry for you. A woman who is healthy, fit, and has a history of low-risk pregnancies and easy deliveries but is in her forties may actually be a better choice than someone younger who does not maintain as healthy of a lifestyle or who has had difficult pregnancies or deliveries.

If you’re matching with your gestational carrier independently, it’s a good idea to check with your fertility center and ask about their particular age guidelines. While all centers have age limits, some are more flexible than others in interpreting them (in my experience the larger centers had more fixed, less flexible requirements, while the smaller centers were much more willing to look at the whole picture of a potential carrier’s health). Some fertility centers will make exceptions if your surrogate has already carried a child for you (i.e, if you’re trying for a sibling) or if you’re hoping to have a family member or close friend serve as your carrier.

Again, any potential carrier, previously known or unknown to you, has to be medically suitable for the surrogacy process. And just because a woman is younger does not necessarily mean she’s better able to serve as a gestational carrier – there are a wide range of medical, social, emotional, psychological and even financial factors to consider.

If you or your agency or your fertility center have a firm cut-off age, then let that be your guide in your search for a surrogate. But if you happen to really click with someone who isn’t the ideal age you anticipated, don’t let age overshadow your decision process – try to keep an open mind. You just may find your perfect match in someone you least expect! 

Scenes From My Surrogacies: A Memoir in the Making

October is National Pregnancy and Infant Loss Awareness Month and so as part of raising awareness and educating the public about miscarriage, stillbirth, and infant loss, my posts this month reflect this theme.

I alternated between passing and inspecting tissue on the toilet and laying limp in a heap on the bathroom floor for about an hour as the cramping and contractions ebbed and flowed. Had I passed the baby yet was all I wanted to know. It was all I needed to know.

I heard my daughter passing by in the hallway and I yelled, in as calm a voice as possible, asking her to send Doug upstairs. By the time he got to the bathroom, I’d rallied a brave face.

“Oh my God!” he gasped, coming into the bathroom.  “Are you OK?”

“Yeah, I whispered, “Didn’t you hear me pounding on the floor?”

“I thought it was one of the kids messing around, I’m so sorry,” he said, getting down on his hands and knees. “What can I do?” he said, coming near me.

“It’s just a lot of blood. Don’t touch me!” Every part of my body hurt by this point and I was still in my laboring frame of mind where being touched would send me into mental and emotional orbit.

“Do you need anything? Can I get you something? Do you need a washcloth or a towel? Do you want me to stay here with you?”

“No,” I said, “It’s OK. Just keep the kids away.”

Ten Quick Facts About Pregnancy Loss

October is National Pregnancy and Infant Loss Awareness Month and so as part of raising awareness and educating the public about miscarriage, stillbirth, and infant loss, my posts this month reflect this theme.

For most people, a miscarriage is devastating to go through and it can be hard to accept such a sad outcome, particularly when the pregnancy was very much wanted. Although there are few things that comfort a woman going through a miscarriage, it's important to understand just how commonly they occur. Here are ten quick facts that shed light on the frequency and reasons behind miscarriage and pregnancy loss: 

1.  For the general population, approximately 20% of all pregnancies end in miscarriage

2.  Over 80% of miscarriages happen before 12 weeks

3.  Approximately 75% of miscarriages are due to abnormalities with the embryo (usually, but not always, chromosomal in nature)

4. The remaining 25% of miscarriages are caused by implantation issues (problems with the uterine lining, the mother’s immune response, or biochemical abnormalities)

5.  Women in their mid-twenties have a 20% chance of miscarrying due to chromosomal issues

6.  Women in their mid-forties have a greater than 50% chance of miscarrying due to chromosomal issues

7.  Once a fetal heartbeat is detected, the risk of miscarriage is approximately 5%

8.  Stillbirth, which is considered fetal death after 20 weeks, occurs in .6% (or 1 in 160) of pregnancies

9.  The risk of stillbirth (the baby dying in utero prior to being born) or neonatal death (the baby is born alive, but dies within 30 days from birth) is about .5% (or 1 in 200)

10. At least 22% of pregnancies end before they can be detected by urine or blood tests

Scenes From My Surrogacies: A Memoir in the Making

October is National Pregnancy and Infant Loss Awareness Month and so as part of raising awareness and educating the public about miscarriage, stillbirth, and infant loss, my posts this month reflect this theme.

Although I really didn’t want to go this route, together my intended mother and I decided that if the bleeding didn’t start by the following Monday, I’d schedule a D&C. I needed to stop wondering, she needed closure on her grief, and we both needed to begin the process of putting this pregnancy behind us and looking toward the future. It had been three weeks since the ultrasound showed that the baby had stopped developing, though I had inklings of it a couple of weeks before that.

And setting a date for a D&C was all it took. I’m fairly certain that it was committing to this mental benchmark on the calendar that allowed my body to finally let go.

It was Sunday evening and the weekend was winding down. The dishes were done, Doug was settled on the couch watching soccer while working on some freelance projects, and the kids were scattered to their own pursuits. I was sitting at my sewing table, sketching and moving pieces of fabric around trying without much success to design a new quilt, when I felt the first twinges creeping up and across my low belly. Although I had not been through a full miscarriage before, it was impossible not to know was happening.

The cramping was mild but steady and I was surprised at how similar the waves of pain felt to the beginning stages of labor, which seemed like a cruel joke.

The biggest difference I could tell between the onset of labor and my miscarriage was that those initial feelings that wash over me – the involuntary part of my mind that I tune into once the physical changes start, the part of me that tells me the truth when my rational side wants to explain away the signals my body is sending - were saturated with grief and desperation rather than the wonder and excitement that comes from ending a pregnancy by delivering a baby. 

Seven Tips To Ease the Way if Your Gestational Carrier Has a Miscarriage

October is National Pregnancy and Infant Loss Awareness Month and so as part of raising awareness and educating the public about miscarriage, stillbirth, and infant loss, my posts this month reflect this theme.

For many couples, it’s an unfortunate fact that miscarriages tend to go hand in hand with fertility treatments. While many studies show that pregnancies through IVF don’t have any greater risk of miscarriage than naturally conceived pregnancies do, sometimes it can feel as if they do, given how closely IVF pregnancies are watched and monitored.

And while any kind of pregnancy loss is devastating, it can be particularly difficult to go through a miscarriage as an intended parent because of the third party involved in your pregnancy - your gestational carrier. Since she was the one who was pregnant, she must now endure the physical and emotional aspect of her pregnancy loss and it can be a hard to know how to ease the way.

Of course there’s no one best way to handle a miscarriage during surrogacy, but here are some tips to help ease the way through this painful and stressful time:

• Remind yourself (and your surrogate, if need be) that no one is at fault for the miscarriage, no matter how hard it is to accept. Your gestational carrier should have a proven history of conception and successful pregnancy and birth, so it’s highly unlikely there was anything on her part that caused the loss. With gestational surrogacy, the most common cause of miscarriage is chromosomal abnormalities.

My experience – Although I’d never had a miscarriage with my own children, both times I had a miscarriage, I wasn’t surprised because the intended parents had also had many miscarriages of their own, which points to chromosomal factors as a likely cause.

• Rest assured that your surrogate mother does not blame you for the miscarriage either. Nothing could be further from the truth, even if the pregnancy ended due to chromosomal issues with the embryo. Any well-screened and emotionally stable gestational carrier knows there is always a risk of miscarriage with IVF and although it’s difficult to go through, she knows it can be part of the process.

My experience – I was surprised that I didn’t experience my first miscarriage until my seventh pregnancy, given how common they are.

• Take the time you need to initially process the news before talking to your surrogate mother. If you’re overcome with grief when you find out about the loss, take some time to work through your initial feelings and calm down a bit. If you’re concerned about not being in touch with her right away, send a quick text or email that says “I’m thinking of you and I need a little bit of time before I call you, but I’ll call you as soon as I can.”  This lets her know that you still care about what happened, but that you need to process it for bit so you can better support her. While it can be therapeutic to cry together, it’s not very helpful if you’re so upset you’re not in control of your emotions.

My experience – I had my doctor call my intended mother to tell her that the baby no longer had a heartbeat, and she called me about an hour later, which was for the better because we’d both had some time to let the news sink in before we talked.

• Don’t be surprised or offended if your gestational carrier does not seem as upset as you are. Everyone processes loss differently, and she may still be trying to come to terms with it. Or it’s possible that she wasn’t surprised by the miscarriage, since some women get a feeling that something’s not quite right in the days or weeks preceding a loss.  Your surrogate may also be temporarily more preoccupied with what comes next for her physically than she is about the loss, or she may have been through this before and be able to better take it in stride.

My experience – When I had my second miscarriage, I knew at least a week before the appointment that the baby wasn’t going to make it, it was just a feeling I had, so when the ultrasound tech didn’t find a heartbeat, I wasn’t surprised. I was actually a little relieved that there was a reason behind my suspicions.

• When you’re both calm and clear-headed, discuss what, if any, medical procedures need to be done. Your gestational carrier will immediately stop her estrogen and progesterone and depending on the situation, will schedule a D & C with her doctor or will wait for the bleeding to start (if she’s not bleeding already). If she has the choice between having a D&C or waiting for a natural ending to the pregnancy, support her preference.

My experience – My first miscarriage was losing one of twins, so the baby was reabsorbed as the pregnancy continued with the surviving twin. With my second, I decided to wait for the bleeding to start in hopes of avoiding a D&C. It took over three weeks for the bleeding to start (which was a little nerve-wracking, for sure!), but I’m glad I was able to avoid surgery.

• After the miscarriage, be in touch with your surrogate mother but on the other hand, don’t smother her with attention. While you’re both healing emotionally, your gestational carrier is also healing physically and it will take some time for her hormones to return back to their pre-pregnancy levels. Let her know that you’re there for her if she needs anything and try not to feel offended if she needs a little time and space for as she heals and her hormones drop to their pre-pregnant levels.

My experience – I always appreciated when my intended parents sent me something that my whole family could enjoy, like a fruit basket. Yes, I was the one physically going through the miscarriage but my family was also supporting me at home, so I liked that they felt appreciated as well.

• Once the initial shock and trauma of the miscarriage has passed, don’t be afraid to talk about what comes next for your surrogacy journey together. Whether you have frozen embryos to use or you’ll be starting a fresh cycle or something else, your gestational carrier will probably appreciate having a new plan to look forward to. After all, she wants to carry a baby for you, and the miscarriage is just a stumbling block on the way to making your dreams come true.

My experience – I lost a baby in late October but didn’t have the miscarriage until mid-November. During this time we agreed that we’d wait out the holidays and do another frozen transfer in January. This was a relief to me so that I didn’t have to schedule appointments over the holiday season, but having the plan in place gave us all something exciting to look forward to in the new year.

If there’s one thing that’s universally true about miscarriage after an IVF cycle, it’s that it’s a painful ending to a very much wanted pregnancy. As an intended parent, it can feel especially difficult because it’s hard to watch another woman go through something so sad and painful as she helps you become parents.

Yet while it is hard for your gestational carrier to endure a miscarriage, she also knows that unfortunately, sometimes it’s just a natural part of the process. Once she’s recovered and you’ve had time to come to terms with your loss, it’s important to lean on each other for support and make plans to move ahead on your fertility journey together. 

Scenes From My Surrogacies: A Memoir in the Making

Would she, as some point, want to ask me about what it was like to be pregnant with her, a conversation most children have with their mothers at some point in their young lives? Would she ask her two dads about me, wanting to know details about my pregnancy with her, and what would they say? What could they say?

As she got older, would she find it fascinating or questionable or shocking or disappointing that she was conceived before her parents were married? Or was that a completely outdated consideration? Or was it a crazy notion in the first place, given that she was the child of two gay men and her life would always be far from the mainstream from the outset? What difference would it make anyway when she was conceived, especially when gay marriage was not even legal when we conceived her?

Were these issues that would someday concern her, or even consume her, and would I feel responsible for it? 

How Do I Choose the Right Fertility Center?

When you need medical care in order to conceive a baby, it can feel like nothing is more important than which fertility center you choose.  How exactly should you make that choice when there’s so much at stake? You may live in a more rural or remote area where there are only one or two choices available to you and that will limit your options if you want to work with someone locally. However, fertility centers are popping up all over and soon you may have more options to select from. And if you live in or near an urban center, the choices may seem endless. So how do you make a choice, particularly when your decision affects not only you, but your gestational carrier too? Here are some of the key factors to consider:

Insurance Coverage

If you haven’t checked it already, the best place to start might be with your insurance coverage. Depending on what state you live in and the specifics of your individual policy, you may find that some or even all of your IVF fees may be paid for. If this is the case (lucky you!), be sure to check to see which fertility centers near you participate with your insurance.

Don’t choose a fertility center just because it’s covered on your insurance, though – just because the clinic has a contract with your insurance carrier does not automatically make it the ideal choice for you and your unique situation. Be sure to look at all of the various factors that contribute to IVF success and make your decision taking everything into consideration.

Also, be aware that while your insurance may cover the cost of going through IVF for yourself, they may not cover all or even any of the cost of going through IVF when using a gestational carrier. Be sure to ask your insurance carrier to specify the limits of their coverage.  In many cases they will cover your part of the cycle and medications, but not your surrogate’s – so be sure to ask.

Clinical Success Rates

Once you’ve made a list of possible clinics to work with, you should research the success rates of each center you’re considering. You can compare fertility center success rates through the ART Success Rate page on the CDC’s website. While you want to choose a clinic that creates a respectable amount of pregnancies each year, don’t feel obligated to choose the one with the highest success rates, because the statistics are not as straightforward as they seem.

Many different factors influence a clinic’s success rates, including ages of their patients, the type of procedures being performed, and how the clinic screens who takes part in their treatment, among other things. The fact you’ll be using a gestational carrier definitely affects your own personal success rate – usually for the better.  So take success rates into consideration along with other factors. In addition to the CDC report, fertility centers should post their own success rates on their websites – if they don’t, be wary.

Size of the Fertility Center

Fertility centers can range in size from a solo practitioner, who will be the doctor you’ll see at every single visit, to large, multi-office centers that employ a big staff.  While it’s uncommon for there to be only one doctor on staff (given the 365-days-a-year demands of fertility treatments), there are many centers that are small and offer very personalized care with a team of two or three reproductive endocrinologists. Many people enjoy this smaller and more intimate atmosphere.

When you choose a large fertility center, you will most likely have comprehensive resources available to you, including a full nursing staff, an in-house lab, social workers and psychological support including support groups, and perhaps even wellness services such as yoga, nutritionists, meditation, etc. Larger fertility centers usually have in-house egg and sperm donor programs as well (with small clinics you might have to use an outside resource). A drawback to the larger centers is that you probably won’t see the same doctor at each visit, though you’ll likely have one nurse who coordinates your care and who you’ll speak with on the phone.

Personally I’ve worked with one vey large fertility center (the largest in the country, in fact), two medium-sized centers, and one small office, and each experience had its benefits and drawbacks. I liked the one-stop shop aspect of the large clinic and the convenience of their many locations, but I also appreciated the very personal service we got from the small clinic. And ultimately I was successful with all of them, which is the bottom line.

There is no one right-sized fertility center for everyone – it’s a lot like choosing a college – it’s not exclusively about size, it’s about the right match.

Personality

Once you’ve narrowed your possible choices down to one or two (or three at the most), you should contact each fertility center to set up an initial meeting. Many clinics have open house nights and more and more centers are hosting webinars where you can find out more about the doctors, staff, and what they offer.

When visiting a fertility center you can find out what’s done onsite and what’s done at other facilities (such as a lab, hospital or satellite location), and what’s contracted out (like social work or psychological services). If you visit during the day, you can get a feel for the atmosphere of the office – is it loud or disorganized or does the staff seem rushed? Or do they make you feel comfortable and confident and do things seem to be running smoothly?  Do you find the doctors warm, compassionate, and engaging, or are they more clinical and distant, leaving the “warm fuzzies” for the nursing staff? You should get a tour of their facilities (within reason of course, considering patient confidentiality and sterility) and an explanation of what’s unique to their facility.

Cost and Financial Management

IVF and surrogacy are very expensive, it goes without saying. If you’ll be paying out-of-pocket for your cycle, what does their fee include? When comparing costs between fertility centers, make sure that you’re comparing similar scopes of service. Also, ask about what financial arrangements they make with their patients – some centers expect full payment up front, while others have financing plans available, and yet others offer different types of money-back guarantees based on age and diagnosis.

Location

It’s highly likely that you’ll be making multiple (many!) visits to the fertility center as you prepare for, and then take part in, your transfer cycle and then monitoring afterward. You could be in for a lot of driving.  While you shouldn’t choose a fertility center on location alone, you may want to consider it as a factor if you’re weighing several possible options.  If the clinic you like the best is some distance from you, ask them about what procedures can be done at other facilities that are more convenient to you. Not everything has to be done at their office, so it pays to ask how you can minimize lengthy travel.

It’s always valuable to talk to patients from the fertility centers you’re considering. If you don’t know anyone personally who has used a particular clinic, check online review sites (though like anything online that’s open to the public, take everything with a grain of salt – it’s usually the extremes who are motivated to share online – the extremely happy and the extremely dissatisfied).

Above all, trust your instincts. If you feel an affinity toward one clinic, that’s probably the best place for you. And if something doesn’t seem quite right with the most known clinic in your area, that’s good information too. There is no one best solution for everyone, so trust your own research and your gut and you’ll be most likely to make the best and most successful choice for you. 

Scenes From My Surrogacies: A Memoir in the Making

It was evening; the room was dim. As she pulled open the door, the stark hallway light flashed across a green sheet of paper someone had posted on the door. On the sign I could just make out the image of water droplets on a falling leaf. Someone had placed it on my hospital door when I’d arrived. The nurse told me it was the universal symbol of grief.

Another contraction came on and I gripped the bedrails. Breathe in, breathe out, out out, out.  AHHHHHHHHHHH I moaned as the pain seared all across the front of my body. I was holding out on the epidural because I wanted to let my cervix dilate as much as possible on its own before asking for pain relief. I’d had good luck with epidurals in the past, but the outcome is always dicey and this wasn’t a time I wanted to take any chances. I’d had c-sections before as well and they turned out fine, but that wasn’t how I wanted this to end. I needed to do this myself or I would forever regret it. 

Should India Ban Commercial Surrogacy?

There’s no question that surrogacy, even at its best and conducted domestically, is fraught with ethical issues. When all parties enter into a surrogacy arrangement as equals, with fully conscious and informed consent, and everyone is absolutely clear on their roles and the boundaries that pertain those roles, it can be a wonderful, collaborative and mutually beneficial experience for everyone.

There is also little question that surrogacy in the United States is expensive and favors upper-middle class and wealthy couples seeking to have a family. The boon of overseas surrogacy arrangements, such as those facilitated through fertility centers in India, help to bring the cost down significantly given the cheaper cost of medical care overseas and the lower fees paid to women who serve as surrogates.

But the Indian government is seeking to end commercial surrogacy in its country by forbidding its women citizens to serve as surrogate mothers for anyone except close relatives who are infertile, which would effectively end overseas surrogacy arrangements for American (and other) couples.

The government’s logic is two-fold. Their first concern is that commercial surrogacy objectifies and quantifies a human life, which most will agree is priceless. But according to a recent article in The Washington Post, it sounds as if the legal framework for surrogacy arrangements and contracts need to be more clearly defined:

“Divorce is highly prevalent in foreign countries. We have had cases where the couple takes their child from the surrogate mother and then they get divorced after some time. The child belongs to nobody. This is why we disallowed foreigners.”

This is clearly a case of ambiguous legal arrangements. How could a child belong to “nobody?” What about the child’s genetic parents? Unless the genetic parents have given the child up for adoption (which is exceedingly unlikely after going through surrogacy to have the child), the child belongs to them and the surrogate mother has no legal or social claim to the child. Even if an egg or a sperm donor is used, there is almost always one genetic link to the child. And let’s take a step back – how many couples divorce and actually want to abandon their child in the process?

The second concern on the part of the Indian government is that poor women, the ones who act as surrogate mothers, are being exploited in the process of carrying babies for foreign couples. This may, in fact, be true. But the solution to marginalizing Indian women is to create a more functional and empowering framework for surrogacy, not to ban the act of surrogacy altogether.

The issue of surrogate mothers being viewed as “breeders” or a marginalized class of women is not uncommon in conservative parts of the United States, either. A quick Google search will turn up plenty of hits supporting the view of abolishing surrogacy because it trespasses on the human rights of the woman acting as a surrogate, not to mention the child brought to life as “a commodity.”

I can say with certainty that the lives I brought to this earth, and the lives that every surrogate mother I know have brought to this earth, are all precious and beloved. No child is more wanted and yearned for than those who are born through surrogacy.

As a middle class woman who served as a gestational surrogate for six different American couples, I never considered myself marginalized or “a breeder,” even when one of my surrogacy arrangements was less-than-ideal.  I passed not only physical screenings, but multiple psychological screenings that determined I was a good fit for the gestational surrogacy process, both the good parts and the not-so-good parts. Because nothing that is so complicated and emotional as infertility, IVF, and surrogacy is all good all the time – to declare it otherwise is shortsighted and naive – proper screening, communication, medical care and psychological support are the cornerstones of success. I entered all of my surrogacy arrangements fully informed of my own rights.

Women who act as gestational surrogates overseas may not have the benefit of fully informed consent and an understanding of their legal rights, and until this is the case, I support limitations on couples using foreign surrogates just because the cost is cheaper. Not to mention the potential effects on the children of such arrangements – I support full disclosure and an open door policy between intended parents, gestational surrogates, and the children they create.  I believe this is what’s necessary to prove that these children are in fact loved and valued and not merely a product of a commercial transaction.

And until a system can be put into place in countries like India, a framework that allows for surrogacy to be treated as a uniquely loving partnership that fully respects all parties involved, but especially respects the women serving as gestational carriers, India just may be doing the right thing by curtailing commercial surrogacy arrangements both domestically and abroad. 

Scenes From My Surrogacies: A Memoir In the Making

It seemed completely natural for me to choose a lovely picture frame as a Christmas gift for her. It was something to hold the best of the early, sketchy black-and-white films the ultrasound machine would spit out for us at the end of each exam. That way she too could feel close to these babies. They were her babies after all, I was just nourishing and growing them for the time being.

She appreciated the gift and at the end of the doctor’s visit we carefully trimmed the slick ultrasound paper and slid it into the frame.

“I’ll have to get your gift to you, I’m so sorry I left it behind” she said as a casual, off-hand remark as we were saying our goodbyes.  She was getting ready to fly to Europe for a vacation with her parents, a gift from them to her as a way to pass the time while her husband served overseas.

I thought perhaps she’d send me a Christmas card before she left, but she didn’t. I guess it had slipped her mind, just like bringing a gift to the woman who was carrying your babies had slipped her mind that day at the fertility center. I wasn’t expecting much, just a token that assured me that she and her husband appreciated what I was doing for them. 

It was the thought that counted, but as I learned over the coming months, that thought would never be very forthcoming. 

Can You Ask Your Gestational Carrier to Follow a Special Diet?

As intended parents, you have a vested interest in everything your gestational carrier eats (or doesn’t eat!) because she’s nourishing not only herself, but your precious baby throughout the nine months of pregnancy. So naturally, you only want her to consume what’s best for her and your baby.

So can you request her to follow a particular diet?

The short answer is:  Yes.

But should you request her to follow a particular diet?

The more complicated answer is: It depends.

Whether or not it’s acceptable to ask your surrogate to eat a certain way often boils down to the reason why you’re making the request. If you’re Jewish and follow a kosher diet, or you’re Mormon and avoid all forms of caffeine, or you’re a strict vegan or vegetarian and don’t want your baby exposed to animal products, it makes sense that you would want your surrogate mother to follow the same dietary guidelines.

In these and similar cases, intended parents should make their requirements part of the initial screening process for any potential gestational carrier match so both parties know from the outset what the expectations are.  If parents are seeking an independent match, they should list their dietary expectations in the ads they place, and if they’re working through an agency, any potential matches should be made aware of the requirement before even meeting for the first time. This ensures that no one wastes the others’ time.

But what about when dietary requests aren’t religious, cultural, or philosophical, but are more preference? Can intended parents request their surrogate mother to eat a certain way or avoid particular foods?

There are widely accepted guidelines for foods any pregnant woman should avoid, such as raw sushi, unpasteurized cheeses, fish that’s high in mercury, alcohol, etc. And seemingly every day there’s new (and not to mention conflicting!) research popping up declaring new additions on the to-be-avoided list for the general population – gluten, soy, artificial sweeteners, high fructose corn syrup, nitrates and nitrites, refined sugar, etc.

There are times, of course, when a special diet is medically necessary during pregnancy – in the case of gestational diabetes, for example.  Or there may be other times an OB advises her patient to increase her calcium or protein intake. A gestational carrier should always follow her doctor’s advice.

Absent medical necessity though, can intended parents expect their surrogate mother to follow their own dietary preferences?

If dietary guidelines, expectations or wishes are discussed as part of the contract negotiation process, it’s best to address them in a frank and candid manner so any potential surrogate can make an informed choice about the rules she’s agreeing to abide by for the next year or so. And if she agrees to follow them, she should keep her word.

And as intended parents you should clearly spell out your expectations about various foods or substances. For example, if you want her to avoid caffeine (more than is typically advised for pregnant women), does that mean no decaf coffee or iced tea, or even some sports or soft drinks? What about chocolate? Believe it or not, years ago a fellow surrogate was carrying for a couple who requested that she not ingest any caffeine. While she followed that request to the best of her knowledge, they found out she was eating chocolate chip cookies, which to most people would seem an innocuous treat. But their ban on caffeine included chocolate, and the cookies were made with semi-sweet chocolate chips and the intended parents were very upset.

It was an innocent mistake on the part of the surrogate, and one that could have been avoided with clearer communication at the outset.  The parents assumed that the surrogate knew about caffeine in chocolate, while in actuality it hadn’t occurred to her.

I had a falling out with my first intended father because he was adamant about me consuming more protein during my pregnancy. My doctor felt my weight gain was adequate and the twins I was carrying were growing fine, but my IF was concerned about pre-eclampsia and preterm labor and felt that increased protein on my part could prevent those complications from developing. I was healthy and doing my best with the pregnancy and resented his lack of faith in my judgment, and our relationship never recovered from the strain (nor did I develop any complications and I delivered the twins at 39 weeks).

If a particular diet is important to you, communicate it early and clearly to your gestational carrier and be sure she fully understands everything it entails. And should she require a special diet during the course of the pregnancy, you should expect her full compliance.

Otherwise, it can be tricky to watch your gestational carrier eat foods that you personally might not eat if you were pregnant yourself, but it’s also important to acknowledge that your surrogate mother is experienced with pregnancy. She knows her body best, and most carriers will do their very best to delivery the healthiest possible baby to her intended parents.  And the occasional less-than-ideal treat really is OK once in a while (the only time I’ve ever eaten Pop Tarts is when I’ve been pregnant – I have no desire for them when I’m not pregnant).

If you have concerns, by all means speak directly to your gestational carrier, or speak to her in conjunction with her doctor. But as hard as it may be to do so, it’s most important for you to trust her to do her job and let her know you have faith in her body. Even if her body says a few extra trips to Dairy Queen might be nice. 

Scenes From My Surrogacies: A Memoir in the Making

It can be a hard line to walk at this stage, wanting to be positive and encouraging about how well the egg retrieval and fertilization will go, but yet not too over-the-top positive because that’s unrealistic. I am mature and educated and well-informed and refuse to let wishful thinking take over and sweep away my grip on reality, because I know that nothing is guaranteed and heartbreak goes hand-in-hand with fertility treatments.

So as a surrogate – the one who has entered into these peoples’ lives with the sole purpose to fix things and make their most closely held dreams come true – I find that it’s also my responsibility to stay grounded in the truth and accept that we can not just believe or pray or wish hard enough for success and make it so. That’s just not how this works. I know this fact, and I live by this fact, but there’s also some suspension of disbelief that happens for the sake of the intended parents. It’s just the polite thing to do. 

What Medications Does My Gestational Carrier Need?

If there’s one thing that’s for certain, it’s that there are a heck of a lot of medications used when treating infertility. But what about for surrogacy? Given that gestational surrogates are healthy, generally fertile women, it might seem surprising at first thought that serving as a gestational surrogate would require the use of a lot drugs, but in fact it does.

Though each reproductive endocrinologist or fertility center has its own unique medication protocol, they will all include three basic things:

• A way to control the gestational surrogate’s natural cycle (birth control pills and/or Lupron)
• A way to grow the uterine lining (some form of estrogen)
• A way to thicken the uterine lining and nourish the embryo (some form of progesterone)

In more specific detail, these are various drugs a gestational surrogate may use:

Birth Control Pills

When planning for a fresh embryo transfer cycle, the doctor will synchronize the gestational carrier’s menstrual cycle with the intended mother’s (or the egg donor’s, if donor eggs are being used). This is so the surrogate mother’s uterus is ready to receive the embryos once the eggs have been retrieved and fertilized in the lab. The easiest way to synchronize the cycles is with the use of birth control pills.

Lupron

Many (though not all) fertility specialists use Lupron to shut down a gestational carrier’s natural menstrual cycle. The main reason for this is so that she does not ovulate herself, which would cause the transfer cycle to be cancelled. Lupron is said to create a state of “chemical menopause” and is administered either through daily subcutaneous shots in the belly, or through one large intramuscular injection in the hip that’s effects last for six weeks.

Estrogen

Because the gestational carrier is in chemical menopause, she will need medication to begin building up her uterine lining. There are many different forms of estrogen that may be used – injectable (intramuscular, usually in the hip), oral, or transdermal (skin) patches. Some reproductive endocrinologists prefer to use a combination of methods, such as oral plus patches.

Progesterone

Just like estrogen, the surrogate’s natural production of progesterone has been halted by the use of Lupron, so progesterone is given just before the embryo transfer until near the end of the first trimester. Progesterone thickens and grows the uterine lining so it can nourish the embryo and fetus until the placenta takes over that role. Progesterone is commonly given by intermuscular injection (in the hip), but can also be administered through vaginal suppositories.

Doxycycline

This antibiotic (or another similar one) is often used just prior to the embryo transfer to eliminate any bacteria in the uterus or vaginal canal that might affect how the embryo will implant.

Valium

Some, but not all, fertility doctors prescribe a dose of Valium just prior to and just after the embryo transfer. It’s thought to keep the uterine muscle smooth and relaxed and thus, increase the odds of implantation.

Medrol

This mild steroid is sometimes used to prevent or minimize any inflammation in the uterus, thus helping the embryo implant in the uterine lining.

Aspirin

A dose of baby aspirin each day is prescribed by some doctors as a way of thinning the blood. This is thought to provide better circulation to the uterus and developing placenta, thus helping the embryo grow.

Medical protocols change over time as research advances and new treatments are developed. And of course your fertility specialist should look at your gestational carrier as an individual to come up with a medical plan that will maximize her chances of getting and staying pregnant. If she has had problems or concerns with her fertility drug protocol in the past, she shouldn’t hesitate to bring it up – there is often considerable flexibility in the ways the cycle medications can be managed.

Her blood levels of estrogen and progesterone will be tested throughout the early days and possibly weeks of the pregnancy, so adjustments can be made as necessary to ensure the best chances for a sustained and successful pregnancy.

Although it seems like a lot of medications for one person to take, your gestational carrier will be weaned off her fertility drugs before the end of her first trimester, as her body takes over providing everything the baby needs. You can both look at it this way – it’s a short, yet understandably intense time, but it leads up to what you’re both looking forward to- an enjoyable, healthy pregnancy and the birth of your baby! 

Scenes from My Surrogacies: A Memoir in the Making

I was never one to say to the doctor “put the baby in his mother’s arms immediately, before handing him to me” and I often wonder if this is really selfish of me.

I mean really, these people have waited how long to have a baby and here I am sayingno, give me the baby first!  That feels incredibly rude and insensitive to me, when I think about it.

But a lot of childbirth is not actually thinking about it. It’s doing. It’s reacting. It’s doing what comes naturally when your reflexes kick in.

When that baby is low and engaged in your pelvis and you feel that insane gripping pressure come over your whole belly, the only choice you have is to bear down and push.  To not push is to go against every natural feeling that taken over your body at that very moment.

And once that baby slides out, I have only one reaction – GIVE HIM TO ME. MY BABY.

Holy shit. If I had ever said this while getting my psychological screenings done to become a surrogate mother, surely this would have disqualified me on the spot. 

Surrogacy and Social Media

The use of social media today – Facebook, Instagram, Snapchat, Twitter, among many other different platforms – has become so ubiquitous that oftentimes we don’t give more than a passing thought to how we share information and the impact of what we share. And there’s no doubt that social media has helped facilitate quicker communication and cultivate a more global community, which in most cases, is a welcome development for the gestational surrogacy community.

The surrogacy community is a small one, particularly within the United States, and surrogate mothers often spend a good deal of time online. It’s understandable, for sure – while it’s unlikely that a gestational surrogate knows more than few other surrogate mothers in real life (if even that, depending on where she lives), she can easily connect with many others online – others who have gone through or are going through the same series of events that she is. By and large, the surrogacy community is a warm, welcoming, and supportive one.

As an intended parent, you too may be connected to one or more online groups or surrogacy-related accounts yourself, so you probably recognize how valuable they can be. You and your surrogate mother may have even found each other through a matching website or through social media. The surrogacy community’s online presence has opened up the process in ways we could have never predicted years ago, and most of these developments are for the better.

But given the personal nature of pregnancy, birth, and surrogacy in general, as well as given the inherently public nature of social media, it’s not a bad idea to take a few minutes to think through your own feelings about online information sharing – both your own posts and any posting or sharing your gestational surrogate may do.

Naturally, your surrogate mother will acknowledge and perhaps share details about her pregnancy experience – this is to be expected, since people can plainly see her growing belly in photos as well as in real life. To anyone except the casual passer-by, she’s likely to have shared that she’s a gestational surrogate and carrying the baby for someone else – this too is natural information sharing that’s to be expected. But over the course of the whole experience – pre-transfer preparations and the actual transfer, the pregnancy, the birth and beyond – how much privacy or publicity are you comfortable with?

Some questions to ask yourself:

• Am I comfortable with my name being used in social media? First name or first initial? Last name or last initial?
• Am I comfortable with my photo being shared on social media?
• Am I comfortable being “tagged” or “mentioned” on social media so others can find me, perhaps others whom I haven’t shared the news with?
• What health or medical updates am I comfortable sharing, or being shared by my surrogate mother?
• Once my child is born, what level of photo sharing am I comfortable with?

You may be at ease with sharing nearly every aspect of your surrogacy experience – many people are. They find comfort, support, encouragement and celebration to be one of the chief benefits of using social media, while they also enjoy educating the public about the loving miracle that surrogacy most often is. If you’re at ease with sharing, be sure to discuss that with your gestational carrier – not only to let her know she has the green light to share her experience as she sees fit, but also in case she has her own reservations or doesn’t share your same level of openness.

And the converse may be true as well – your surrogate might enjoy sharing updates and photos from the pregnancy, while you crave a bit more privacy.  While you probably don’t want her to feel like you’re censoring her communication (and it’s likely that she’s receiving a lot of support from her online connections, which is valuable), it is important that you feel respected as well.

Having a talk early in the surrogacy matching process about online communication and information sharing is the best way to start your experience on the same page and avoid hurt feelings.  Also, as things come up throughout the process (such as sharing the news of a pregnancy or a negative beta, or a medical complication), it’s wise to touch base on what’s okay to share and what you or your surrogate would prefer to remain private. A good rule of thumb is that if you wonder to yourself if you should share something, it’s always better to ask first.

Everyone is working toward the same goal – walking the road to parenthood together and having a healthy, gratifying experience along the way, and everyone has different social needs to help them feel happy and fulfilled. Social media can be a great way to give and receive support, share information, and educate a large group of people, as long as all parties are comfortable with the level of sharing. And the only way to find out where that comfortable level exists is to ask – it’s a simple and ongoing conversation that will help everyone have the best experience possible. 

Scenes From My Surrogacies: A Memoir in the Making

Until this pregnancy, at least one of my intended parents would always accompany 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 on my belly that there baby was moving. I never got bored of watching their faces as 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” as a woman who was unable to carry for herself might feel?  It may have been mostly petulance on my part, however, holding the opinion that I wasn’t going to coerce anyone who didn’t want to be there to listen to their baby’s hearbeat to come to my appointments if it wasn’t their natural inclination. 

42 Inspiring Infertility Bloggers Share How to Stay Positive on OvulationCalculator.com

Whether you’ve gone through infertility treatments yourself or surrogacy is your only option for growing your own family, trying to conceive can be a grueling, nerve-wracking, and anxiety-producing process.  Even when things go smoothly and as planned (And let’s be honest, how often does that happen? Much less often than when things go awry – it’s Murphy’s Law after all!), the process can be a stressful and all-consuming one.

But the good news is that many, many couples (and singles, too) have been through the process of getting pregnant and have plenty of insight to share. Some have been successful, and some have decided to remain childless, and some have pursued other options.  But collectively they’ve amassed a world of wisdom and Lisa Newton from Amateur Nester has compiled it all in one place.

I am honored to be part of the group of infertility bloggers to contribute to her wonderful post called “42 Inspiring Infertility Bloggers Share How to Stay Positive” on ovulationcalculator.com.  This amazing group of women (and a few men!) offer you their best tips for making it through your journey to parenthood in the calmest and most rewarding way.

And of you’re one of the lucky ones for whom conception comes easily (whether it’s your own or your gestational surrogate’s), surely you know someone who’s experienced more bumps along their fertility road – maybe share this post with them to offer them some encouragement.

Together as a community we lift and hold one another up by our words, actions and deeds – so I hope you take some inspiration for yourself and pass some on to someone who might need it!