The Vestiges of Infertility

Today I am dedicating my blog to National Infertility Awareness Week and to the launch of Justine Brooks Froelker's latest book The Mother of Second Chances, based on her blog Ever Upward releasing on April 17th. For five weeks, 25 amazing women will share their stories of infertility and loss as part of this incredible blog tour, because together we can shatter the stigma.

Yesterday Candace shared her story and tomorrow we will hear from Kelly at The Dovecote. We would love for you to participate by sharing these posts far and wide. We’d especially love to see your own broken silence by sharing your own infertility story using the hastags: #NIAW, #infertility and #EverUpward.

I never threw away the papers. I never intended to hold onto them, but then again, I never expected to have them in the first place.

They are stacked and neatly folded into quarters and tucked into the outside flap pocket of my pink flowered toiletries bag, the one I use when I travel. I fill the interior of the bag with the typical sundries – toothpaste, soap, a hairbrush, an emery board, assorted potions. Once in a while I’ll stick a shower cap in the outside pocket and I’ll catch a glimpse of the papers I have yet to remove from the bag that goes everywhere with me.

Over the past twenty years, those papers have been to California (several times), Canada (twenty times, at least), and Costa Rica (only once, sadly), along with a host of other states across America. They have even cruised to Bermuda. When I leave home for more than a night, the papers come along with me.

But I don’t need them any more; like an appendix, they are vestigial from a much earlier phase of my history when they served a purpose. I have outgrown their usefulness, though they maintain their place in my life (and in my bag) regardless. They are part of who I am and they tell my story.

The papers are three sheets of graph paper filled with tiny pencil dots and scratchy zigzagging lines. Day after day, month after month, I would plot my daily temperature on the small black intersections and connect the lines across the axis. Some graphs have dosages marked next to them – these were from the months I was prescribed escalating amounts of Clomid.

None of the lines moved in the direction they were supposed to, despite the fact that I was only 25 years old and 25 year olds were not supposed to be infertile.  Every month resulted in a basal body temperature chart that not only showed that I wasn’t ovulating, it sketched out a rudimentary yet immediately identifiable black-and-white graphic illustrating the reality of wanting so badly to conceive but having no hope of doing so. Month after month I drew a new image of failure.

This is not a sad story, however. After eighteen months of charting and hoping and legs-up-on-the-wall after baby dancing, we conceived and I delivered a healthy baby girl nine months later. I never charted my cycles after that - our other two children were conceived very quickly. I had three children in three years and I was never happier.

My pregnancies and deliveries were redemptive, empowering and magnificent - I never felt more like my true, most authentic self than I did when I was pregnant. I loved it so much that I went on to be a gestational carrier, birthing nine additional babies for six different couples. Beyond becoming a mother myself, I’ve experienced no greater joy than helping infertile couples become parents, for I have walked in those shoes.

By all accounts, I am a success story. And I truly believe that I am.  But I am more than just my successes. I am also my failures. They’re all part of who I am today.

Although I’ve delivered twelve babies, there’s a significant portion of me that still identifies with my infertility diagnosis. I can still conjure the feelings of emptiness and frustration and despair that defined that time with a ferocity that equals the elation I felt seeing each positive pregnancy test over the years, knowing that my family was growing or my intended parents’ lives were about to change forever.

And my life changed too, because my heart grew just a little bit more as I delivered each child and each surrogate baby. Science is finally beginning to understand what I’ve known all along – that each baby who lives inside your body changes it on the cellular level. Bits of each baby’s DNA live on inside the mother (or in my case, surrogate mother) forever. I never needed science to tell me this is true, it was just something I’ve always known to be fact.

Infertility does the same, I’ve found. It lives on, no matter who or what has transpired in my life during the interceding twenty years, for better and for worse. Though my own infertility was resolved, it was and never will be removed.

It will always be part of who I am, and I have the papers to prove it.

Scenes From My Surrogacies: A Memoir in the Making

My doctor was one hundred percent supportive of me delivering this baby vaginally, which was a rare quality to find in this day and age. But neither of my previous cesarean sections had been “my fault” – as if there is such a thing as “fault” in childbirth. Neither of the caesareans were due to me or my body failing to do its part – in both cases it was the babies who weren’t in the right position to be born vaginally. And considering that before my first c-section I’d already delivered four babies vaginally, we knew that the ideal exit route – through my vaginal canal - was in good working order.  

Even so, even with the verbal consent and support of my doctor, I knew I had an uphill battle ahead of me with the hospital and all the staff I’d encounter there. 

What Is Compassionate Surrogacy?

Let’s start by clearing one thing up right away – make no mistake, all surrogacy is compassionate. Any woman who agrees to be a gestational carrier rightly deserves to be called compassionate.

But aside from using the term compassionate to describe the kindness of a woman willing to dedicate her body to having a baby for someone else, it’s also a term used to describe a particular kind of surrogacy – surrogacy in which the woman receives no compensation for her time and effort carrying a baby. Uncompensated surrogacy is also sometimes called altruistic surrogacy (and again, all women who carry children for others can be described as altruistic, but in the infertility world, altruistic surrogacy is a term used when a woman receives no payment).

Compassionate surrogacy is by far the most common in, though certainly not limited to, cases in which a woman carries a baby for a family member or a friend. In these situations she has an already-existing close tie to the infertile (or male) couple and offers to help them as their gestational carrier. While a woman who undertakes a compassionate surrogacy does not receive payment, she may be reimbursed for any actual costs she incurs during the pregnancy and delivery such as co-pays, deductibles, charges for prescriptions, etc. and she could be reimbursed for lost wages in the case of bed rest or for the cost of child care should she need it due to the pregnancy. Each case is individual.

It’s also important to understand that just because a woman and a couple undertake a compassionate surrogacy arrangement and are family or close friends, it does not alleviate the requirement for a full contract between the two parties. In fact, the contract for a compassionate surrogacy and a compensated surrogacy should be identical, with the exception of the section on payment amounts and method.

Also, intended parents and gestational carriers who undertake a compassionate surrogacy agreement should conform to the usual steps taken when there is payment involved, in order to protect each of the parties. These measures include psychological screening prior to beginning a cycle, review of the surrogacy contract by an attorney who represents the gestational carrier, as well as candid discussion on issues such as the number of embryos to transfer, views on selective reduction and termination, desired contact during the pregnancy and afterward, etc.

There is no doubt that a woman who undertakes compassionate surrogacy is giving a couple an incredibly generous gift, one that can never be repaid. This does not mean, though, that a woman who seeks compensation for her services as a gestational carrier is any less kind or should feel selfish in any way. Since most couples and carriers who work together are strangers at the outset, the fact that payment is conferred helps ensure that both parties feel good about their role in the process. Intended parents need not feel like they’re taking advantage of the woman who’s dedicating her body to their child, and the surrogate mother need not feel taken advantage of.  Each party has their own end benefits with a compensated surrogacy agreement.

Also consider that pregnancy and birth, just by their very nature, can be a complex and somewhat risky process. When a woman carries a baby for someone who is a stranger to her at the outset, the compensation arrangement (along with good medical insurance and a life insurance policy) can help offset and mitigate the risk.

Compassionate or altruistic surrogacy is truly one of the most profound gifts anyone could offer to another person, and it’s very likely to be a beautiful and rewarding experience for all parties involved. If you’re considering this kind of arrangement though, just be sure to treat the process with the same amount of care, reflection, dialogue, and legal protection that you would put into an agreement with someone you didn’t know so well, in order to protect all of the parties involved. 

Though it may seem like a lot of hoops to jump through with someone you already know and feel comfortable with, it’s a small step to ensure peace of mind and a happy outcome for everyone. 

Scenes From My Surrogacies: A Memoir in the Making

The nurse finished up her check of me, then the room, completed some paperwork, and briefed the young woman on the incoming shift.

“I’ll probably see you tomorrow then, so take care” she said as she got ready to leave.

“Oh, do you work in the morning?” I asked.

Meanwhile I grasped the bedrails as another contraction gripped my belly with surprising strength. Things had been pretty slow until then.

“No, I only work the evening shift,” she said, “I’ll be back again at this time tomorrow night.”

I breathed through the contraction.  Breathe in, breathe out, out, out. Breathe in, breathe out, out, ouuuuuuuut.  The vise-like pain started to subside.

“But surely I won’t still be here tomorrow night, will I?” I asked once I caught my breath. “She will have been born by then, don’t you think?”

“Every labor is different, you know that. Especially this one. These things take time, sometimes a lot longer than you expect. I’ve seen women labor for a day or more before the baby is ready to come out.”

She was right, I was well aware of that fact. This wasn’t my first baby, it was my tenth. But even still, it wasn’t what I expected to hear, nor what I wanted to hear.

It was evening; the room was dim. As she pulled open the door, the stark hallway light shown brightly on the green sign posted on the door. On the sign I could see the image of water droplets on a falling leaf. They had placed the sign on my hospital door when I’d arrived. They told me it’s the universal symbol for grief.

How to Make Sense of Fertility Center Success Rates

Whether you’re looking at fertility centers because you’ve struggled to get pregnant on your own or because using assisted reproduction is your only path toward parenthood, undoubtedly your number one question is “how successful are they?”

Which, quite frankly, is a loaded question, because there are so many different ways to define success. For example, any (or all) of the following factors could be used to measure success of a fertility center:

• Number of IVF cycles performed each year
• Number of cycles that result in egg retrieval
• Number of cycles that result in embryo transfer
• Number of pregnancies achieved
• Number of babies born

And to add to the data, there are many different factors that can impact IVF success rates:

• Average age of women undergoing treatment
• Health history of the women and men seeking treatment
• Number of women using donor eggs
• Stimulated versus natural cycles
• Number of fresh versus frozen transfers
• How patients are screened for their suitability for fertility treatment
• How many cycles employ preimplantation genetic screening

And so on. There are many ways to parse the data as it relates to IVF. And although the vast majority of fertility centers operate because they truly want to help people realize their dreams of parenthood, we can’t discount the fact that fertility centers, like any other business, have to make a profit. They are entrepreneurial corporations just like Uber or Google or Microsoft. Yes, they want to solve problems for their customers (and perhaps that’s true for fertility centers more so than any other type of company), but the bottom line, just as with any other business, is profit.

Which is not to say that fertility centers are out to get rich at the expense of their clients. I do not believe this is the case. It does mean that fertility centers, like other businesses, have to advertise or at least maintain a prominent web or community presence to attract new patients. And what’s one of the key facts about themselves  they can advertise? Their success rates, of course.

But while quoting any one particular success rate might make for a straight-forward  advertising campaign, as a consumer it’s not a particularly good way to judge the quality of care or even how likely you are to get pregnant yourself. As we know, infertility is a complex disease that requires complex solutions and even when the cause of infertility is known, treatment options can vary widely based. So how should you evaluate different fertility centers when choosing one for your care?

The gold standard of evaluation of the fertility center success rates lies in the data collected and analyzed by the Society of Assisted Reproductive Technology (SART).  Every year they collect scores of data from fertility centers around the country, analyze it, and generate reports for consumers. Because this process takes a fair amount of time, the most recent report (which is still, as of this writing, considered preliminary) is from cycles completed in 2014.

When looking at the results for fertility centers you’re considering, the single most valuable data point to examine is the percentage of embryo transfers that result in live births. The reason this is the best statistic to examine is that it reflects a true, take-home-baby rate, as opposed to a pregnancy rate. What’s the difference? The live birth rate excludes pregnancies that result in miscarriage (or more uncommonly, stillborn), so it’s a much more accurate marker of success.

Also it’s important to keep in mind the age of the egg donor, particularly if you’re using a gestational carrier. If you’re using your own eggs for the IVF cycle, be sure to look at the statistics that match your age and not the age of your surrogate mother. Because of her medical history and previous successful pregnancies, her age should not figure prominently into the odds of success.

The SART report does come with one caveat that’s important to note – the reports do not account for medical history or health of the fertility centers’ patients. What this means is that theoretically, one clinic could have very tight standards for couples with whom they’re willing to undertake an IVF cycle. By excluding these more difficult cases, they’re treating women who are more likely to get pregnant, and this could artificially inflate their percentages of success.

One of the greatest benefits of the SART report is the way it’s organized – you can search by state and therefore compare the rates of fertility centers near you. And you may find some smaller centers that you didn’t know existed that could be a great match for you. This report allows you to get a head start of comparing the options, which is extremely valuable.

But don’t let the SART report guide your entire decision, even if one fertility center has an outstanding take-home-baby rate. It’s equally important that you see the office, meet the nurses and doctor(s), and get a good feeling about the operations. You will be spending a fair amount of time at the facility, not to mention a substantial amount of money, so it’s best to make a decision with the most amount of information possible.

The SART report is an excellent place to start, and you can find it here.

Scenes From My Surrogacies: A Memoir in the Making

My kids had never seen an ultrasound before, and they were eager to get a glimpse of the twins. At home we’d joke about “the stowaways” – the term we’d given to the babies I was carrying that didn’t belong to us. When Doug or I would call them that, the kids would giggle like we were all in on one big secret.

Their giggles were worth gold to me. I’d always wanted them to feel part of the process, invested in the joy of creating families for others. They didn’t share my passion for pregnancy or childbirth of course, nor did I expect them to (they were still much too young to have an appreciation for what’s essentially a nine-month miracle and times two when you’re carrying twins). But this idea of being a family was central to my existence, and I worked toward that ideal with them every day. Even though they were still quite young, I wanted to be a living, breathing example to them that there were ways that each of us could be a miracle to one another, and my way was to create families for people.

Who Is On Your Surrogacy Support Team, Part Two

In January I posted about all of the key parties that work together to execute a surrogacy arrangement.  Even for a simple surrogacy experience, it’s no short list! Your initial surrogacy team of professionals are the ones who work together to meet your basic medical and legal needs – they include the staff of your fertility center and the lawyers you need to execute the surrogacy agreement prior to your cycle, during the pregnancy, and then after the birth.

But this list does not include the wide variety of others who might also support you through your surrogacy. There’s another group of professionals, in keeping with the team analogy, might be called your “second string team.”  And I don’t mean to imply that they’re less valuable to your surrogacy experience; I mean that they’re not required, medically or legally, to execute a surrogacy. They’re “nice-to-have” rather than “need-to-have.”

That said, you may find that you rely on some of these professionals even more than your nurse or your doctor. Every fertility journey is highly individual and each person has his or her own unique needs and ways of meeting those needs. So let’s look at this next round of folks and how they might fit into your own fertility and/or surrogacy experience:

Nutritionist

Whether you’re cycling to produce the highest quality eggs or sperm possible, or your gestational carrier is currently pregnant with your baby, some people find it’s helpful to consult with a nutritionist. Some nutrition professionals specialize in fertility, pre-conception and pregnancy – ask your fertility center for recommendations. A word of advice, though (and this is based on personal experience!) – tread lightly if you’re asking your gestational carrier to consult with a nutritionist. You chose her to carry for you because you trust her and her successful pregnancy history and good judgment. She could feel that you’ve lost your faith in her if you offer the services to a nutritionist, so be sensitive to this possibility. 

Massage Therapist

IVF is time consuming and stressful, plain and simple! The more you can relax through the process (easier said than done, I know), the more you can handle any bumps in the road (there are always some). A good massage therapist can help you stay relaxed while you’re cycling and can help keep your gestational carrier comfortable during her pregnancy, not to mention keep you calm and relaxed in the weeks leading up to your baby’s birth.

Acupuncturist

Acupuncture has been offered as a complimentary treatment for IVF for many years. Some fertility clinics offer it, while others work with local acupuncture practitioners or they can refer to you practitioners. Acupuncture is process-oriented, meaning that the best results are obtained over many months of treatment, though it can be done post-transfer and early in pregnancy to minimize the risk of miscarriage.

Yoga Teacher

Yoga, in addition to helping build muscle strength and flexibility, can also help improve blood flow to your reproductive organs. It also helps with relaxation and stress management and can provide a much-needed diversion from cycling and fertility treatments. Like acupuncture, some fertility centers offer yoga classes for their patients, while others can refer you to local yoga studios that offer fertility-centered classes. Or consider taking a generic class that lets you escape for an hour or so on the yoga mat – many find that experience to be helpful and refreshing as well.

Infertility Support Group

There are plenty of infertility or even surrogacy-specific support groups around, if not in person (clearly more common the closer you live to a big city), then online. RESOLVE, the national association dedicated to infertility, has many chapters across the country with in-person support groups that regularly. And you can find virtual support for your journey with kindred spirits on one of the many websites dedicated to infertility or surrogacy.

Therapist

Coping with the emotions of your fertility treatments and surrogacy journey can feel like a heavy load at times. When chatting with support groups, whether online or in person, doesn’t fully relieve you of your stress, a therapist who specializes in fertility issues can help you process through your thoughts. Your fertility center either has a social worker on staff or coordinates with one (and you may have already met them when you started), so don’t be afraid to get in touch with them. Just having a knowledgeable, yet uninvolved person (unlike friends or family who mean well but may not know how to be helpful) to talk with can help you sort out and relieve the concerns that weigh on you.

Personal Trainer

While some people enjoy the gentle ease of yoga classes, others like to get a good sweat going to relieve their stresses. If you’re not a regular exerciser already, it’s valuable to spend at least a few sessions with a personal trainer to design a workout routine that will help you toward your fertility goals, whether it’s weight loss or just improving your fitness.  For exercise to be most beneficial, it’s important that you maintain the proper intensity level – not so easy that it’s a waste of time, but not so difficult that it depletes your energy stores. Plus getting into a healthy exercise routine now will help you stay in the groove once your baby arrives, when you’ll need all the energy you can muster!

Doula

Although you aren’t the one giving birth to your baby, this is still your birth. A doula typically helps the pregnant woman prepare for the birth and supports her through labor, delivery, and in some cases, the first few days or weeks after baby’s arrival.  In a surrogacy arrangement, a doula can support your gestational carrier through her labor and delivery, or she can help the intended mother through the birth preparations and in the initial days/weeks after her baby’s arrival, or she can do both. Many doulas are experienced working with entire families so don’t be afraid to ask for what you need for your own unique surrogacy situation.

Photographer

In addition to taking photos of the birth (when you will undoubtedly be wrapped up in the details of your baby’s arrival), a photographer can also work with you during your surrogate’s pregnancy to record the special time. You may want belly shots of your gestational carrier, but don’t forget to include yourself and your partner during this special time, too.

Meal Delivery Service

Your surrogate may enjoy not having to cook once in a while during those exhausting last months of pregnancy, and the same applies to after she gives birth and is recovering. Meal delivery is a thoughtful and welcome gift for this time. But don’t forget yourself and your needs – you’re going to be taking care of a newborn 24/7 for a while, which is exhausting in itself. By planning ahead and ordering a few extra meals to be delivered during the first month or so of your baby’s arrival, you’re giving a much-deserved gift to yourself while you focus on getting to know your new little one.

Are there any others you would include? If so, please share in the comments below! 

Scenes From My Surrogacies: A Memoir in the Making

I couldn’t hand the baby over to her parents yet because her umbilical cord was still connected to the placenta, which was still inside my uterus. I was comfortable for the time being, but I knew that would come to an end soon. In a few minutes, the cramps would start to pulse and rage throughout my uterus and would not subside until I delivered the placenta.

I dreaded that part more than I dreaded pushing a baby out. (This was true only once I’d already pushed the baby out. Prior to that point, I’m sure I’d tell you that delivering a baby was worse. It’s all relative to the moment you’re in the middle of in childbirth.) Although the placenta was smaller, softer and more flexible than a baby (there was no skull or collarbones to negotiate through my pelvis), I always found it more difficult to deliver. I’m not sure why, though maybe it’s because of the intense cramping and the delayed urge to push.

Or of course it could be the physical reticence of another foreign object having to travel the same path that the baby just did and the muscle memory of the pain from just minutes ago. I’m not entirely sure why but for whatever reason, the time between me getting the urge to push out the placenta and it actually evacuating my body are moments that are filled with panic and dread. Even the distraction of the baby, which I try to use to my best advantage, isn’t enough to overcome the mini-breakdown I’d always manage to have until the second that two pound mound of tissue finally plops out of me. 

Writing Your Surrogacy Birth Plan

When it comes to birth plans for labor and delivery, there seems to be two different types of people – those who think through every possible scenario and desire that might arise while giving birth, and those who decide to take it as it comes and make decisions on the fly. And when you’re delivering your own baby, either approach has its merits.

When it comes to surrogacy, however, some forethought is not only valuable, it’s necessary.

A typical birth plan addresses a whole range of issues, including (but not limited to) prenatal care leading up to labor, when a couple will seek medical care, where the woman will labor, how she wants the health of the baby monitored during labor, eating and drinking during labor, pain relief options she does or does not want, who may attend the birth and in what role, the lighting, temperature, and configuration of the delivery room, how she wants the pushing stage of labor to be managed (nurse/physician directed or not), birthing positions she’d like to use, who will catch the baby as it is born, who will cut the umbilical cord, who gets to hold the baby first, when and where the baby’s measurements and vital signs are taken, how the baby will be fed, where the baby will sleep at night, and more.

Whew!

But wait, there’s more. If you’re planning a surrogate birth, there’s a host of other considerations to address in your birth plan, including the legal paperwork that may need to be executed while you’re at the hospital, or possibly even before the birth. These laws and regulation vary by state, and can even differ depending on the state the surrogate lives in, the state she gives birth in, and the state the intended parents live in. Therefore it’s essential to work with an attorney knowledgeable of the laws that apply to your specific surrogacy arrangement.

Also, because the baby will theoretically have three parents present (you as the person who gave birth to the baby and the baby’s two parents), it’s important to legally establish, through HIPAA and other hospital paperwork, who can make decisions on behalf of the baby and who will have hospital bands on their wrists for access to the nursery.

But back to the birth plan…how can you ensure that your wishes (and those of your gestational carrier) are respected while at the hospital? Not to mention that it’s very likely that a lot will be going on and everyone is prone to distraction?  By writing up a birth plan, that’s how.

Many of the issues that you’ll address in your birth plan are topics that you’ve probably discussed already either in the process of matching with one another or in talks you’ve had throughout the pregnancy. For the most part, writing up a birth plan is a process of putting your wishes and expectations down onto paper. The only exception to this is any paperwork regarding the birth certificate and custody of the baby – this need to be completed in compliance with local laws and hospital policy.

Your birth plan should begin with identifying information – the gestational carrier’s name (and make sure she’s identified as the GC), her partner’s name (if applicable), the intended parents’ names (and specify that they are the legal parents of the baby) and the names of anyone else who will be attending the labor and delivery (e.g., a doula, a photographer, a grandparent, etc.). Remember, the goal of a birth plan is to eliminate any surprises, and this includes surprises for the hospital staff as well.

Topics for your birth plan that relate to labor and delivery are:

• Where you plan to deliver
• Who will be present for labor and/or delivery
• What pain relief options, if any, you’d prefer
• Any special requests for music, imagery, or other labor support tools
• How the pushing stage will be managed (physician/midwife directed or not)
• Who the baby should be handed to
• Who will cut the umbilical cord
• In the event of a cesaerean birth, who is allowed into the operating room
• What photos or videos may be taken
• How the baby will be fed after birth
• Where the intended parents will stay while the baby is in the hospital
• Who will have hospital bands that allow access to the nursery

Topics for your birth plan that relate to the legal paperwork are:

• What documents you may need to have on file with the hospital prior to the birth
• What documents you need to bring with you to the birth
• What documents you need to complete during your hospital stay
• What ID you need to have at the hospital
• Power of attorney or hospital form authorizing the baby’s parents to make decisions regarding their child once s/he is born
• Who the baby will be discharged to

As a separate document, you may want to have a list of names and numbers for:

• Emergency contacts for the gestational carrier’s family
• Emergency contacts the intended parents’ family
• Contact information for the gestational carrier’s attorney
• Contact information for the intended parents’ attorney
• Contact informationfor the surrogacy agency, if you used one

You may of course have additional topics related to your unique situation or preferences that you want to add to the birth plan, so by all means, do so. You want to be as explicit as possible in your document, without being overwhelming – remember, in order to carry out your plan the hospital staff needs to read and remember it! Most nurses and staff are attending to several patients at once, so making your birth plan too long and wordy will not help them read and digest it enough to act according to your wishes. Include everything you need to, but use clear, direct and simple language to make it easier for the hospital staff to help you.

Are there other topics that you included, or plan to include, in your surrogate birth plan? I’d love to know – please share your ideas in the comments below. 

Scenes From My Surrogacies: A Memoir in the Making

I’ve always wondered if there’s something significant about my compulsion to send handmade gifts to the families I’ve carried babies for. And not just any handmade gifts, they have to be things that I’ve made myself. Perhaps there’s some kind of subconscious message I’m trying to convey – “Hey - I created everything that is most precious to you – your child – and although that project has long since passed, look! I will still keep creating for you!”

The earliest memory I have of making something surrogacy-related is a handmade card for my first intended mother. I was mostly into paper arts at the time – card making and scrapbooking – because my kids were still very young and it was easy to manage in tiny scraps of free time.

I made many other things for her during my pregnancy with her twins, cards mostly, hoping that by acknowledging the significance of the events we shared together it would help her come around to they way I viewed the surrogacy – as something I wanted to share with her rather than do for her.

Though it never really did work out that way. 

Why the "Personhood Bill" is Bad for IVF (and what you can do about it!)

Abortion is hardly a new topic in the infertility community. While on the surface the idea of fertility treatments and abortion seem like they reside on opposite sides of the spectrum, on further inspection they’re actually much more closely linked than many people realize. And in today’s political climate, the issue has become quite literally a do-or-die situation.

It’s not my intention to stir the political pot (though honestly, what could I dredge up that hasn’t already been tossed around these days?!?) or convince you of the righteousness of the conservatives or the liberals. That’s not my point at all. I’m in no way deviating from my goal of helping people become parents.

There is currently a bill in the House of Representatives called HR 586 or the "Personhood Bill” which seeks to criminalize abortion. What does abortion have to do with fertility treatment and IVF, you may wonder? You may even be personally opposed to abortion (or selective reduction, or pregnancy termination as it’s often called in the fertility word, but it all means the same thing – ending a pregnancy through medical intervention) and perhaps would never consider it for yourself or your gestational carrier. Which is a respectable perspective to have of course. However, it can also lead to a very false sense of complacency regarding HR 586.

You see, the Personhood Bill seeks to define the beginning of human life as the moment conception takes place. And you may see it that way too - after all, once the egg is fertilized by the sperm it starts dividing and growing into cells, then transforming into an embryo. It is in fact alive.

But here’s the issue with defining human life as starting at the moment of conception as part of the effort to outlaw abortion. By defining it that way, HR 586 affords all fetuses (regardless of gestational age), all embryos (regardless of quality, condition or size), even all fertilized eggs the exact same rights as all living, breathing human beings. The same rights to life, liberty, and the pursuit of happiness as guaranteed by the US Constitution.

Do you see the problem here?

In the quest to criminalizing abortion, the Personhood Bill would also criminalize IVF given the fact that not all embryos are afforded a chance to grow into human beings. By the nature of the in-vitro process, embryos are discarded for various reasons – some don’t grow quickly enough or appropriately, some are tested and found to have genetic defects, some are just left over from successful IVF transfers. Some are donated to scientific research.

But by affording “personhood protection” under the proposed bill, none of these things could happen because they may be viewed as endangering the life of a human being (even though they're still just cells in a laboratory petri dish). Most people consider those cells as having the potential to develop into a human being, but not an actual human being yet. The threat of personhood is that IVF as we know it could be outlawed.

This is not the first time that a bill such as HR 586 has been initiated – in fact, similar bills have been put before Congress since 1995 and have always failed to pass. However, in 2017 we find ourselves with a Republican House, a Republican Senate, a Republican President, an unpredictable corps of presidential advisers, and the very strong potential for a conservative leaning Supreme Court.  This constellation of government forces makes it more likely than ever that a bill such as HR 568 could pass (and if we’re to take away any one lesson from the previous year in politics it’s to expect the unexpected).

What can you do to help prevent the Personhood Bill from becoming law? Speak up! It’s critical that you contact your House Representative and let him or her know that you oppose HR 586 and the negative impact it has on couples undergoing fertility treatments – the people who are actually trying to have a family! If you don’t know who your House Representative is, you can find out here.

The very best way to make your views know is to call your Representative’s office and speak to a staffer, letting them know that you oppose HR 586 because personhood is bad for families by restricting family building options. If you can’t get a live person on the phone, it’s fine to leave a message – your input will be tabulated.

These are uncertain political times we’re living in and we’re in highly uncharted waters. Now is the time to speak out against legislation that’s bad for women, bad for families, and bad for science. Please call today and make your voice heard! 

Scenes From My Surrogacies: A Memoir in the Making

The background music stopped and the roar of the conversation got louder, but then quieted down when the band starting playing what sounded like wedding ceremony music (it was a foregone conclusion that there’d be no playing of “Here Comes the Bride” today).

The officiant stood high on a staircase landing above and in front of the guests, who were all seated at small cocktail tables scattered throughout the ballroom. One of the grooms stood on the landing as well, with a look of elated anticipation on his face. The other groom apparently had not arrived yet.

I looked over at Doug and wondered to myself how many people get to experience this in their lifetimes? How many people get to attend the wedding of two gay men? And to then kick my wonder up another several notches, how many people get to attend the gay couple’s wedding, roundly pregnant with the grooms’ baby?

Not many, I assumed.

Who Is On Your Surrogacy Support Team?

In the very early days of surrogacy (prior to in-vitro fertilization) surrogacy was a relatively simple process involving a man and his sperm, a surrogate and her uterus, and perhaps a doctor to help facilitate the insemination (but not always – home inseminations weren’t uncommon back then).  Most likely there was a consenting wife of the man and a consenting husband of the surrogate, as well. But for the most part, there were only a few people involved in the surrogacy arrangement.

As IVF developed and became the standard method to achieve a surrogate pregnancy, so developed the industries surrounding it as well. Which in most cases is a good thing – each professional has their own unique role to play in the process and each member is a valuable part of the whole team. For each piece of the surrogacy puzzle, the goal is to ensure that gestational surrogacy unfolds smoothly and safely for all parties.

So who are these people, and what roles do they play? Let’s take a look:

Reproductive Endocrinologist (or RE)

The RE is the doctor who oversees your care at the fertility center as well as approves your gestational carrier and oversee her care as well. He or she is the main medical person on your team.

Fertility Nurse

The Fertility Nurse is the person you will likely have the most contact with at your fertility center, as she will manage all of the details of your treatment such as schedules, lab tests, medications, etc. Once you begin your actual treatment cycle, you will be in frequent touch with her as she checks in with you on your progress, lab results, and schedule for upcoming treatments.

Financial Counselor

Most fertility centers offer various programs to help manage the cost of IVF, and your financial counselor is the person who works with you to choose the program that best suits your individual situation.  He or she is knowledgeable about different treatment options and the costs, risks, and benefits of each.

Surrogacy Agency

If you do not have a friend or family member who will carry for you and you’re not looking for a gestational surrogate independently, the surrogacy agency is who will find, screen, and match you with potential carriers. Some agencies only do the matching process, while others are full-service and make arrangements for attorneys, escrow, the psychologist and social worker. Full-service agencies (meaning they continue to work with you beyond the initial matching) also check in with you and your surrogate throughout the pregnancy to make sure everything is going smoothly, and they can help resolve issues should things not be going smoothly

Psychologist

Most surrogacy agencies and fertility centers require psychological screening for any woman who wants to be a gestational carrier. This screening generally includes a face-to-face meeting between the psychologist and the potential carrier, as well as the successful completion of a written mental health screening test.

Social Worker

Many, but not all, fertility centers require a meeting between intended parents, their chosen gestational carrier, and a social worker. This is to ensure that all parties have a full understanding of the process and each has a full understanding of everyone’s wishes and expectations.

Attorney for Surrogacy Agreement for the Intended Parents

Most surrogacy agencies have an attorney on staff or one they work closely with who draws up the legal agreement used between the intended parents and the gestational carrier. The attorney explains the agreement to intended parents and can also make any changes they request prior to presenting the agreement to the gestational carrier.

Attorney for Surrogacy Agreement for the Gestational Carrier

All gestational carriers should have their own attorney review their agreement, explain any ambiguous or confusing parts, and prepare any changes that she might request. Should any legal issues arise during or after the pregnancy, this attorney can also offer her counsel. The intended parents pay this attorney’s fees for the initial contract review and revision.

Escrow Agent

The escrow agent manages the finances between the intended parents and the gestational carrier so that money does not have to pass between them directly, which can make either party uncomfortable. Most agents expect that the full amount of the carrier’s fees are deposited prior to the start of the fertility cycle, and the escrow agent disburses the funds to the carrier according to the terms of the agreement between them. In some cases the surrogacy agency handles this, while in others a third party escrow agent does it.

Attorney for Birth Order/Birth Certificate

Some agencies offer these services to their clients, while others refer intended parents to attorneys in their home states (or countries) to complete any pre-birth or post-birth paperwork that’s necessary to establish full and legal parentage for the intended parents.

Should you decide to use a surrogacy agency, they will tell you which parts of the process they are able to manage and which parts you will need to handle yourself. Even if you have to secure some of the services on your own, your agency should be able to give you referrals and guidance on who to contact. If you decide to pursue an independent surrogacy agreement, be sure to do your research on which professionalsto use and whenever possible, get a personal recommendation.

They say it takes a village to raise a child, though in the case of surrogacy, it’s clear that it takes a village to make a child! With each professional performing their own expert role in the process, your surrogacy experience should unfold smoothly and successfully.  

Surrogacy just might be the ultimate team sport! 

Scenes From My Surrogacies: A Memoir in the Making

Happy New Year, everyone!  I've changed things up a bit and instead of just posting my memoir excerpts in written form, I'm also offering an audio version for those of you who'd like to hear me narrate the stories myself. I have to say that I really love this addition - I think it adds a little something to the stories - bringing them to life even more, perhaps. 

You can hear the audio version in the SoundCloud link on the picture of the baby, below the text excerpt.

I hope you enjoy it! 

I’d come off the morphine and onto something else that dulled the pain of my incision but didn’t knock me out so completely, which made for a fitful night of sleep. It was challenging given the incision and stitches that left me hesitant to move around too much (and definitely not roll over, which was always one of my greatest pleasures after giving birth), but it was an even bigger challenge trying to tune out all the baby-related activity happening in the bed next to me.

I had always wondered what the transition from couplehood to parenthood was like for people using a surrogate mother, and now I had a front row view of the process, whether I wanted it or not. Which I did, I was convinced, and despite all the sleep I could not get, I was grateful that they actually wanted me to be part of their new role as parents. But at 2am, the hour in which simple, everyday annoyances seem to take on monstrously sized significance, I was questioning my own desire (and judgment) to bear witness to each middle of the night feeding, each diaper change, and each nurse evaluation.  I was exhausted, I was in pain, and I was no longer pregnant with over 15 lbs of baby. I just wanted to sleep and it was my own decision that was keeping me from just that. 

What Having Surrogate Children Really Feels Like

One of the most common questions that I’m asked once people find out that I’ve been a surrogate mother is “What is that like?”

Which, to be honest, is soooo hard to answer because it’s such a vague question!  But over the years I’ve come to realize that what they really want to know, and perhaps feel too shy to ask outright, is what is it like to have a baby and give it away. Or what is it like to have children out in the world that you gave birth to, but who are not yours to raise?

Now forgive me for using the phrasing of “give a baby away” – those are not the words with which I choose to describe my surrogacy experiences. But let’s be honest, those are the words that come to mind for a lot of people. And that’s okay, even if I wouldn’t have chosen them myself. Hey, I get it – gestational surrogacy can be hard for a lot of people to wrap their heads around.

But going back to the question of what it’s like to bring children into the world who are not my own (and I want to underscore that I’m speaking of only my own experiences – obviously another gestational carrier might have a completely different experience), I thought I’d share a little about that today.

If I had to pick just one word to describe how I feel about the surrogate children I’ve given birth to, I’d choose the word “connected.”  And I don’t mean connected in terms of LinkedIn or networking – that definition falls woefully short of my intention. Of course we’re connected, I carried them and gave birth to them after all!

Instead I use the word “connected” in the same way we describe ligaments and tendons in the body as “connective tissue.” Ligaments, tendons, cartilage, etc, are not independent fibers that merely run between bones or muscles – they’re actually bound to, and part of, the two things they bridge.  A ligament joins two bones together but actually grows from each of them; a tendon tethers a muscle to a bone but is not independent, rather it grows from the bone and from the muscle that it joins together.

Grown from, grown between, grown together, inextricably connected. That’s what it feels like to be a surrogate mother.

When raising your own children, it’s easy to understand how the connection you feel with them at birth (and even prior, for most women) grows and deepens over time. This is nature’s way – it’s what we expect to happen. And in many ways, it’s the foundation of our society.

When giving birth to a surrogate baby, that feeling of connection is different. The best way I can describe it is as a feeling of deep protective love, yet not in a fully vested, parental way. I suppose it’s the way an adult might feel about their nieces or nephews (I don’t have any, so I can’t say first-hand).  It’s a deep connection – one that triggers our physical sensations of love – yet not so much as to interfere with the baby’s relationship with its parents.

Almost any surrogate you might ask would tell you that despite this intense feeling of connection, there is no sorrow in separating from the baby after the birth. There may be sadness that the surrogacy experience is over (and wildly fluctuating postpartum hormones contribute greatly to those feelings), but the sadness is rarely a sense of loss over the baby. Remember, gestational surrogates are primarilymotivated by their love of pregnancy and the desire to help others become parents.

Recently I’ve come across more and more studies that are shedding light on the long-term physical implications of carrying a baby. These studies do not focus strictly on pregnancy and its effects, but instead they examine the lasting changes in a woman’s body that result from carrying another human being – a person with different DNA - inside her.

And what they’ve found is fascinating. Different studies show that when a woman carries a baby, parts of the baby’s cells and DNA stay in her body for years after the birth, possibly indefinitely. Some of the studies that have shown this are here and here and here.

Me? I’ve always known this on a physical level. It’s just something I’ve felt inside me since I delivered my first surrogate baby (twins in 2002). And although the family has chosen not to keep in touch with me and I’ve never seen the babies since leaving the hospital, I still feel a visceral physical connection to them, as if our bodies, in some small way, live in communion. And now, based on the research, we know that this is true.

There’s now evidence of the flip side of this scenario – that the gestational carrier’s genetics affect the babies they carry – and that deserves its own post given the possible implications of it.

As an intended parent, I think it’s important to recognize and even appreciate the bond that forms between your gestational carrier and your baby, a bond that will stay with her for life, regardless of your continued contact or involvement. And as a gestational carrier, it’s equally important to realize this form of attachment can (and probably will) happen.

Which in my opinion, isn’t a bad thing! In fact for me, it’s one of the loveliest results of surrogacy – carrying the essence of so many children in my heart, whether they are my own or not.  Because as my body senses it (even though my brain may disagree), they’re all my own on some microscopic level. And as is often the case, science is finally catching up with what mothers, surrogate or otherwise, have known all along. 

A New Year's Wish for You

As we bid 2016 goodbye and welcome in 2017, we take time to reflect on our successes, our happiness, our sadnesses and our obstacles. I wish you a year full of peace, laughter and love as well as courage, hope and faith to overcome any challenges you may face. 

May 2017 be a year full of wonder and love!

Scenes From My Surrogacies: A Memoir in the Making

I paused to breathe; he patiently listened.

“You know as well as I do that I just don’t believe in induction. I hate this. “ I whimpered.

“You’ll be fine, m’am, you’re a pro at this.” he said. He’d been in the States for 40 years but his accent was still so thick I never knew if he was calling me m’am or Mom. I could barely make out half the things he said, yet I trusted him more than anyone else with my care. “I’m on call that day so I’ll make sure there’s room for you,” he added.

It was a relief to know that, but not enough to override my distrust in the medical management of an otherwise natural process.

“You’re right to do this. You know that, don’t you m’am?” he asked.  As doubt made its way across my face he took my hands in his. “There’s just no other way that makes sense and this solves a lot of problems for you.“

“Besides, you know you’ll have your baby before that, right m’am? You always do.” I didn’t know what to make of his eagerness to agree to the induction, but god, I hoped he was right.

Did he even know my name after all these years, all these babies we had together?  I wasn’t sure. I wondered, but I didn’t care. All I cared about is how he respected, even revered, my pregnant and birthing body. He’d believed in me even more than I did so many times over the past ten years.

“I know,” I sighed.

An induction was something I wanted to avoid at all costs, but then again, so was cancer. And unlike me, my husband didn’t have any say whatsoever in his condition.

The Empowered Pregnancy Summit

Surrogacy is about one thing – having a baby. But then again at the same time, surrogacy is about many things at once – not only having a baby (or to clarify, one woman having a baby in place of another), but it’s also about pregnancy and the transition into parenthood. Although surrogacy may be simple in its goal, all of its components are actually quite complex.

Much of the focus of the surrogacy process is placed on getting the gestational carrier pregnant, and understandably so. That can seem like the most complex and daunting part for many people, especially if they’ve struggled with infertility. But if all goes as anticipated, concerns over achieving a pregnancy soon give way to watching the baby develop, monitoring the health of the surrogate during her pregnancy, and then finally, the birth.

Some intended parents are at ease with stepping out of the pregnancy and childbirth spotlight and taking the role of caring and interested observer of their surrogate. And there is nothing wrong with this approach, if it’s the most functional and satisfying path toward parenthood for them. But other intended parents may want more – they may desire not only a close and communicative relationship with their gestational carrier, they may want to forge their own unique way of experiencing the pregnancy (albeit not first hand, but in their own special way), the delivery, and their transition to becoming parents. 

Recently I had the pleasure of taking part in the Empowered Pregnancy Summit, an online series of interviews hosted by Krystina Sloan. Krystina is a doula (someone who offers labor and post-partum support) and lactation consultant (someone who offers breastfeeding support) and through this summit, she’s gathered a range of voices in the pregnancy, birth, and parenthood space. 

I was thrilled that she asked me to participate and talk about my experiences as a gestational carrier – specifically what the pregnancies and births were like and what I got out of the various surrogacy journeys I completed.  And let’s be honest – after going through 10 pregnancies, 11 births, and delivering 12 children, I’m at no loss for what to say about the topic!

But I admit that at first I was hesitant about sharing the link to the whole summit with you, because I know pregnancy and motherhood can be a sensitive and often painful subject for those who are still undergoing infertility treatment. So for those of you still in the thick if it, I offer you love and light and very fertile thoughts that your dreams are soon realized in the new year.

And for those of you expecting a baby through surrogacy, I think the Empowered Pregnancy Summit is a really special chance to explore some of the issues surrounding pregnancy, birth, and the transition to parenthood in a relaxed, flexible way. You can pick and choose which of the seminars to watch – you can watch just mine, or all of them, or anything in between that strikes your fancy. Krystina details the various sessions here on her Facebook page, if you’d like to read more before signing up.

Or if you’re ready to watch and listen now, you can access it here. The sessions are free and available until Sunday, December 18, so don’t wait and lose out.

I hope you enjoy the webinars! 

Scenes From My Surrogacies: A Memoir in the Making

The email I’d received that morning closed with “Have a nice life!”  Actually, it had been send during the middle of the night.

The previous evening she sobbed into the phone when I told her I couldn’t carry for her, that we just weren’t a good fit for each other. She was shocked, she said, because this all seemed so right.  Everything seemed perfect to her, she gasped out between sniffles and tears. 

I quietly explained that I needed low-key, low-intervention care for my pregnancies, otherwise I would end up unhappy and resentful. I would feel coerced with any treatment that wasn’t medically necessary.

She, on the other hand, needed more reassurance from the doctors. I respected that. She’d had a complicated pregnancy and required expert care to get her and her daughter safely to the other side, and understandably she operated from this frame of reference. I told her that there were plenty of other women who were a better match to be her surrogate.

She found comfort and reassurance in all the intervention, whereas I only felt needless meddling. Fate might have brought us together, but it had also left us worlds apart on this one small, but critical issue.

After she hung up the phone, I sunk low into the faded glider in my bedroom, left over from my years of nursing and midnight feedings. I rocked gently back and forth trying to disperse the anxiety that I’d gone into the call with.  Eyes closed, I rocked and rocked and rocked and breathed deeply.  It was the right decision, I knew, but not an easy one to give voice to.

The next morning there was an email from her. It was one paragraph long, full of disappointment and anger and blame. She would never have any more children, she wrote, because she believed I was the one meant to carry for her, and was astounded that I would do this to her. She would never find another surrogate, the email said.

If I wouldn’t carry for her, then she wouldn’t have any more children, she’d decided. That weighed heavily on me.

And then she told me to have a nice life.

Gifts With a Surrogacy Theme

If you’re like most people, your holiday shopping is well underway by now (maybe you’re even close to being all done – lucky you!). If you or someone you love is in the middle of a surrogacy journey, you might be looking for an extra special or highly personal gift to celebrate the unique experience. I have some great suggestions, ideas, and links for you!

If you’re an intended parent, the first question you might have is whether you should give your gestational carrier a gift that’s just for her, or perhaps something for her whole family. Of course there’s no right or wrong answer when it comes to gift giving – it’s all very personal – but I’ll offer this guideline.

If your gestational carrier is currently pregnant, you might want to give her a personal gift, as well as give a gift to her family. Surrogacy is most definitely a family event and requires patience and understanding from everyone, so acknowledging that fact through a family gift is a thoughtful gesture.

Some gifts that are great for families are:

• A fruit or other gourmet food basket
• A gourmet cookie/dessert basket
• A gift certificate to the movies, a play, or a sporting event
• A gift certificate to a favorite restaurant
• A game the whole family can play

My favorite family gift that we received was Vitamix blender. Sounds a little crazy, right? But we love to make our own fresh juices and our previous juicer had worn out, so this was a very thoughtful and very much appreciated gift that we all enjoyed.

As for what kind of personal gift to give your gestational carrier, well, that’s personal of course! What are her passions or hobbies? How does she like to spend her time?  One of the more thoughtful gifts I received during my surrogacy experiences was a special package of fabric imported from England. Because I love to sew and make things and the fabric wasn’t easy to obtain in the United States at the time, the fact my intended parents thought to seek it out for me was incredibly special, and every time I use a bit of it I think of them.

Many gestational carriers collect things with an angel theme because angels are a commonly used symbol for surrogacy, representing the miracle of life and the special care your gestational carrier has for your baby. Gifts with an angel theme are quite popular, like jewelry or figurines.  These flowered-themed angel figures from Wind and Weather are very pretty and unique:

If your surrogate enjoys jewelry, you could give her something that recognizes or commemorates your surrogacy experience. It could be something surrogacy-specific, like this necklace from NovaHomemadecreation on Etsy:

Or just a lovely piece of jewelry that has nothing to do with surrogacy, but is just something your gestational carrier will enjoy wearing day-to-day, is also a wonderful gift.  My very favorite bracelet was a gift from one set of intended parents and has nothing at all to do with surrogacy – they just really nailed my tastes when they picked it out, which makes it even more special!

If you’re cycling or getting ready for your transfer, how about lucky socks from surrogacygoodies.com?

Or SurroSisterDesign on Etsy offers a great assortment surrogacy-themed t-shirts (including maternity styles!), water bottles, decals, and this beautiful tote bag:

And for most anyone involved in your fertility journey, no matter where you are in the process, TTC Greeting Cards has so many things are are not only gorgeous, they have just the perfect message. They offer much more than just greeting cards (which are works of art in themselves!) – they have printables, socks and t-shirts each with beautifully stated messages, like this one:

Wishing you a happy holiday season full of good cheer!