Monday, May 28, 2012

Surrogacy FAQ

So I'll digress again and post about the top questions we have gotten since we've started our surrogacy journey. This addresses the most common questions we've been asked as well as some of the controversy surrounding surrogacy.

1. “So do you know what you are having?”

This is a popular question, for obvious reasons! However, in India it is illegal to detect or reveal gender. There are some cultural reasons that boys are preferred. The darker side of this is that is in many cases people have aborted girls or even refused to take a girl home from the hospital, which led to the law being created. Some girls have been given a name that means “unwanted” and there was a huge renaming ceremony held recently because of this in Mumbai.

Some reasons for this are that girls require an expensive dowry when they are married, and they typically live with the husband’s family and take care of them in their old age. That means boys will bring home a large dowry and a homemaker/caregiver. Because of this gender preference issue, Indian law is strict about revealing the baby’s sex.

We do get some sonogram pictures emailed to us but will not get videos, so it is pure luck if bits and pieces happen to be at the right angle. The pictures have a huge fax stripe across them and have been scanned into a poor quality scanner before being emailed to us. At the bottom of every page there is a disclaimer stating that the sonogropher has not “detected or revealed” gender. We’ll take a good look at every scan we get and show a few of our doctor friends, but it looks like we are in for a wonderful surprise in October!

2. "So is eggs, and umm...Vinnie's...ya know...stuff?"

(Below is the ddiplomatic answer I gave to acquaintances)

We understand the curiosity factor and why this is the most common question we've been asked so far, but this question is a little personal. We'll let everyone have the fun of guessing, but the important thing is that we'll always be open and honest with our children when they are old enough to understand about how others have helped us on our fertility journey. If it doesn't matter to us, it certainly shouldn't matter to anyone else. We firmly believe that we each are the captain of our own ships and genetics don’t govern our destiny, so we look forward to seeing who our children become regardless of the impact of nature as well as our nurturing over the course of their lifetime.

3. “Why India?”

India is where Vinnie’s family is from, and we have enjoyed their tremendous hospitality in Delhi several times. I’ve been there twice and Vinnie five times, and he does speak some Hindi. We are both familiar with the country and culture, and have much support there and from our Indian community here in the US. We began our life together there when we were first dating before we became a family, and now we return to make our family complete.  It is truly wonderful how it has come full circle and India has become the land of opportunity for us.  Despite tremendous growth and progress as well as embracing developing technologies and becoming a rising economic power, India is still a country afflicted by much poverty. This means the money we are spending will go so much further and will without a doubt change the lives of the surrogate and her family in a truly significant way.

The most simple answer however is cost. Surrogacy in America is easily at least three times the cost in India, and fraught with far greater legal and financial risks from what I’ve read. As we’ve spent 8 years living through the hell of infertility and extreme expenses that go along with it, we don’t have over $100,000 to spare. Insurance covers nothing when it comes to common infertility treatments in our case, not to mention surrogacy. Only 3 companies in the US cover surrogacy when I last researched, and the cost was so high it would be cheaper to pay all medical expenses out of pocket and hope all goes well. That is hardly responsible. To try to cover a surrogate anyway without disclosure to the insurance company would be committing felony insurance fraud, and would likely be discovered during the delivery or after attempts to get the birth certificate altered to the biological parents ($7,000 legal fees for that alone). This made us very sad because at one point we did have a wonderful woman volunteer as a surrogate for us without asking anything in return, but due to insurance and legal costs alone there was no way we could responsibly afford it.

4. "So how does that work with the surrogate?"

This question has come up a lot and it sounds like people are really asking about the surrogate selection process and how they avoid forming an attachment to the baby (or in our case babies!) they are carrying for nine months. In order to qualify as a surrogate she has to be married with at least one child, whom she carried to full term with no complications. The egg implanted in the surrogate is not her own, which in addition to the selection and counseling process provided assures that she does not form an unhealthy level of attachment.

There are legal documents that protect both parties in the agreement, and the contracts clearly put the health of the surrogate as the top priority.  We have found this comforting, and it helps us to trust that our clinic has their priorities and ethics straight. International law can get complicated, so choosing a clinic like Akanksha with a superior reputation ensures that all parties are treated fairly and things will go smoothly.

It will certainly be difficult to let go after nine months of bonding, but this is a decision she and her family have not made lightly and have been well prepared for. I’m sad that I’ll never be able to understand what she has been through to deliver these babies to us, but I am certainly more grateful than she’ll ever be able to understand.  She is doing this not simply as a human kindness, but because her family lives on a few dollars a day and she can now provide support them far better than she could have otherwise. We have no problems with her seeing or visiting the babies after birth if she chooses, and will be offering to pay her to produce breast milk for two weeks if she wants to. After that though, the clinic has told us it is best for everyone to not continue contact.

We did not have the opportunity to meet this surrogate beforehand unfortunately, so we only know her name and that she must be an amazing woman to make this sacrifice and help us in such a profound way. We did get to meet our first surrogate, but the attempt failed so it took a second try with frozen samples that occurred while we were back in the states. Thus we’ll just have to look forward to meeting Manju in October. We are mailing her gifts and pictures of our family and home as well as a heartfelt letter we had translated into her native language. We do plan to pay for the modified baby shower they offer as an option for the surrogates to keep her spirits up during the difficult late stages of pregnancy.

5 “Are the surrogates well cared for?”

One of our greatest comforts, especially with twins, is that she has the sole task of relaxing and focusing on taking care of herself and the babies for the duration of the pregnancy. That along with her history of uncomplicated pregnancy helps us to hope that all will progress well.  Most of them choose to stay in the two “Surrogate Houses,” that are host to about 70 active surrogates. Medical care and exams are provided on site on a weekly basis. Does anyone in the US have their doctor and specialists make home visits weekly?  Organic, healthy food is provided daily along with nutritional counseling.

Family members can visit once a week. Many of them travel from great distances to become a surrogate, so the money provided will allow their family to visit for the 9 months duration. In addition they will now have some spending money typically well beyond their normal income to support their family in the meantime.  Keep in mind many married women are used to their husbands working in a large city while they live in village and only see their spouses a few select times throughout the year.

The surrogates mostly rest and commune, but also benefit from classes to include English lessons, which can provide gainful employment in the future that they would not otherwise have enjoyed. They do often keep their surrogacy a secret, because so many people in the community do not understand the scientific sophistication of fertility medicine, and not everyone understands how they can be pregnant with someone else’s child without having extramarital relations. Their confidentiality is well protected, as is ours to prevent any attempts at seeking additional compensation beyond what has been agreed upon.

6. “But isn’t this taking advantage of poor, uneducated women in the third world who have no idea what they are getting into?”

As much as there has been media coverage sensationalizing the risk of taking advantage of poor women in the third world, we are confident that our clinic and the physician couple who are running are doing things the right way. We initially learned about Dr. Nayana Patel’s clinic from her interview on Oprah.  She has a signed head shot in her office. J  You can see multiple interviews of Dr. Patel on You Tube, and I think you will like her style as much as I did when it comes to how she handles the questions and unwarranted criticisms.  It took us three years to be accepted into the surrogacy program because there was a wait list. She was focused on being careful not to overextend herself and reduce the quality of care to the surrogates when the demand rose because of the publicity that Oprah brings.

Documentaries like "Google Baby" that focus on the questionable ethics of one clinic in particular, raise valid questions, but do not present the whole picture of surrogacy in India. We are confident that our surrogate has entered this process with an educated understanding of the risks and consequences, as well as the benefits. Her husband must have full consent and support her in this decision and sign the contract beside her.  I see her as a very strong as well as smart woman, who has chosen to make huge sacrifices for over nine months of her life. She knows exactly what pregnancy entails from having done it at least once before. Even if she has not had the benefit of a full secondary education she has lived a life that has made her tougher and in many ways smarter than the rest of us. Many of them have experienced a   hard life with living on a few dollars a day, which I argue is an education beyond what someone as privileged as I have been could ever understand.

In return she will gain an amount of money that is a salary of many years of what could have been hard labor.  Most commonly  the money is used to purchase a home and a put her own children through college, raising her own standard of living to an entirely new level and giving her children a better life than she could have imagined for herself. If someone has not personally visited a third world country, it is unlikely that they can even imagine how profoundly such a sum of money can impact the destiny of an entire family. We feel blessed that in exchange for creating our family and granting us happiness more profound that we ever dared to dream, in exchange we are making as profound of a difference in the life of another family on the other side of the world and granting one or more children a far better life.

7. “Isn’t there a risk of wealthy Americans ‘outsourcing’ pregnancy and birth to the third world to avoid stretch marks?”

Fears like this are extrapolated using a logical fallacy call the slippery slope. The pundits latch on to this one because sensationalism sells. It’s like saying that by allowing gays to legally marry pretty soon we’ll wind up allowing people to marry their dogs or inanimate objects. Sigh.

Anyone who has been through the process could never imagine someone doing this as an “easy solution” because it is anything but. Having been through it, I cannot fathom any way where someone foolish enough to try this could even get through a beginning phase of the process.  It would be far costlier, but much easier to abuse surrogacy in the U.S. than to go overseas in my personal opinion.

But Dr. Patel handles her critics below better than I ever could. My favorite part is how she questions the fact that if you do surrogacy in the U.S. no one is using the word exploitation, but once you do the same thing in the third world it is assumed as such.  I'm so glad that she sees the truth around her in the joy she brings to so many, and is strong enough to ignore the criticisms of those looking for headlines.

Fast forward 8 yrs later...

So what happened then? Do you ever notice how in the movies the love stories tend to end once the couple finally realizes their love for each other? They seldom tell the tales after the wedding and before children. I always noticed in my parents photo albums how there were only a select few photos from after the wedding and before they had my brother and I.

I'm sad to say that for eight years there are not that many photos of Vinnie and I building our life together. Things started off wonderfully, and we tried to start a family right away. Why? Because I knew I wanted to be a mother and because somehow deep down I knew we would have problems and it would take a while. How did I know that? I don't know. But I just knew things with my body weren't right even though my doctor, who had been my OB/GYN since I was 14 years old, tried to reassure me that everything was fine.

It's not to say that Vinnie and I have not built many happy memories together in these past eight years. We have. But only those who have been sucked into the black hole that is infertility understand what it is like. Most people are happy having BBQ's and fun with friends and enjoy their life without children, knowing they'll have everything they want someday. But when you are ready for children, all that changes. You have all the free time in the world to go to parties and engage in hobbies and enjoy yourself, but it is empty somehow because it is not how you want to be filling your time. And you can't exactly enjoy all that free time very easily when you spend it scrimping and saving every dime because the infertility black hole sucks your money away from you as fast as you can earn it. In some ways I feel like I lost eight years of my life.

So I became a workaholic instead after my first miscarriage to fill the time. The miscarraige devastated me so much, as did each one after that.  I don't care to recount the details, other than it seems like it is so callous how everyone expects you to move on and get over it so quickly like it never happened.  So I endured them silently, as I did the post-partum depression that accompanies it. Did you know that you can still get post partum depression without a live birth? It actually puts you at higher risk if you are childless.  I even hate the word itself. Mis-carry. It sounds like you did something wrong doesn't it?

Every passing month of failure it became harder to keep up a facade of happiness and endure the pain. I became darker and more cynical with each passing year, and hope faded to almost nothing. Parts of me shut down one by one. I think most people blamed me for my negative outlook. For not having faith, perhaps? Human beings find it much more convenient to blame the victim in most circumstances I find, because it helps them to feel more immune somehow to the pain that others suffer. They have to believe there is a reason for everything. I don't, but I think God helps us find reasons in the darkness. So God did not cause me to miscarry or cause 12 young people to get crushed by logs cause he needed another angel or their work on earth was somehow done. God has plenty, and they were not done, I assure you. And while it has made me stronger, I've endured enough in this life already I do not need to be any stronger thank you very much. I was rather certain if one more person told me to "just relax and it will happen" I was going to punch them in the face and lose my career due to the unfortunate ensuing assault charges. Don't even get me started on why you should never say that to someone suffering from infertilty.

But Vinnie stuck by me even in the worst moments when all hope seemed lost. And he still loved me even when I felt like a shadow of the woman he fell in love with.

 I like a recent quote by Joe Biden, who from the loss of his wife and one of his three children to a car accident is someone who truly understands loss and pain.
"For the first time in my life, I understood how someone could consciously decide to commit suicide. Not because they were deranged, not because they were nuts, but because they had been to the top of the mountain and they just knew in their heart they'd never get there again."
I spent years on suicide hotlines, and have for a long time understood the path from crisis to suicide and helped many people in their darkest hours.  But it wasn't until I suffered infertility that I developed a deeper understanding of what it does to you when you lose hope.

Finally being pregnant in many ways is like being on top of the mountain Biden speaks of. I liken it to getting ripped out of heaven, and everything thereafter loses it's flavor because you finally know what it's like to be truly happy. It is easy to judge me for losing hope, but for the eight years that passed nothing but roadblocks presented themselves, and most were financial. Infertility is exorbitantly expensive. To attempt IVF with my condition and repeat miscarraiges is like buying a new car with only a 10% chance it will run at all. My husband lost his job and struggled to find work for two years. My insurance covers nothing related to infertility and my employer pulled their adoption assistance program in budget cuts. And the adoption tax reimbursment is slated to end on Dec 31st, 2012.

It turns out I had Poly Cystic Ovarian Syndrome. PCOS is by no means a death knell to ever having a baby carried to term. Many women with PCOS do. But not me. Women like Posh Beckham and many I've met on infertility forums seem to have success. But they also seem to have a lot more money to throw at treatements with low odds. For me, I could get pregnant but even with the proper precautions for my condition I still miscarried. IVF gets you pregnant. For preventing miscarraige all you can do is take a progesterone pill and cross your fingers.

Jillian Michaels from Biggest Loser decided not to go through the roller coaster she'd seen others with PCOS suffer through and "just adopt." This week after a several year wait and struggle she finally got her baby, now toddler actually, home. This happened the same week as her partner was able to give birth to an infant with the help of a sperm donor. I am so happy for her, though admittedly slightly jealous that she is amongt the small 20% of PCOS sufferers (along with Posh Beckham) who manage to not be obese. PCOS gives you the world's worst metabolism, but being wealthy and paid to be a fitness expert seems to help matters I guess.

By the way, PCOS is not just an "infertility disorder." It gives you a very high risk of diabetes and heart disease, and at one point before my lap band surgery I was diabetic. I've been pre-diabetic since my early 20's.  It also causes you to be chronically fatigued, have male pattern hair growth, wicked mood swings, and irregular periods among other things. It just plain sucks. It sucks even more to go through puberty not knowing you have it and blaming yourself for the symptoms and getting teased mercilessly by your peers. And it REALLY sucks when your doctor could have diagnosed you at any point since you were 14, but doesn't bother to because he thinks it is "just an infertility disorder" and diagnoses you at 26 while in the middle of an internal exam at your insistence that something has to be wrong, then tells you to "look it up on the internet" and leaves the room! I switched doctors after that. If I sound bitter, I am.

"Why didn't you just adopt?"

I have really grown to hate this question.

People don't realize the cost of adoption and surrogacy in America is exorbitantly expensive, and that infertility is a disease better suited to the wealthy. As sad as it is, the cost of adopting one infant child in America would be far more expensive than having twins via surrogacy in India. Adoption of a newborn involves extensive wait times, expense, and risks as well as heavy competition “selling” yourselves to potential birth mothers who can easily change their mind very late in the game. I have witnessed the nightmare of a friend whose birth mother changed her mind at the last minute, and I know that I am not strong enough endure like she has.  If you are not a young male/female couple in excellent health with a Christian belief system, it can be far more difficult if not impossible. It is for these reasons so many turn to international adoption, which is fraught with many of the same problems but involves a little less risk and less expense. However, it is still more expensive than surrogacy from what I've experienced, especially when you are cut off from any reimbursement programs. I have a hard time not seeing all that bureaucracy and financial demands that you have to wade through for years as people profiting off of the pain of infertile couples and orphaned children.

While we do plan on adopting later, know that adoption involves a very long, invasive, and often costly process with few guarantees. Low cost adoption that we will be doing involves not only long waiting times, but also older children, medical and developmental disabilities, but also a high risk of losing the child to the birth parents/family even months after you have raised them and become attached to them as your own. We hope to someday add to our family through fostering and/or adoption, but that is a very difficult journey that we will be ready for at a later time. We want to feel ready for an older child, as well as a child that may need expensive medical treatments or developmental support. But the plain fact is that I am not strong enough to have a child become mine and lose it and be back to childless again. I'm. Just. Not.

As a final note, people who have had the luxury of fertility and biological children can sometimes be quick to judge others as selfish if they do not immediately accept alternative choices. However they seldom educate themselves about the complexities and expense presented to those who have not been as fortunate as they have been. Those who do judge take for granted how hard it is to give up and grieve for the losses associated with not having biological children nurtured from birth. So don’t judge until you’ve walked a mile in someone else’s shoes. Or in this case traveled a few thousand miles and walked for nine months in someone else’s sandals.

So at around 7 1/2 years of marraige I am finally at the end of my rope. I'm angry and bitter and cynical and hopeless. I'm also finishing the police academy while working full time, a feat of tremendous accomplishment. I figured if my dreams of a family couldn't come true, I could at least make a career dream  come true and be able to do the reserve or perhaps full time police work. It's the only other dream I've ever had for myself beyond marrying a great guy and having kids and a modest home. But as the final months of the academy approached, I was sent into a tailspin when I got a call from my incredible father-in-law.

Most people joke about and resent their in-laws. Mine are awesome. Mine love me unconditionally and treat me wonderfully, and I'm incredibly lucky to have them. That being said, my father-in-law has a way of pushing to get what he wants. In Indian culture it is simply haggling. For him it is more than that. He is a man that doesn't give up. He never gave up, even when I was ready to. Thank God for him.

In 2008 he had heard about the Oprah show with Dr. Patel featuring surrogacy in India. I felt a burst of hope when he called to tell us about it. I had previously considered surrogacy because I'd had an offer from my best friend, who is the most amazing woman I know. But sadly due to necessary legal costs and lack of insurability without exorbitant fees we were once again unable to afford it in the USA. Thanks again U.S. healthcare system, the source of all my debt.  So with my heart in my throat, he emailed Dr. Patel our request to do the surrogacy program. We were rejected. She didn't have all that many surrogates at the time and was helping couples with  more profound infertility issues. Like no uterus and such, I assume. She also said she did not think she could get good eggs from someone with PCOS. She turned out to be right about that years later, but I digress. 

I was once again devastated. But remember how I said that my father-in-law never gives up? He emailed her secretly without telling us. Then we he was stricken with prostate cancer he saw his opportunity to email her again with an extra plea for sympathy given his illness. This time she agreed. Dr. Patel's clinic had grown in its capability over the 4 years since our rejection and had more available surrogates.
In shock and with tears we agreed to try it. I had hope again, and I felt alive again. This had to work. On little to no sleep after hours of cramming I took the police exam and made the top score in my class, finished my last day at my job after demoting myself to finally focus on my family, then got on a plane to India by myself. My husband would come later after I had weeks of IVF injections in Anand, Gujarat. I passed out from exhaustion on the plane from London....and when I woke up I was in India again after almost nine years.

Monday, May 7, 2012

So it begins...growing up Grover!

So many a person has told me I should write a blog chronicling the start of our family...finally after 8 years of failed attempts! Now that I've learned what a blog is and seen a few, I'm in agreement that before I forget everything this is a great way to record the memories that we are making while we wait for our twins to arrive, and record and share our lives after they are born. Thanks to being blessed by a surrogate in India and the help of Dr. Patel in Anand we are finally going to be parents! I'll begin to tell our tale by going back in time a bit, but first I have to figure out how to do this whole blog thingamabob.