Making Peace with YourselfLEARNING THAT YOU can’t carry a child can bring overwhelming sadness. Your heart mourns the loss you never knew, while your head asks punitive questions like, “Why is this happening to me? What’s wrong with me? Is God punishing me? How did I get so unlucky? How can I face my family and friends?” Now that you have had months and possibly years of physical proof that having a child naturally or with your doctor’s help is unlikely, you’ll need to grieve your loss before adding a fourth person to the mix.
Making Peace with Yourself
Most of us grow up thinking our kids will have our nose, our mom’s cheekbones, and our grandpa’s ears. It may come as a devastating blow to learn that this may never occur. It’s important you give yourself time to process this information before embracing a pregnancy that may not involve your biology.
WHAT TO KNOW ABOUT THIRD-PARTY REPRODUCTION
While involving yet another person in your quest to have a child is a wonderful way to end your childlessness, it’s also a decision that you need to make with great care. Up to this point chances are you have experienced a number of failures that have driven you emotionally. Conscious or unconscious emotions can cloud your judgment, so it’s wise to seek professional guidance before asking a family member, friend, or unknown individual to be your donor or surrogate.
Third-Party Reproduction vs. Adoption
Third-party reproduction is different from adoption. While adoption involves parenting a child who already exists, third-party reproduction is the plan you make before your baby’s conception.
We met with Dr. Potter to discuss our options for sperm and to find out what he advised. We initially wanted to use a “known” donor and start that process, but after having issues with scheduling, my wife and I both agreed that it was likely better to go with an anonymous “Open ID” donor. That was pretty much the hardest part about the conceiving process. From there we were met step by step with the most amazing staff, and any question I had was quickly and beautifully answered.
—Tabby, 33, software engineer
WHEN TO CONSIDER SPERM DONATION
Sperm donation may provide an answer if your partner’s sperm is keeping you from getting pregnant or if you’re trying to have a baby without a partner. With treatments like ICSI, the chances of needing a sperm donation are rare, but it does occur. If your doctor insists you need one, talk it over with your partner and make sure this is something you both agree on. If not, you have a number of other options to choose from.
When Sperm Donation Is Not the Best Solution
After our fourth IVF cycle failed, Brett and I were ready to try something different. In a consult with our doctor we discussed the option of donor sperm. I think that was the first time we seriously considered the idea of involving another person in the creation of our child. That’s when we started playing with the scenarios of “what and when to tell.” I remember realizing that the baby we dreamed of may not be our biological child. While using a third party was an option, it left us with a strange sense of balance that, for whatever reason, we never became comfortable with. After much consideration we chose to adopt; a blessing that we’ve never second-guessed.
—Jodie, 39
Egg donation may be the answer you’re looking for when other fertility treatments don’t offer hope. Egg donation involves removing eggs from a fertile donor, fertilizing them with your partner’s (or donor’s) sperm, then placing them inside your uterus. This technique has been around only since 1983. Before then women had no way of getting pregnant if they were diagnosed with menopause, lack of eggs or eggs with diminished quality, genetically transmittable diseases, or situational infertility resulting from radiation or chemotherapy.
Who needs an egg donation? If you have tried three or more IVF cycles that didn’t result in a viable pregnancy, you may want to consider one. If you’re in your 30s or 40s, you may require donor eggs because your egg quality and quantity diminishes with age. To support this, the CDC reported in 2010 that 73 percent of women older than age 44 using ART relied on donor eggs.
INDICATIONS FOR EGG DONATION
• absence of ovaries
• menopause (whether natural, surgical, or situational from radiation or chemotherapy)
• multiple miscarriages
• multiple unexplained failed IVF cycles
• poor response to fertility drugs
• hereditary risk of genetic diseases
Only you can decide whether egg donation is a procedure you wish to pursue. If the idea of carrying a baby with half of your family’s genes (your husband’s) sits well with you, then egg donation is a procedure you’ll want to ask your doctor about. Keep in mind that many of the issues adopted children face surrounding identity also apply to children born as the result of egg (or sperm) donation. Whether this is the first addition to your family or you’re giving an older (biological or nonbiological) child a brother or sister, see chapter 15. But if having a baby with half your husband’s genetic makeup and half of another woman’s genes bothers you, then egg donation is probably not for you.
Religious upbringing, moral underpinnings, cultural views, or disapproving family members may also cripple your ability to move forward. Some people find they’re dead set on carrying a baby that is 100 percent their own and anything less is unimaginable. For these couples, hearing the words egg donation is like receiving a death sentence. For others, hearing these words offers renewed hope and an exhilarating chance to resolve what’s become an exhausting battle with infertility.
Once you know where you stand on egg donation, talk with your partner. If you’re willing to try, make a list of benefits and risks and then share these with each other. If you’re both in agreement, talk with your doctor about how you can start the process. This is also a great time to speak with a social worker or therapist who specializes in arranging egg donations so she can give you more information about what to expect.
WHAT YOU NEED TO KNOW ABOUT EGG DONATION
Egg donation is a wonderful way to have a baby, and it’s a lot less complicated than surrogacy. The practice of transferring human eggs from a fertile woman’s womb to an infertile woman’s womb began in the early 1980s. After years of unsuccessful egg transfers, the first baby from a donor egg was born in 1986. Since that time, donor eggs in the United States and overseas have become quite a commodity. In fact, agencies and egg brokers have built a sizeable business addressing this demand (see chapter 14).
Source: CDC 2001 Assisted Reproductive Technology Success Rates
Figure 9.1. Live birth rates
By now your RE has probably told you the single-most important factor to having a healthy baby is the quality and age of the egg. This is why mothers who use donor eggs have a higher success rate than those who use their own.
The same goes for embryos. The number of births per transfer of donor embryos is always higher than that of nondonor embryos. See for yourself and compare the difference.
Figure 9.2. Fresh vs. frozen embryo per transfer
How Successful Are Egg Donations?
In the United States alone, the CDC reported that in 2010 there were 18,011 cycles using donor eggs or embryos (12 percent of all ART cycles). Among older women, 73 percent of all ART cycles used donor eggs.
Couples receiving an egg donation in the United States will find this procedure readily available. Here are some benefits to consider when using an egg donor.
• Your baby carries half your family’s genetic makeup.
• You don’t miss out on carrying and delivering your baby.
• Odds are much higher that your pregnancy will take.
• Younger women have fewer issues with genetic defects.
• Donors are screened in advance for preexisting conditions.
International couples will need to confirm whether the law governing their province or country permits them to receive an egg donation. Couples who live in countries like Australia, where the waiting list for donor eggs can exceed six years, often choose to contract with US clinics and physicians.
WHY EGG DONORS DO WHAT THEY DO
Egg donors don’t see their eggs the same way recipients do. Recipient couples pore over applications looking for donors who look like them. They take great pride in finding donors with “clean” medical histories and who have no incidences of breast cancer, alcoholism, or depression.
Giving Eggs Away
Egg donors don’t see that they’re giving themselves away when they donate eggs because they envision themselves as moms later in life. While you may fear that your egg donor will come back and want your baby, that’s the same as assuming that your neighbor will take your cake just because they loaned you an egg.
But donors see their eggs as something they have that they really don’t need. Not to minimize gifting, but from a donor’s perspective, donating eggs is similar to donating blood. An egg donor knows she has an adequate supply of eggs, and if she gives a few away, she’ll still have plenty.
Egg donors are usually attractive working women or college students between the ages of 20 and 32. Sometimes money enters the picture because the process requires a shorter involvement and it can be quite lucrative. Egg donors can name their price. Agencies tend to have some criteria over pricing, which includes allowing proven donors to request higher asking prices. Keep in mind that there is no guarantee that a donor who asks for $30,000 is any better than one who requests $6,000. A donor has no guarantee that her next fertility cycle will mimic her last; each cycle is different. But if a donor knows that her eggs have already achieved pregnancy, she can ask for a higher price because she has a history of success.
Although money may be the catalyst for an egg donor, her heart typically follows. The type of donor you want is a young woman who feels that egg donation is rewarding not just on a financial level but also on an emotional one. She also needs to be mature enough to understand that her contribution may have a lifelong impact.
Making Egg Donation Affordable
One way to reduce the high cost of egg donation is to share an egg donor either with another couple or with a company that wants to freeze the unused eggs and sell those at a later date. The use of shared donors has been around for some time, but companies such as Donor Nexus (myeggdonation.com) have further refined this practice. They select donors who are likely to yield a high number of eggs. Then they match one, two, or three couples to fresh eggs from each donor. Eggs not matched to fresh cycles are frozen unfertilized and sold to couples using frozen donor eggs in the future.
In a shared donor cycle couples receive a set number of eggs that an embryologist will inject with sperm from either their partner or a donor. The number of eggs injected is usually five. This typically allows couples to have a fresh transfer of two embryos and have three left over for a frozen transfer at an unspecified date. Donor Nexus and like programs can reduce the overall cost for a donor egg cycle by more than half, with the average shared donor cycle costing $18,000 at Donor Nexus versus $36,000 to $40,000 with a traditional agency.
Using frozen donor eggs is another option that can reduce the cost of treatment. Most companies offer several payment options, but the cost typically ranges from $15,000 to $18,000 per cycle. Myeggbank.com provides six eggs that will be thawed (regardless of whether they survive thaw), whereas myeggdonor.com (Donor Nexus) provides five eggs that survive thaw.
There is a central question you and your partner will grapple with when considering to go with an egg donor: Do you want a donor you know, or would you prefer one who is anonymous? So now you have decide whether to approach a friend or relative to do you the honor of being your donor versus selecting an anonymous donor from an agency. Using a known donor can be less expensive if you can forgo paying them or at least agree to something reasonable. This can save you $10,000 to $15,000 off the steep egg donor price tag of $36,000 to $40,000. While this bottom-line saving can be music to your ears (and your partner’s), it sometimes comes with a hidden emotional cost.
When a friend or a relative agrees to be your donor, you have effectively taken your reproductive future into your own hands and beyond your doctor-patient relationship. This means you no longer have control over whether family, friends, or even acquaintances know you are using donor eggs. There are always additional risks that your relationship with a family member or friend can become tense, awkward, or even sour as result of this newfound responsibility. Known donors also might not be ideal donors. They may be older, have their own fertility or health issues, or be prone to rekindle former family rivalry. This is for you and your partner to decide based on what you know about the donor, her ovarian reserve, and whether you believe your relationship will stay intact throughout the pregnancy.
Using an anonymous donor allows you to know what the donor looks like, what her personality is like, and it gives you insight into her family, health, and education, though you will not know her true identity. The same anonymity is afforded to you and your partner, and it gives you maximum control over whether to broadcast that you’re using an egg donor. Anonymous donors typically do not want to meet the prospective parents, but there are always exceptions.
One of the most common questions asked by anyone considering an anonymous egg donor is, “What does the typical egg donor look like?” First, donors are generally attractive young women. Agencies invest time and money screening donors and creating their profiles. Most agencies have found that couples selecting donors prefer attractive donors regardless of their own personal appearance; prospective parents typically try to give their child any advantage they can. When using your own eggs, you have to go with what you have, but most going the donor route and paying lots of money to do it overwhelmingly choose eggs or sperm from attractive donors.
Most egg donation programs want donors who meet their basic criteria. They’re looking for healthy, well-educated women with solid backgrounds who are donating as much or more for altruistic reasons as they are for financial gain. Reputable agencies have similar if not identical requirements, which include that a donor must be
• within a center’s stated age requirements,
• of good physical and mental health,
• educated and stable,
• weight and height proportionate, and
• mature enough to understand this supportive role.
IDEAL DONORS
• are less than 30 years old,
• have no significant health issues,
• have a BMI of less than 30 (i.e., are not obese),
• have a normal psychological evaluation,
• have a normal genetic screening,
• have a negative screening for drugs of abuse, and
• have normal ovarian reserve demonstrated by prior egg donation cycles or recent testing.
Finding a donor who meets your particular criteria is much easier than you think. Selecting an anonymous donor means you will brainstorm the characteristics that your ideal donor might have. These characteristics might include hair color, eye color, a resemblance to you (the mother) and your partner (the father), ethnic background, skin tone, education level, height, weight, special traits or skills (i.e., athletic or musical). These traits can be ranked, and you can assess each donor candidate based on these criteria.
So now that you know you have your ideal donor in mind, where can you find donor candidates? There are many businesses that specialize in donors. You can go through a reputable agency that specializes in third-party donations, or your doctor may know of someone who has donated her eggs. Third-party agencies have hundreds of profiles of women on file, and one of their staff members will help you step by step through the selection process on site. If you elect to use a known donor, your doctor will usually recommend that you and your partner as well as the prospective donor meet with an independent mental health professional (usually a marriage and family therapist) to try to identify potential conflicts that may cause problems in the future. In this scenario you would most likely meet the therapist wherever she operates.
No one says that your donor has to be your best friend, live-in, attend your child’s birth, or even get regular holiday cards or photographs. In fact, many of them don’t want that kind of relationship. But telling your child personal information about his donor is much more psychologically satisfying than saying, “We chose B8542.”
Communicating why you chose a specific donor helps your child understand what makes him special. For instance, you might say, “We chose Megan because Dad and I spoke to her on the phone, and she shares so many of our family values, and she kind of looks like me, and she likes pizza like you do. Besides that, she plays piano like you, grew up in Texas like we did, and loves animals just like you.” There is just something irreplaceable about describing a person a real person instead of an application.
WHEN TO CONSIDER EMBRYO DONATION
Embryo donation is an option if you have an intact uterus and are considering adoption. It is an excellent option for couples considering adoption because it is much less expensive and less complicated legally. The benefits of embryo donation over adoption have become substantial in light of recent changes to the adoptive process that render all adoptions open. Until recently it wasn’t uncommon for agencies to handle closed adoptions, where the adoptive parents and the birth mother received undue confidentiality and anonymity. With mandated open adoption, however, this can no longer occur. This change has led to an increasing number of potential adopted children being aborted rather than born. It has also led to a shrinking pool of adopted children in the United States, and those children who are available tend to come from parents who have psychological, social, or drug issues. The embryos available through embryo donation, however, come from couples who are psychologically healthy and in stable relationships and want children. Another plus is that these are couples who have achieved enough financial success to be able to afford to have children via IVF.
The downside to embryo donation versus egg donation is that you lose control over the genetics of the child. You will typically have much less information about the donors than you would with egg donation. There usually is only a thumbnail sketch and basic health information. With egg donation you will be able to pick both the egg and sperm donor. The sperm donor may be your partner, creating a genetic link that you know well.
Sometimes cost is a factor when considering a donor. At Dr. Potter’s HRC Fertility the cost of embryo donation (in 2013) is $4,000 for the first cycle and $3,500 for subsequent cycles. The price at your local fertility center may vary, so you may want to shop around to find the price you’re most comfortable with.
There are two basic ways to obtain embryos: embryo donation (described earlier) and embryo adoption. Embryo adoption is an open process like adoption. It adds about $4,000 to $6,000 to your bottom line, but because it’s open, it allows you and your partner the ability to take the first step in finding a donor. Organizations like Snowflakes (see Appendix A) can help with embryo adoption. For embryo donation your RE should have access to donated embryos and can help you find a match. Organizations like the National Embryo Donation Center (embryodonation.org) can also help you find a match.
If you find that you long to experience pregnancy firsthand, then embryo donation or embryo adoption might work for you. The issues you may face later are similar to that of an adopted child. Your child will not have a genetic relationship with you or your partner, and somewhere down the line you’ll need to deal with the question of what and when to tell (see chapter 15).
As we discussed in chapter 1, becoming pregnant is both simple and complex. Although it only takes one sperm, one egg, and one uterus, many of your body’s processes like menstruation, ovulation, fertilization, implantation, and gestation must harmonize before your baby can be born.
MEDICAL INDICATIONS FOR SURROGACY
• absence of uterus (from birth or surgical)
• uterine abnormalities (birth, scar tissue, or fibroids)
• maternal diseases like severe diabetes, kidney disease, lupus, or rheumatoid arthritis
• severe uterine deformities or numerous miscarriages
• multiple unexplained failed IVF cycles
• poor uterine lining despite all efforts
If fertility treatments are not helping you realize your dream of having a baby, your doctor might recommend using a surrogate. This may come as a setback to some, yet others may view it as a godsend. Only you can determine how you feel about bringing in another woman to help you have a baby.
Moving to Surrogacy
Our first doctor told us we better find a surrogate. He didn’t even consider how we might react to his ultimatum. I don’t think it’s right for anyone to tell you what you need to do with your reproductive health. What woman doesn’t want to carry a baby? You don’t just throw out the “S” word; you need to lead into it.
—Cesar, 42, marketing director
While some doctors may not be as tactful or sensitive as others, if you find yourself feeling hurt or angry at what your doctor has to say, you probably need to take some time to consider alternatives. Surrogacy is not the answer for every couple and not all who discuss it will embrace it. Still, there are a number of reasons to have a baby using a surrogate. Here are some of the key benefits to you.
Involvement. Surrogacy allows you to be involved as much (or as little) as you like in the development and birth of your child. There are no war scars from using a surrogate. You don’t need to worry about stretch marks, varicose veins, swelling, weight gain, morning sickness, gas, heartburn, constipation, incontinence, nasal congestion, shortness of breath, hemorrhoids, backaches, fatigue, mood swings, or unusual cravings. Whew!
Biological Factor. You use your partner’s sperm (if viable), making your child biologically related to your partner (and you, if your eggs are viable).
Parental Rights. When your baby is born, you become the legal parents through a court order.
If you’re tired of trying what’s not working, are open to this concept, and want to increase your odds, surrogacy might be the best alternative for you. Many couples look at surrogates as helpers. They ask willing family members, friends, or purposely look for someone outside of their immediate circle. Sometimes friends you know who have children might empathize with your struggle to have a baby and might offer to be your surrogate.
Surrogacy is not anyone’s first choice, as it is complex and expensive, but many have used surrogacy to create the family of their dreams. Using a surrogate allows you to have a close connection with your baby from the start. Most surrogates, depending on their personality, are more than happy to have you accompany them to doctor appointments and give you access to your baby through talking, reading, or palming their stomach for an occasional kick. Video calls via Facetime and Skype create an opportunity to be virtually present even when you are far away.
Having a surrogate carry your baby also gives you the chance to relax and not worry about appointments, test results, or whether a fertility treatment worked. Surrogacy is safe because you work with a woman who has children of her own, has an established pregnancy history, and is ready to help you achieve your dream of becoming a parent.
WHAT YOU NEED TO KNOW ABOUT SURROGACY
Surrogacy dates back to biblical times. Abraham, the father of three religions (Judaism, Christianity, and Islam) wanted a son, but his wife Sarah was infertile. Sarah offered her maid Hagar to Abraham so he could have a biological child. Nine months later Hagar delivered a son named Ishmael for Sarah and Abraham. This is the oldest recorded history of traditional surrogacy that we know of.
Traditional surrogacy involves inseminating a woman who will then carry a baby genetically related to her and the intended father. Your fertility specialist inseminates your surrogate with a sample from your partner (or sperm donor). With traditional surrogacy, your surrogate and your partner have a genetic relationship to your child.
Figure 9.3. Traditional surrogacy options
Gestational surrogacy is relatively new. With gestational surrogacy a woman receives an embryo transfer from either fresh or frozen fertilized eggs. These eggs can be made four different ways: 1) by the intended mother and father and implanted into surrogate, 2) by an egg donor fertilized in the lab with semen from the intended father, 3) by the intended mother inseminated with a sample from a sperm donor and implanted into the surrogate, or 4) with a egg donor fertilized in the lab with semen from a sperm donor.
Figure 9.4. Gestational surrogacy options
WHY DO YOU NEED PROFESSIONAL GUIDANCE?
Even if you enjoy tackling long-term projects independently, finding an egg donor or surrogate is where you should draw the line. This is because of the hefty emotional, financial, and legal risks involved with third-party reproduction. But don’t fret: professionals in this field are skilled at helping you through this life-changing process. After all, besides marriage, the single-most important commitment a couple can make is to start a family.
Your professional team will help you understand what you’re signing and will make you and your partner feel comfortable that your family is adequately protected under the law (which varies depending on your state and country). Keep in mind that donating an egg or embryo or carrying your child for nine months is a tremendous commitment, even for a family member who has agreed to receive compensation. Although you can approach third-party reproduction like any other business contract, we believe you’re missing a key component if you can’t celebrate the donor or surrogate who made your journey possible.
Saying Okay When It’s Wise to Take a Breather
Lack of success in fertility treatments results in increasingly complex steps. If you started with an IUI, you might try IVF. If that doesn’t work, you might try an egg (or embryo) donation. If that doesn’t work, your last stop before adoption is finding a surrogate.
It’s easy to slide into autopilot and say, “Okay” when maybe you need time to reconcile your feelings and the underlying emotional consequences that occur when you alter your game plan. Taking time out doesn’t mean that any one of these steps isn’t right for you; it means that you need time to embrace a pregnancy that’s not what you originally imagined before plunging ahead.
Having the right professionals on your team can make your surrogacy experience enjoyable. There are three experts you won’t want to do without: an experienced reproductive endocrinologist, a well-informed attorney who specializes in third-party reproduction contracts, and a mental health professional trained in third-party reproduction. Think of these professionals as three extra sets of ears (and eyes) that can identify problems before they occur.
Reproductive Endocrinologist
Your RE is the professional who will coordinate your involvement with your egg donor or surrogate. He’ll give nature a hand by using the latest technology to help you get pregnant, or he’ll help you have a baby through a surrogate.
Besides guiding you, answering questions, and educating you on the process, your fertility specialist is the gatekeeper for every aspect of your surrogacy or egg donation. Without his approval or medical clearance, your hopes of building a family can come to a standstill.
Mental Health Professional
Your mental health professional (MHP) or therapist will sometimes act as a case manager, working closely with your doctor and attorney to iron out medical, financial, contractual, and unforeseen issues like bed rest for complicated high-risk pregnancies. This is the kind of professional you want.
Some psychologists and MHPs will conduct an interview, give a psychological test, write a report, and then they’re done. You want an MHP who will follow you throughout the duration of either process. Egg donation is less involved and may last several months, whereas surrogacy may last about 18 months until your baby is born.
The most important reason to consult with an MHP is to allow your heart to catch up with your head. If you’re uneasy about seeing one, understand that her role is not to determine whether you’re psychologically fit to be parents. Reputable MHPs see their role as providing an opportunity to talk through issues and decisions couples face when building families.
MHPs can also help in the early stages during the matching process and even postpartum. If your MHP follows you throughout the entire process, she’ll have an accurate pulse on what’s going on in terms of timing, contracts, addenda that need to be addressed, trust fund or escrow account payments (you’re required to establish either a trust fund or escrow account for pregnancy-related expenses that your donor or surrogate may encounter while under contract), and any other pressing issues that she can handle. If your MHP is not willing to act as your case manager, you’ll need someone else to coordinate the process to keep it on track.
Most fertility specialists will not approve your surrogate until an MHP conducts psychological screening. This means that regardless of whether you have a family member or friend in mind or you’re searching for someone outside your circle of contacts, the surrogate you select needs clearance to determine whether this is the best situation for her too.
Attorney
You’ll want an attorney who specializes in family formation law. This means the majority of his practice deals with third-party reproduction and adoption. Your attorney will need to know the rules and regulations that govern your residence (laws vary depending on state and country). You’ll also want an attorney licensed in the state that you or your surrogate plan to give birth in.
Your attorney is the quarterback who oversees every aspect of your surrogacy or egg donation to make sure all parties comply with appropriate laws. He is also the only professional whose sole job is to protect the rights of the intended parents—an important person to have on your side.
Some couples forgo an attorney for financial reasons and use a contract they download from the Internet. Legal experts advise against this. Contracts are continually updated, so you may miss out on an important clause that could leave you open to future litigation. Your entire legal fee runs about $1,000, and for counsel who can make the difference between an airtight contract and one that leaves you open for a host of problems, it’s worth the cost.
Besides, there’s not a reputable RE around who will grant you medical clearance if you have not had appropriate legal counsel and clearance from a qualified attorney. This is as much a safeguard to you as it is to your donor or surrogate and your doctor.
Intended couples may not be aware that every surrogacy requires a court hearing to establish who the legal parents are. Your attorney can finalize your parental rights prebirth. In case you’re wondering how to have your name put on your baby’s birth certificate instead of your surrogate’s, your attorney can do this too.
Frozen Success
Some nurses had never dealt with a surrogate. They didn’t know who had the right to do what, who signed papers for the baby, and so on. We had to share the court papers with them.
—Ignacio, 39, police officer
Your attorney will handle both of these issues prebirth because if you wait until postbirth you 1) you run the risk of confusing the hospital staff about who the legal parents are, 2) the hospital staff might deny you access to your baby, and 3) your name will not be put on the birth certificate. Some intended parents have had to step-adopt their babies after birth because they didn’t handle these matters earlier.
Contracts are essential because they spell out what individuals can and cannot do legally. Besides abiding by local laws, there are a number of issues you should be aware of. The first and most obvious one involves protecting your genetic material so that there is no doubt that your eggs or embryos are yours. Your contract needs to specify that your donor relinquishes all rights to your eggs or embryos. This means she doesn’t own your genetic material, will not have a say about how it will be used, can’t come back at a later date and claim them as her own, does not have visitation or future input in how you’ll raise your child, and will not have further contact with you unless you agree otherwise.
The second, most critical element that you’ll want in your contract is appropriate informed consent—medically, legally, and psychologically. This is especially important in an egg donor relationship. Your donor needs to fully understand and appreciate the ramifications of going forward. She needs to be aware that she is required to take fertility medications that will hyperstimulate her ovaries. She also needs to know the entire medical process and long-term ramifications if something were to go wrong, including her own infertility. Not only will you need informed consent, but all members of your professional team must also provide clearance documents on her ability to do this.
Your contract spells out any limitations or restrictions on use of eggs, embryos, or sperm. For instance, if a donor specifies that she is donating her embryos only to a sole heterosexual married couple, then her fertility specialist cannot donate those same eggs to a cohabitating couple, a single woman or man, a same-sex couple, or to multiple couples. Likewise, a fertility specialist must abide by the donor’s restriction if, for instance, she stipulates in her contract that she feels comfortable donating her embryos only to a Christian family. Surrogacy contracts should spell out the maximum number of embryos the parties agree to transfer and under what circumstances (if any) do they agree to terminate the pregnancy.
Legally, intended parents can’t pay for sperm, eggs, or embryos or for relinquishment of any rights that donors may have. Instead, couples pay donors for their time, inconvenience, medical expenses, pregnancy-related costs, assumption of risk, and loss of wages. Other expenses you need to cover include legal fees, cost of preparing a contract, and fees to ship eggs, embryos, or sperm. By law, giving away genetic material has to be a donation. If lawmakers didn’t interpret gifting this way, the term donation would not apply.
Donors need to give intended couples full disclosure. Everything the donor says about her medical history, genetic background, mental health, social status, income level, and lifestyle must be absolutely correct. Both parties need independent legal counsel so someone is watching out for their best interests.
WHAT SCREENING APPLIES TO DONORS AND SURROGATES?
Egg donors are screened for carrier status of common genetic diseases, psychological problems (this involves a frequently used personality test referred to as an MMPI [Minnesota Multiphasic Personality Inventory] plus an interview), basic health issues (history and physical), sexually transmitted diseases, and family history of significant health or psychological issues or drug abuse.
Gestational carriers are screened for all of the above plus they have a uterine cavity evaluation to make sure that they are capable of successfully carrying a baby to term.
Couples who have limited resources might cut corners and find their surrogate online. But this may leave you less than satisfied. The same goes for putting together your own questionnaire and application and conducting your own interviews. While this may work for some, it can also backfire. Most couples searching independently for a surrogate are so desperate that they’ll do almost anything to fulfill their desire. What you want to prevent is having a small agency take advantage of you just because you’re vulnerable.
Couples who search for a surrogate on their own without professional guidance can wind up handing $50,000 to $100,000 to a lady who manages two surrogate moms from the confines of her own home. Some of these women who run mom-and-pop agencies out of their house might even opt to be surrogates themselves. This is not what you want. There’s no way of knowing whether these women will find the right surrogate for you, end up as surrogates, or wind up on bed rest from high-risk pregnancies.
There is a chance that with a large agency you might feel like a number, but you also have access to professionals and services that a small agency can’t afford like a trust fund administrator, a 24-hour answering service, secretaries, directors, and administrators.
WHY SURROGATES DO WHAT THEY DO
Most surrogates are stay-at-home moms. They choose surrogacy because it’s a way they can make an extraordinary contribution to the world. Simply put, they’re the cupcake bakers, PTA participants, Red Cross blood donors, family tree historians, photo album and memory book makers, and Hallmark card buyers.
Why I Wanted to Be a Surrogate
I wanted to help. We already had two children, so I thought maybe I could make a difference for someone. I love being pregnant, and it seemed like a wonderful way to give. My husband, Billy, said it was a cool thing to do. He had no objections, moral or otherwise.
—Summer, 28, real estate student
They spend their life doing selfless things to make people happy. By nature, they’re concerned about doing a good job. Many surrogates are married, have a stable life, a healthy support network, and own their home, dispelling the myth that these are down-and-out women who are supporting drug habits.
I was always concerned that Summer wasn’t eating right or was having a glass of wine. But when I got to know her it was clear she was doing everything possible for our baby.
—Ignacio, 39, police officer
The surrogate you’ll want is someone you feel comfortable with. Just like meeting a new friend, you’ll want some degree of chemistry that makes you want to communicate with her on a frequent basis. You’ll want someone who is upbeat, cooperative, and compliant with your needs. This means that you need to be reasonable in your requests and not overly controlling. If you find yourself questioning a candidate’s motives or capacity to provide a nurturing environment for your child, then it’s time to politely end the interview. You can take this time to rethink your feelings or, if you’re sure this is what you want to do, start fresh with a new candidate. Think of meeting potential surrogates as a primer for interviewing babysitters, nannies, or daycare workers; you wouldn’t let just anybody take care of your child, and the same goes for surrogacy.
Finding Your Ideal Surrogate
When I saw Summer walk into the room I sensed a strong connection and sobbed. I knew she was the one.
—Claudia, 35, teacher
Above all you’ll want to feel comfortable with your surrogate, and you’ll want her to reciprocate. Like it or not, you’ll both be in this relationship 12 to 18 months, so you’re wise to make the best of it. The nine months your baby is developing inside your surrogate is likely the longest your child will ever be away from you until he or she reaches adulthood. That’s huge when you consider that your surrogate may be someone you don’t even know. Once you find a surrogate who puts you at ease, you’ll sleep easier knowing that you picked the ideal environment for your child to grow in.
CRITERIA TO LOOK FOR IN A SURROGATE
• between the ages of 21 to 40 *
• given birth to at least one child *
• BMI less than 30
• physically fit
• nonsmoker and no recreational drug use *
• no health limitations and has a healthy reproductive history *
• normal uterus *
• financially independent
• good credit history *
• no history of psychological problems and normal psychological screening*
• lives in a jurisdiction favorable to surrogacy (e.g., surrogacy is illegal in the state of New York) *
• stable in all areas of her life *
• her children live with her (if applicable) *
• can articulate her reasons and motivations for becoming a surrogate
• projects a level of confidence about her decisions
• exudes a level of empathy for others
The ideal surrogate is hard to find, and most do not have every one of these attributes, but the hypothetical “perfect” surrogate would have all requirements denoted with an asterisk.
Finances are a large and important part of the picture, but keep in mind that surrogates make about $18,000 to $24,000 excluding medical and extraneous expenses (maternity clothes and parking for doctor visits). If you divide this wage by the average time a surrogate spends undergoing screening, fertility treatment, achieving pregnancy, carrying your baby and recuperating, her salary comes out to about 80 cents an hour. That’s less than some factory workers make in third-world countries. But unlike factory workers, your surrogate is on call 24 hours a day, seven days a week.
Insuring Your Surrogate
Insurance is absolutely necessary. Some surrogates use their own medical insurance policy, some apply for coverage but carriers decline them, and others request that the intended parents purchase their coverage. If your surrogate is willing to use her own insurance and her carrier covers surrogacy, then you’ll want to proceed in this direction. But if the answer is no to both, then you’ll need to find a reputable insurance company that will cover her. Many insurance companies refuse to cover surrogates, some cover everything but medications, and others cover the majority of your surrogate’s expenses while pregnant. Once your surrogate is pregnant, you’ll need to purchase a life insurance policy for her that makes her family the beneficiaries.
Traditional surrogates don’t view giving up a baby with half their genetic makeup the same way intended moms do. If they wanted a baby, they’d make one with their own husband. They’ve done that before, and from their perspective they would have lost those eggs anyway in their menstrual cycle. This way they know that at least one of those eggs will mature into a baby who will receive love and nurturing from parents who put everything on the line to start a family.
When Your Wife’s a Surrogate
I love my wife. Summer always puts other people first. That’s who she is. She did whatever it took to make sure Claudia and Ignacio had a shot at parenthood.
—Bill, 28, chef
Matching your personality to your surrogate’s may not seem that important. If you view surrogacy as nothing more than a business arrangement, chances are it won’t seem important at all. But if you understand why corporate America spends millions of dollars on personality profiles, you know that certain personalities work together better than others. Surrogacy is no exception.
Matching works best when both parties show empathy for each other. Their values, interests, philosophies, ethics, and even religious ideations should be similar (unless they’re accepting of other people’s belief structures). For instance, you wouldn’t match a surrogate who wants an extremely involved intended mom with a high-powered CEO who spends most of her time on an airplane. This is a recipe for failure. At the same time surrogates who can’t stand being micromanaged won’t do well with parents who want to dictate every aspect of her life while she is carrying their child. Before long your surrogate will become hostile or passive aggressive, and this is not the environment you want your child in.
Defining Your Relationship
You and a stranger embark on an intimate journey that can last up to 18 months. Boundary issues may cause you to seek control over “your baby,” as your surrogate seeks privacy over “her body.” Awareness of where your surrogate begins and where you end can prepare you for any friction you may encounter along the way.
Common issues that build a gap between you and your surrogate include disagreements over what OB/GYN to use, what to eat or drink, how much to sleep, whether to exercise or travel, who has access to the delivery room, and how frequently to stay in touch if you live in the same city or in a different state or country.
Sometimes willing parties may learn that they acted too hastily in signing up once they learn what’s required in a surrogacy relationship. For instance, a sister or sister-in-law may not know how to say no to you, but after learning what is involved (time commitment, daily shots and risks of medical complications, including the possibility of carrying multiples), she may admit to an MHP that she really doesn’t want to go through with it. This is not a situation you want to deal with five months into her pregnancy.
When Using a Family Member Works
Our surrogate was my sister, so I definitely want our sons to know how important she is in this equation. I will tell them that her tummy wasn’t broken, so she carried them for us.
—Devon, 35, court reporter
Remember that your sister, sister-in-law, aunt, mother, or cousin can be a surrogate for you. But an unhappy surrogate isn’t the answer. What you don’t want to do is coerce a family member into an arrangement. A reputable MHP will have a good sense of whether your surrogate is choosing to carry your child out of obligation or because she couldn’t see it happening any other way.
MYTHS OFTEN ASSOCIATED WITH SURROGATES
• She plans on keeping your baby.
• She’s selling her body to finance a drug habit.
• She thinks only about money.
• She plans to run off to Mexico with your baby.
• She’s looking for someone to micromanage her.
• She’s interested in talking about only you and your baby.
• She’s willing to stop her life so you can have your baby.
UNDERSTANDING EVERYONE’S PERSPECTIVE
As mentioned earlier, corporations spend millions of dollars giving their employees personality profiles so they can understand how to work together better and enhance overall business performance. Although we’re not suggesting that both you and your surrogate take one, we are suggesting that your relationship will be smoother if you each know where the other stands.
Surrogates and couples come from two different sides of the emotional spectrum. Surrogates come with a desire to be a dream maker. They approach surrogacy with the enthusiasm of a cheerleader. They’ve had great pregnancies, they love being pregnant, they feel like they do pregnancy well, they’re going to be able to give a couple a baby, and they love being a parent themselves. They sign up with a very expectant, optimistic view of the world. In short, they’re thrilled to be there, and they come to surrogacy by choice ready to help.
Couples come to surrogacy as a last resort. Most approach it skeptical, guarded, uncertain, and disillusioned. If this describes you or your partner, you probably feel beat up emotionally and financially. After all, your body has let you down. This can cause you to feel a tremendous amount of grief. You may even be grappling with skeptics in your family or circle of friends who ask questions like, “Are you sure you want to do this? Why don’t you adopt? And how do you know this woman’s not going to run away to Mexico with your baby?”
Repeated pregnancy disappointments, gynecological surgeries, and a million other things can taint your optimism. Your dwindling pocketbook has erased your confidence. If this wasn’t enough, now having a family depends on paying even more people, including an attorney, a psychologist, and an agency, to meet a stranger who might be able to give you a baby.
As far as high risks are concerned, surrogacy makes Vegas look good. Talk about a roll of the dice: you wouldn’t put $100,000 on the table without a gut feeling that you would win. The stakes are higher than playing the stock market.
Giving a Gift of a Lifetime
Surrogacies and egg donations are business relationships that are deeply personal. Pretending that they’re anything different is a quick way to ruin one of the most selfless ways to give outside of organ donation.
DOES YOUR STATE PERMIT SURROGACY?
Jurisdictions that don’t permit surrogacy contracts may force you to find a surrogate outside the state you call home. Why? The United States does not have a national policy governing surrogacy. Each state sets its own laws overseeing this practice. Some states have laws that prohibit surrogacy, some have laws that permit it on a conditional basis, and some prohibit or permit it even though they have no laws on the books that address it at all. State laws vary from making surrogacy contracts enforceable to criminalizing all forms of commercialized surrogacy. States that prohibit surrogacy can declare your contract unenforceable and issue you jail time and a hefty fine (up to five years and $50,000 in Michigan).
Figure 9.5. Surrogacy map As of fall of 2011. State laws are fluid and constantly evolving. Check with a surrogacy attorney in your area.
Courts and lawmakers across the country are trying to keep pace with reproductive issues. Legislators and judges enacted existing legislation to protect women from exploitation and protect children in situations of adoption. Some of these laws are so outdated that couples wishing to build families can run into roadblocks even when dealing with their own embryos.
Laws Haven’t Kept Pace with Today’s Families
Antiquated laws in some states have forced intended parents to circumvent them by adopting their own biological children. This means that if your state law doesn’t recognize surrogacy and you contract with a surrogate in your state, the courts may not recognize you as the legal parent and you may have to adopt your own biological child. Some couples go around this by contracting with a surrogate in a state that recognizes surrogacy.
Lawmakers tend to make laws that center around these three questions:
1. Is your surrogate contract binding?
2. Does your surrogate have the benefit of informed consent when she signs a prebirth contract granting you custody of the child she’s carrying?
3. Is it lawful to compensate your surrogate for services associated with rendering, carrying, and conceiving your child but not for the end result?
Surrogacy Laws Made on the Spot
Although few states have enacted laws on surrogate parenting, the context surrounding this family-building option is generating immense interest among legislators, legal scholars, and the public. There’s little debate that surrogacy at the legislative level and in the court system is inciting optimistic and pessimistic reactions, leaving an inconsistent quilt of laws governing what citizens can and can’t do when it comes to creating a family in their own state. Until lawmakers address surrogacy as a practice instead of making laws when isolated cases reach court, surrogacy will remain in a state of ambiguity.
So what does this mean for couples overseas? Like the United States, the rest of the world views surrogacy with legal, ethical, and moral eyes. Lawmakers in foreign countries are addressing surrogacy with the same intent as lawmakers in the United States. Table 9.1 shows how a number of countries view third-party reproduction.
Table 9.1. How the rest of the world views third-party reproduction
Keep in mind that even though we provided an overview of how states and countries around the world deal with surrogacy, laws are fluid and subject to change. Check with an experienced surrogacy attorney before proceeding with an arrangement.
WHEN TO RECONSIDER THIRD-PARTY REPRODUCTION
There are a number of reasons to decide against surrogacy or egg donation. They can be as simple as personality issues or as complex as choosing to adopt because of family upheaval or conflicting religious beliefs. If your match isn’t working or if you have a change of heart, you’ll need to opt out before your surrogate starts fertility medications. Once she’s pregnant you won’t have a choice. It’s best not to move forward in the following cases:
• You feel conflicted about a child who doesn’t fully share your biology.
• Your surrogate or donor is too young or too old.
• Your surrogate or donor refuses psychological screening.
• You’re not willing to carry multiples.
• Your surrogate refuses to carry twins or multiples.
• Neither party is willing to take out an insurance policy.
• You’re unwilling to set up a trust fund or escrow account.
• Your donor or surrogate is making extraordinary demands.
• Your agency engages in questionable practices.
• You disagree ethically or philosophically with your donor or surrogate.
• Either party disagrees on the need for prenatal tests and procedures like amniocentesis, multifetal reduction, or abortion.
Don’t be surprised to find that opportunists exist even in your attempt to acquire quality egg and sperm donations (see chapter 14). Keep in mind that none of these options include extras like legal fees, phone conversations, video conferences, and personal meetings, which can run another $10,000. This is another reason you may want to avoid answering egg donor and surrogate advertisements yourself. You wouldn’t hand over your child to a stranger, so why would hand over your ability to reproduce to someone you met in a chat room?
Table 9.2. Total costs of egg donations and surrogates
WHAT QUESTIONS SHOULD YOU ASK?
Having a baby with help from an egg donor or surrogate is not a decision you should make overnight. Family building options are not for everyone. Yet plenty of parents with children conceived this way say they would do it again in a heartbeat. Knowing what to expect through education, research, counseling, and talking to couples who have traveled this path before can help you make an informed decision.
If you are considering third-party reproduction, ask yourself the following questions (be sure you can honestly answer yes to all before proceeding):
• Have you made peace with the fact that you can’t have a biological child?
• Are you comfortable involving a fourth person to help build your family?
• Do you have an airtight legal contract that specifies your needs?
• Have you and your egg donor or surrogate had the appropriate medical, legal, and psychological screening?
• Have you gotten beyond the fear that your egg donor or surrogate will want your baby?
• Are you aware that a good professional team can help you avoid unethical people who prey on couples desperate to have children?
• Are you unsure of telling your child about his donor or surrogate?
• While third-party reproduction is a wonderful way to end your childlessness, it’s a decision you need to make with great care.
• Contracts are essential because they spell out what individuals can and cannot do legally. What is legal in one state or country may not be legal in another. Check with an attorney experienced in third-party reproduction before proceeding.
• Paying for genetic material is illegal. Intended couples pay donor and surrogates for their time, inconvenience, assumption of risk, and lost wages.
• A large agency has resources to help you through the matching process by looking at personalities and motivations early on.
• While money may be the catalyst for an egg donor, the heart typically follows.
• Telling your child personal information about his donor is much more psychologically satisfying than saying, “We chose B8542.”
• The biggest fallacy when considering surrogacy is that your surrogate wants your baby.
• Surrogates and couples come to their relationship from two different sides of the emotional spectrum: surrogates come with a desire to be a dream maker, whereas couples come as a last resort.
