May 16, 2012

Today we signed the Carrier Agreement, which governs our relationship with the surrogate. I can’t say too much about our carrier because of confidentiality clauses in the agreement, but I will disclose the one thing that caused us the most concern in this relationship. She lives in Tennessee.

We originally hoped that the carrier would live somewhere in New England. We hoped that we would be able to visit her regularly and attend all of the doctor’s visits with her. We thought maybe we would be too involved, and we would start to annoy her.

But with the surrogacy agency we are working with, you don’t peruse a list of potential surrogates like you do with potential egg donors. Instead, the agency matches you with a carrier they believe shares your expectations for the pregnancy. Both the intended parents and the carrier fill out a questionnaire. In order to be matched, both parties must agree on communications preferences - during the pregnancy and after the birth - and on more difficult questions such as abortion. We were asked if we would choose to abort a child with severe genetic defects (we would) or if we would “selectively reduce” a multiple pregnancy (we wouldn’t, unless the health of the carrier were at risk).

Other than those decisions, I’m not sure what criteria the agency uses to make a match. I’m not sure if our religious backgrounds or personality traits were taken into consideration. We have “met” the carrier three times now, via a video call through Skype. She is quiet, but friendly. We decided to move forward with her after the first call. She seems to be a responsible and conscientious person, who will care for our child while it grows inside her. As I mentioned before, she passed numerous psychological tests and had an extensive interview with a social worker before she was eligible to be matched.

There’s just that one geographical issue. If we had decided to wait for a different carrier, closer to home, we could have extended our wait time by six months or more. Because she is so far away, we will probably only be able to visit her once during the pregnancy. If she has a quick labor, we may not be able to attend the birth.

We expressed our concerns to the agency. They said that this is a relatively close match for them. A slight majority of their clients are from foreign countries. Clearly it is a much more difficult thing for intended parents to make it from Paris to Denver than it will be for us to make it from Massachusetts to Tennessee. According to the agency, almost 80% of their intended parents are able to be there for the birth of their child, even given the distances involved.

How does this work? We were told that we need to trust the carrier and her knowledge of her body. That is a little imprecise for me, but what can I do. It’s just another part of this process that I have to admit is out of my control.

May 8, 2012

I have asked Alberto to stop referring to my sperm as my “little buddies”. I think I’d prefer that people don’t discuss my sperm at all, but I guess it is a necessary part of this process. My sperm has been frequent dinner table conversation recently. Still, there’s something infantilizing about “little buddies”.

He asked what he should call them instead. I tried out the Swim Team, My Soldiers, SWAT, the Sailors, My Missiles, and The Force. Unfortunately none of those have stuck. Maybe we should just go with My Sperm.

In any case, the results of the semen analysis came back today and My Sperm are of sound body and fitness. They should be able to get the job done. Congratulations to me.

However, there was one odd thing on the report. Apparently, 82% of My Sperm have “irregular heads”. The doctor didn’t list this as a concern, but it’s still strange. I don’t know if they are too big (My Giants) or too small (My Roaming Gnomes) or shaped like a heart (My Lovers). As long as they’re not shaped like swastikas (My Nazis?).

I kind of want to see pictures. It would be like a yearbook (Class of 4/25/12, the next class will graduate in a few days, if the mood is right). Or maybe more like one of those moments from nature at the end of CBS Sunday Morning (Charles Osgood: “We leave you this morning at a recent ejaculation in Massachusetts, where a group of sperm are showing off their irregular heads.”).

I don’t think that’s one of the services offered at our clinic, though. Maybe someday I’ll have access to a microscope and some privacy. Until then I’ll be wondering what’s wrong with My Missiles’ warheads.

May 7, 2012

We have chosen an Egg Donor. Unsurprisingly, she is Colombian. She has impeccable cheek bones. She is smart and healthy. I can’t reveal too much identifying information about her, but one factor that lead us to choose her from the Egg Bank over the other twelve or so Latina donors was that she listed Scrabble as one of her hobbies, with the added information, “I rarely lose.”

Bring it on Egg Lady.

Actually, the donor and I will probably never play Scrabble with each other. There are differing philosophies about “open” vs. “closed” donation. Our surrogacy agency is a big proponent of open donation, which is when the donor and the intended parents meet and exchange contact information. The intended parents may or may not share regular updates on the child’s life with the donor, but if the child eventually and at an appropriate age wants to contact the donor, he or she can. The agency believes this is the best way to answer a child’s questions about his or her origins and that he or she will feel more comfortable having the option to meet his or her biological mother.

Our IVF clinic feels that closed donation is best. They believe in a donor’s right to privacy and that the donor should have the right to move on with her life. She will process her feelings about donation and trust that the intended parents are raising their child in a loving environment. The clinic retains the genetic information on the donor, so there is no medical reason why it would be necessary to contact her.

We are open to either type of donation. Ideally, we wouldn’t meet the donor, but we would have her contact information in case the child wants to get in contact with her in the distant future. We want to think of this child as wholly ours and we don’t want to know the biological mother enough to wonder if he or she got some trait from his or her mother. At the same time, we aren’t willing to pass up a good, Scrabble-playing donor, based on her philosophy on open vs. closed donation.

Because this donor did not come from either the IVF clinic’s or the surrogacy agency’s donor pools, but from a third party, I am not sure what her preference is. But either way, we have chosen to work with her and we will work with her choice on this issue.

May 3, 2012

We have now been walked through the steps of In Vitro Fertilization (IVF) four times. Once by each of the IVF clinics we met with and once by the surrogacy agency. Even more times if you count our discussions five years ago.

So I’m going to attempt to recount the process here without consulting Wikipedia.

The first step is for the carrier and the donor to sync their womanly cycles (if you want a more technically precise description of IVF, click here). The carrier goes on low dose birth control pills to suppress her own ovulation. Her eggs are not welcome here. The donor takes fertility medications that cause several of her eggs to become ready at once, instead of the usual one at a time. From what I’ve heard, a cheaper method to sync the cycles would be to have the donor and the carrier become college roommates, but I guess that’s impractical.

Next, everyone travels to the clinic for what is called a “fresh transfer”. The donor’s eggs are retrieved through the use of a hollow needle inserted into the pelvis. The natural father’s sperm is retrieved through the use of pornography.

The clinic combs through the sperm (multiple people who have described this process to me have used the word “comb” which is an interesting visual image) to find the most desirable specimens. Apparently, even healthy semen contains sperm that is deformed or lazy. The ones that are leaping around like golden retrievers are segregated from the ones that look like they’ve just smoked a bunch of weed. At this point, the doctor can either place the energetic sperm in a petri dish with the eggs and let them do what comes naturally, or he can pick up individual sperm and forcibly inject them into the eggs. The latter is more expensive and time consuming but usually results in a greater number of viable embryos. I prefer the second method because I have a suspicion that if we use the first method, my sperm may ignore the eggs and just try to fertilize each other.

Then we wait. I’m not sure if the carrier will be in town yet. It seems like she could arrive late to this particular party. The donor and the intended parents have to stick around to provide a second set of eggs and sperm if the first round fails to produce enough viable embryos. I don't think we'll be hitting the town together. That might be awkward.

We can choose to wait for three days or five days while the embryos grow. I guess if we wait five days, the doctor will know more about the embryos he chooses to implant in the carrier. Presumably if one of them starts to look like it might develop into a professional athlete or brilliant artist, that’s the one that moves to the head of the line. Yes, it is a sign of our era that we’ve started to assess a child’s potential when he or she is still smaller than the head of a pin.

Now, a choice. The doctor can implant any number of viable embryos into the carrier (technically they are “blastocysts” at this point, which just sounds cool – like the little guy is going to be piloting an X-wing through the carrier’s uterus – but I’m going to continue to call them embryos because that’s a term more people are familiar with). Most doctors limit the number of embryos they will implant to two, because they don’t want to have an Octomom situation on their hands.For infertile hetero couples, using their own eggs and sperm, doctors sometimes implant more embryos, but our embryos are more likely to develop into successful pregnancies, because they came from two fertile people.

So the decision is whether to implant one embryo or two. The downside of implanting one embryo is that it has only a 40% chance of success. The downside of implanting two embryos is that it is much more likely to result in twins. (Why is having twins a downside? There are medical reasons but I’ll just cite parental stress as the overwhelming reason why we would prefer a singleton.)

If the first IVF cycle is unsuccessful, we have to start all over. It is likely there will be embryos left over from the first cycle, so the donor and intended parents may not have to return for round two. Any left over embryos are frozen after the transfer, and our IVF clinic has a similar success rate with "fresh" and "frozen" transfers. (In fact, the reason we chose our IVF clinic is because they do not have a preference for fresh transfers, which means that if the carrier and donor are on different schedules we don't have to chose a different donor; we can create the embryos and wait for the carrier's body to be ready.) But a failed cycle is money and time wasted. The carrier needs to wait at least two months before her body will be ready to try again.

For this reason, we have decided to implant two embryos. The odds are about a 40% chance of twins and a 40% chance of a singleton, with a 20% chance of no child at all. If it has to go to a second cycle and we implant two embryos again, there is an overall 94% chance of success. If that also fails and we have to go to round three, the overall chance of success is above 99%. If that fails as well it means God doesn’t want us to be parents and we need to reassess our lives.

We are willing to have twins. Despite the added stress, we know we want to have more than one child and, given how expensive this journey is, twins would kind of be like a buy-one-get-one-free Safeway Club Card deal. Nevertheless, we strongly prefer a singleton.

My mother-in-law is praying for twins. I ask that all who read this try to counteract her by praying for us to have a singleton. But overall we would appreciate your prayers for us to have healthy children in any number.

May 2, 2012

The surrogacy agency that we picked is mainly a law office. This is a different approach than the companies that we looked into five years ago that were mainly fertility clinics. Some surrogacy agencies are independent organizations that outsource every aspect of the process.

And it’s a complicated process.

Gestational surrogacy is an arrangement in which the surrogate agrees to have embryos created from sperm and another woman’s egg implanted in her uterus through in vitro fertilization (IVF). I think when a lot of people think about surrogacy, they think of traditional surrogacy, which means that the egg is the carrier’s own. Traditional surrogacy can be accomplished through IVF or through less sophisticated means (i.e., the so-called Turkey Baster Method, which I pray involves something a bit more high-tech than an actual turkey baster).

Gestational surrogacy offers many legal benefits, but also an important emotional one. The carrier is less likely to form an attachment with the child she’s carrying if she is not its biological mother. The egg donor is unlikely to form an attachment with the child if she doesn’t carry it. In most cases, the egg donor won’t even see the child until much later in his or her life, if at all.

Gestational surrogacy is also a hell of a lot more expensive, mostly because there are more parties involved and IVF is a more complicated medical procedure. The organization that coordinates everything gets an “Agency Fee”, for bringing everything together. This is sort of like the fee a General Contractor gets when building a home.

Since our agency is a law office, they do all the legal work in house. This includes writing the contracts for the egg donor and carrier and finalizing the adoption by the intended parent who is not the natural father. In addition to the legal work, they have a team of licensed social workers on staff who screen the donor and carrier and also offer support to the carrier throughout the process. Both women have to take psychological tests and have to pass background checks. The carrier also has to have an extensive phone interview with the social worker. If the carrier has a partner, he or she must undergo screening as well. The agency recruits donors and carriers, but will work with donors from other organizations’ donor pools. Finally, our agency has an in-house staff of financial coordinators that handle billing and administer the trust account where our up-front fees were deposited.

Our agency outsources the medical work. The organizations that are mainly fertility clinics do it the other way around. We were able to pick essentially any fertility clinic we wanted, although our agency made some suggestions to narrow the field. We went with a clinic within driving distance, although compared to the overall cost, travel to a clinic anywhere in the country would have been a small expense. We chose our clinic because the people we met with seemed organized and emphasized choosing an egg donor based on her qualities not her schedule (more on that tomorrow).

There are intended parents that choose to coordinate this process on their own, just like there are some people who will build a house without a general contractor. They will choose their own lawyer, IVF clinic, egg donor and surrogate. They will attempt to recruit a surrogate online. They may work with an established egg donation agency or they may try to find a donor on the Internet as well.

Even though “going independent” can save thousands of dollars, that is not for us. I’m not going to trust some woman that I found on Craigslist and met once at an Applebee’s to carry my child. We want both the screening and the hand holding that comes from working with an agency. We’ve been assigned a coordinator that acts as a single point of contact and schedules travel as well as visits to the IVF clinic for the various medical procedures involved. She has set up phone calls and answered a ton of questions (or forwarded them to the various legal, financial and medical experts involved).

This journey is already stressful enough without having to worry about syncing everyone’s schedules. Google Calendar is not a substitute for a good agency.

May 1, 2012

I’m learning from looking through egg donor profiles that Columbians are just better looking than the rest of us. Shakira and Sophia Vergara are not outliers. As I click through the different pictures to find out more about these women, inevitably the ones I click on first are the Columbianas.

We have decided to use my sperm to create this baby. We came to this decision because my parents have no biological grandchildren. And all four of my grandparents have no biological great-grandchildren. I’m not entirely sure what the world would be missing out on if it were denied another generation of Smiths and Meekers, but we’d like to find out. The world already has a new generation of Barcenases and ample opportunity for more.

Since we are using white sperm (I mean, sperm from a white person), we want to find a Latina egg. We want our children to look like both of us, as much as possible. I’ve discovered that this process will be considerably easier if/when we use Alberto’s sperm, next time around. There are far more white eggs than brown.

The egg donor coordinator at our IVF clinic explained why. We aren’t the only couple that wants their baby to look like both of them. And there are far more white couples looking for donors and surrogates. This is not because infertility strikes white people more often or that there are fewer ethnic minority and mixed race gay couples that want to have kids. It’s because white people are more likely to be able to afford this treatment. In the case of hetero couples, there are more whites with health insurance that covers infertility (I’m saving the insurance issue for a day that I feel more like going on a rant).

So because of the socioeconomic demographics of the United States, we have a much smaller pool of donors. Ironically, because of those same socioeconomic factors, it’s more likely that donors of non-white backgrounds could use the money. Add in the fact that the eggs in the highest demand come from women who went to or are enrolled in Ivy League colleges, women who will likely make more over their lifetimes than the average donor, and it’s just like any other market – the rich get richer.

But at least God gave us Columbia and made its women fertile.