Conceivability_What I Learned Exploring the Frontiers of Fertility

by Elizabeth L. Katkin

  As it turned out, I didn’t have to wait too long. Just one week into 2006, I had my sixth miscarriage.

  It might be hard to imagine that one could greet a miscarriage with relief, but I did. Strangely, I knew that this miscarriage would be my route to actually having a child. Carrying no longer seemed important. I wanted to be a mother to my child.

  The adoption and surrogacy alternatives suddenly took on new meaning for me. I devoured agency websites, online communities and blogs, scouring the Internet and bookstores for any and all information. I became addicted to www.intendedparents.com and www.surromomsonline.com, matching sites for surrogates and intended parents. I was a lurker. I read profiles. I read stories. I checked Intended Parents regularly, but there were no surrogates registered in the United Kingdom.

  While finding a surrogate in the United States was easier than in the United Kingdom, working with a surrogate in the States seemed complicated, expensive, and legally dicey, as the rules varied drastically from state to state, and it was not assured in many jurisdictions that I would be legally recognized as the mother.

  Given all the medical challenges, legal obstacles, and often complex administrative needs, few couples or individuals choose to proceed on their own. There are, in 2017, more than four hundred agencies in the United States alone offering egg donation, sperm donation, or surrogacy services, and there are law firms as well that specialize in surrogacy contracts. Agencies can help with every aspect of the process, from selecting a donor to managing communications with a surrogate. For many, the support that a good agency provides is invaluable, especially when dealing with a surrogate at a distance.

  When we began to seriously consider surrogacy in 2006, at Dr. Batzofin’s suggestion, I spoke to Melissa Brisman, a nationally recognized reproductive law specialist, who helped me understand the landscape. I studied agency websites. I learned of the need for a clear and detailed contract covering every aspect of the relationship, and every imaginable and unimaginable eventuality: compensation, reimbursable expenses, number of embryos to be transferred, guidelines for selective reduction or termination if necessary, extra compensation in the event of twins, reduced compensation for a miscarriage, travel restrictions, dietary rules, and in some cases even how much caffeine a surrogate is allowed to consume.

  I felt an overwhelming need to control the process as much as possible, handling everything myself, without an agency, in no small part because the agencies seemed inexplicably expensive to me. The issues at times were overwhelming: lawyers, contracts, distance, travel costs, and most important, potential custody issues. Pursuing a US surrogate was not only daunting in terms of time, money, and complexity, it was far away. It was hard enough to contemplate someone else carrying my baby; it was simply a step too far to imagine that I wouldn’t be there, wouldn’t participate, wouldn’t see the thrilling ultrasound scans and feel the baby kick.

  Faced with the dilemma of a doctor we were excited about in the United States and our desire for a local (although yet unidentified) surrogate, Richard and I invented our own solution: an American clinic and a British surrogate.

  Unlike in the United States, where surrogacy is a profitable commercial enterprise, it was, and still is, illegal to pay or advertise for surrogates in the United Kingdom, making it far more difficult to find them, as I had learned through my fruitless efforts. Paying third-party agencies is also prohibited, further frustrating the process. Fortuitously, near the beginning of our search, the BBC ran a show on surrogacy, examining the different laws and procedures in the United States and United Kingdom. The show specifically mentioned Intended Parents, the website that I had perused for countless hours. By a stroke of magnificent luck, some bighearted potential English surrogates must have stayed home that night, watching the telly, for four new English surrogates signed onto the site the next day. Thrilled, I wrote to three of them immediately and spoke to each on the phone. I had a clear favorite. Catherine had one child, who was the light of her life, and had seriously contemplated surrogacy before. Moved by the obvious need in Britain, she was thinking about helping a family. Just a few weeks after I contacted her, Richard and I met Catherine in a pub around the corner from our house. Could this be the woman who would carry our baby?

  Catherine was petite with short brown hair. She was shaking as we met at the pub, every bit as nervous as we were. We talked about the weather (rain), the north of England (gray), and her love of gardening, particularly flowers. We learned that she was the single mother of a ten-year old daughter, and that she had trained as a chef. She worked at a large department store and dreamed of opening her own flower shop or café. We tiptoed around the elephant in the room. We liked her—a lot. We hoped she liked us.

  Fortunately, she did.

  Many conversations later, with the very helpful assistance of a nonprofit (as legally required) group called COTS (Childlessness Overcome Through Surrogacy), it was official. We were really going to do this. Now somewhat expert in surrogacy law, I drafted our own contracts, spelling out the process: Starting in England with hormone treatments, we would all travel to New York for the egg harvest (Dr. Batzofin collects the healthy eggs from me), fertilization (egg meets sperm in petri dish), and embryo transfer (Dr. Batzofin puts the best embryos in Catherine five days later). We would compensate Catherine for her expenses and loss of earnings, but under the law, could not otherwise pay her. As for custody, we would apply for a parental order acknowledging me as the mother, and enabling me to be named as mother on the birth certificate along with Richard as father.

  There were complications, to be sure—emotional this time, rather than physical. Catherine panicked. Her daughter panicked. I panicked. All at different times of course. The clinic called me in London near the end of my medication cycle—meaning I was fully loaded with hormones to develop as many eggs as possible—to warn me that they were concerned that she might not go through with it. Yet many e-mails, phone calls, meetings, tears, and days later, Richard, Catherine, and I all got on the plane bound for New York and Dr. Batzofin. We told a few people, but not too many. It all seemed so . . . experimental.

  I had another “great” IVF cycle, although it would be a lie to say it wasn’t completely nerve-racking. There were unexpected decisions to be made. My uterine lining, which had been inadequately thin for many cycles and was one of the key indicators for my needing a surrogate, was “sufficient” this time, and the doctor raised the question of my trying again. Should I attempt carrying myself? Should we both carry? If we transferred two embryos to each of us that could result in potentially four babies! It might also lead our surrogate to opt out. And could I bear another miscarriage? No, we decided. We would stick to the plan.

  We all stayed at my parents’ house on Long Island, where every afternoon, we would anxiously wait for a critical phone call from the clinic. First, it was the condition of the eggs. Then, the number that fertilized. After that, the quality of the growing embryos. Each call was more terrifying than the last. And finally, the PGS results.

  Again, the numbers dwindled at an alarming rate:

  Twenty-eight eggs retrieved

  Seventeen fertilized

  Thirteen mature enough to be tested

  Three chromosomally normal

  With each diminishing number, we were overwhelmed by our new understanding of how low our chances really were, and how much time we had been wasting the past few years without this critical information. Of the twenty-eight eggs retrieved, only three were normal, an unusually low number—and they were not the embryos that looked the best, by a long shot. Two girls and one boy. Given our history of failures, I wanted to transfer them all. Dr. Batzofin strongly counseled against it. With a good carrier (not me), there was no reason they shouldn’t stick. He urged us to transfer the two best-quality embryos to Catherine. I agonized all night.

  I needn’t have bothered. By the time we got to the clinic the next day, the male embryo had arrested. Before I processed what was happenin
g, Dr. Batzofin transferred two embryos into Catherine’s practically perfect womb (a phrase that stuck when Mr. Braithwaite first joked with her in London). He was extremely confident. One of them, he told us, was a “super embryo.”

  Two weeks later, his confidence was confirmed. At last we had a viable pregnancy without my many medical issues getting in the way. And what a difference it made.

  As I knew it was extremely difficult for some women, I was worried about how I might react to a surrogate carrying our child instead of me. But in our case, as with many others I met, it was not only never a problem, it was pure joy. When we went to the ultrasound scans back in London, we were excited rather than nervous. Each checkup brought good news, not the bleak announcements to which we had become accustomed. When Mr. Braithwaite smilingly told Catherine that everything looked perfect, she replied, “I bet you say that to everyone.” We were quick to assure her that definitely was not the case! Friends and family worried that a surrogate might become attached to the baby she was carrying. Yet as the months passed and Catherine and we grew closer, never for a single moment did any one of us confuse whose baby it was.

  On December 30, 2006, nearly three weeks ahead of schedule, Catherine went into labor. Richard and I rushed to Ormskirk and District General Hospital near her hometown of Southport to join her. Several hours later, we welcomed into our world our beautiful, perfect, healthy, and so longed-for daughter, Alexandra.

  * * *

  A surrogate birth is magical, and rather than feeling like it was “second best,” we felt unbelievably privileged to be part of such an extraordinary experience. We participated in every moment of the amazing arrival of our long-awaited baby, along with our wonderful new extended English family. Catherine’s mother—who helpfully was a midwife—daughter, and sisters showered us with love and welcomed us into their homes as their own family. Our hospital experience was phenomenal, and although unorthodox, felt entirely normal to us. We stood by Catherine’s side in the delivery room, sometimes holding her hand, sometimes giving her space. Richard cut the umbilical cord as I gazed on in wonder. Catherine and I shared a double maternity room, and while I had baby Alexandra by my side and received all the support and copious advice a new mother would normally receive in Britain, Catherine received the tender care that a woman who has just delivered deserves. I learned to breastfeed (I had taken essential hormones to make this possible), and Richard and I together were taught to bathe and swaddle our new baby, and to make a proper bottle.

  After years of failed bets, Richard and I had finally hit the trifecta: with Catherine and her amazing family, a smooth delivery, and caregivers who were kind beyond imagination, we knew we were the lucky ones. We left the hospital on New Year’s Day 2007, Richard looking a bit worse for wear after ringing in the New Year with Catherine’s party-loving, gambling grandmother, and we headed to our London home amazed at our good fortune. The next few weeks and months were busy with the normal newborn-baby things, as well as a few extras—registering her birth in the United Kingdom, applying for a British passport, establishing maternity in the United Kingdom through a parental order (all surprisingly easy, especially with the help of a knowledgeable colleague and friend), trying to get US citizenship for our baby (unexpectedly difficult, despite our both being US citizens).

  When Alexandra was a few months old, Catherine called one day to talk about Number Two. Number Two? She knew we wanted to have two children, she said, and she’d rather do it sooner than later. The idea of having another baby before Alexandra was even eighteen months old was terrifying, but the thought of losing Catherine was even more daunting. We decided to go again in November and stay in New York through Thanksgiving. By this time, Catherine had a boyfriend, Paul, and he joined us as well. It was quite cozy, all of us together in my parents’ two-bedroom apartment.

  We thought the second time would be easier than the first. Same doctor, same drug protocols, same surrogate. Unfortunately, it didn’t work that way. Our IVF cycle yielded only eight eggs, five of which fertilized and developed into embryos. I picked away at my nails waiting for the PGS results. Zero normal. None. No transfer. I was only a year and a half older than I had been the year before. How could we have no normal embryos?

  After discussion with Dr. Batzofin and his embryologist, we decided that the frozen embryos we had from our second (free) try with Mr. P offered our best chance of success. They were frozen in 2004, when I was four years younger. We believed they should have a higher chance of being normal.

  In yet another foray into unknown territory, I dove into the complex world of transferring embryos across international borders in a portable high-tech freezer. Luckily, I found Krystos, my Greek shipping savior. It turns out that transporting embryos is almost as difficult as producing them. While Krystos amazed me with his ability to surmount nearly every obstacle—and there were many—there was one even he couldn’t surmount: Catherine called. She was out as a surrogate. She was going to marry Paul. Although he was very supportive and proud of her having helped us to have Alexandra, he could not deal with his new bride being pregnant with someone else’s baby. It was hard to argue with that. Now what?

  Once again, my type A personality kicked into high gear. I was on the surrogate sites every night. Like in the world of online dating, demand was growing, and by early 2008, it was becoming much more competitive to find a surrogate match in England, especially one willing to travel to the United States for treatment. We opened ourselves to the US option. Eventually, I found a wonderful potential surrogate named Brenda. She was from Pennsylvania, which I knew was a surrogacy favorable state, married (also surrogacy favorable), and had already been a successful surrogate (perfect). We struck up a friendly e-mail relationship and spoke on the phone. It was decided that we would meet in New York and try with the frozen embryos. Brenda was sure it would work; she never failed to get pregnant before. But she had never met my embryos.

  The lab thawed our embryos, and we were planning for a day five transfer, after the results of the all-important genetic testing were available. Bad news again. The embryos were all useless, albeit in different ways. Some were frozen improperly (no surprise, given our experience with that incompetent first clinic), and some had complex chromosomal abnormalities. We looked at the slides with the doctor and embryologist. Even to the untrained eye, it was clear. It was a disaster.

  Undaunted, Brenda agreed to try one more time. We scheduled what Richard and I agreed would be our last IVF cycle ever, for the summer of 2008. We spent the month of July in New York doing another fresh cycle, this time with the drug protocol boosted higher than ever before (as is common in repeat IVF cyclers), in an attempt to produce more eggs. We were looking for the proverbial needle in the haystack, and we needed to search through lots of hay. Other than feeling like hell, which is an understatement, the cycle went well. We had eight eggs and eight embryos.

  But, once again, none were normal. Not one. Zero.

  It was time to give up, Dr. Batzofin said. The embryologist echoed his opinion. My consultants in London echoed his opinion. My obstetrician and gynecologist friends at Brigham and Women’s in Boston echoed his opinion. I had no more good eggs. It was hard news to swallow. But we reluctantly decided that we had reached the end of the road. And we felt lucky every single day to have Alexandra.

  Surrogacy

  Ever since Phoebe, pregnant with her brother’s triplets, burst into American homes in season four of the ever-popular Friends, third-party parenting—comprising egg donation, sperm donation, traditional surrogates (the surrogate carries her own egg) and gestational surrogates (the surrogate carries the egg of the intended mother or a donor)—has caught the imagination of Hollywood and infiltrated mainstream media. Unfortunately, lawmakers, medical administrators, and policy makers remain many steps behind, with regulation of third-party parenting varying widely not only from country to country, but also, within the unregulated United States, from state to state. In some states, for instanc
e, the birth mother of a surrogate baby is recognized as the mother of the baby, regardless of intent or biology, and the intended, genetic mother must legally adopt her own baby. In other states, motherhood is determined by genetics. In yet a third group of states, maternity is determined by contract. Would-be parents in the United States, therefore, must navigate a complex legal journey, while simultaneously making their way through a multifaceted emotional and medical maze.

  Surrogacy arrangements, while a seemingly modern approach to bringing a baby into the world, are not exactly a new development. The Old Testament references Hagar, maid to Sarah, bearing a child for Sarah and Abraham when Sarah was unable to do so. A couple of hundred years later, in Babylonian times, King Hammurabi promulgated the Hammurabi Code of Laws, setting out the rules of the day. Among them: “A childless wife might give her husband a maid (who was no wife) to bear him children, who were reckoned hers.”1 A fairly clear endorsement of traditional surrogacy. The development of IVF enabled the evolution of the relatively less complicated gestational surrogacy, in which the surrogate mother, or host, is not related to the baby she is carrying for the intended parents. Since its first successful, healthy birth in 1985, gestational surrogacy has become the norm for women experiencing infertility or repeat miscarriage, eliminating the need for a traditional surrogate to give up her own biological child.2

  Although surrogacy has been practiced for millennia, the complicated moral and ethical issues involved in surrogacy arrangements—particularly commercial surrogacy in which the “consumers” are often well-off intended parents and the surrogates typically far less affluent—seem to have paralyzed American lawmakers, who, by and large, have left the issue untouched. Does it make sense, for example, that one can buy eggs or sperm on the Internet in the same states where gestational surrogacy is prohibited?