Wednesday, January 13, 2010

Series on Surrogacy- Guest Author

In her every day life, Kymberli is a post-infertility mother to el Cinco: her four kids (all Clomid babies) plus her nephew whom she is raising. Kymberli teaches 8th grade English and her husband, Frank, is a cookie-baking, dinner-cooking, house-cleaning, stay-at-home-dad extraordinaire. Kymberli's alter-ego is a bad ass superhero who has tipped back into the waters of infertility, this time as a gestational surrogate. She's helped one couple build a family with the birth of her surro-son Sam in 2007. In her blog I'm a Smart One, Kymberli discusses the continuation of her efforts to be a surrogate and parenting after infertility.


Since beginning my blog two years ago, many people have contacted me for advice concerning beginning surrogacy journeys either as intended parents or as a surrogate. I’m honored that Erica has asked me to share information that might be helpful individuals and couples who are considering surrogacy as their path to parenthood. Over the next few weeks, I will answer the questions that I am asked most frequently by prospective intended parents.

This introductory post will answer the basic and most important question for both intended parents and surrogates: Where and how do I begin? It will also set the framework for the other important surrogacy considerations; in the coming posts, I'll delve deeper into the emotional and technical aspects mentioned below.

The first step of starting a surrogacy journey isn't placing an ad or signing with an agency; the first step is educating yourself about the surrogacy process and making several decisions as an individual or couple, and then making the dive into surrogacy. It might seem that this is a no-brainer, but it is not uncommon for some prospective intended parents (IPs) and surrogates to jump right into trying to find a match before they even understand the process. First, intended parents should decide on the type of surrogacy they would prefer to purse – traditional or gestational surrogacy.

Traditional vs. Gestational Surrogacy

The most fundamental fact to learn about surrogacy is that there are two types: traditional surrogacy (TS) and gestational surrogacy (GS).
Traditional surrogates conceive through artificial insemination of the intended father's (IF) sperm, either through basic home insemination or through a clinic intrauterine insemination (IUI). Alternatively, donor sperm may be used. In traditional surrogacy, the TS is genetically the mother of baby, and is, in essence, the baby's birth mother.
Gestational surrogates (GS) conceive through IVF transfer of developing embryos. In this case, the surrogate is not related to the baby. Most embryos in a GS arrangement are formed from the intended mother's (IM’s) eggs and the IF's sperm. Though the baby is carried by a surrogate, he or she is completely the genetic offspring of his or her parents.
Sometimes there is a problem with the IM's egg quality, so a fourth party - an egg donor (ED) - is included in the surrogacy process. Conversely, if male-factor infertility is an issue, a sperm donor could be used in a GS arrangement.
In a fewer number of instances, a set of intended parents (IP's) will both have such extensive infertility that they may choose to accept a donation of embryos from another couple, or both donor eggs and sperm are used.
There are even instances of traditional surrogacy via IVF (TS/IVF), in which a surrogate is the egg donor, and then undergoes an IVF transfer of embryos (fertilized with the intended father’s or donor sperm).

Pros and Cons to TS and GS

Traditional surrogacy is less-invasive, less time-consuming, and for IPs, is less-expensive. The central challenge of deciding on traditional surrogacy involves genetics. For a potential TS, this means deciding whether or not she could part with a baby that is genetically hers. For perspective TS IPs, this means feeling comfortable with the knowledge that the child their surrogate carries is her genetic offspring.

Gestational surrogacy alleviates the genetic challenges that are present in traditional surrogacy. The biggest hurdles for gestational surrogacy are the invasive screening procedures, hormone injections and medications, and overall extended length of the entire process. Additionally, for intended parents gestational surrogacy adds costly clinic fees that aren't necessary in traditional surrogacy.

Agency or Independent

Before a match is found, how that match will be found should be determined - either through a surrogacy agency or independently (indy). Through an agency, there is a third party who helps intended parents and surrogates navigate their surrogacy journeys from matching through to the delivery. In indy journeys, surrogates and IPs navigate the entire process themselves.
Agencies handle almost all things related to the surrogacy. They facilitate matching, coordinate attorneys for contracts, pre-screen surrogates, and help arrange clinic appointments. The intended parents and the surrogates can develop their relationships without too many worries about finances or legal aspects. Many surrogates (especially first-timers) opt to go the agency route, as usually it frees them from the worries of being financially "burned" by IP's, where irresponsible IP's leave their surrogates with medical bills or unpaid fees. Agencies are also reassuring for the IP's, as the surrogates have been pre-screened and are already dedicated to the process. Caveat - though agencies hand-walk surrogates and intended parents through the process, not all agencies are equal; if you decide to go the agency route, you should do extensive research on costs, services offered, and track records. This is one instance where word-of-mouth reputation can be priceless.
In an independent journey, intended parents and surrogates do everything by themselves without the use of a third party. Some websites, such as Surrogate Mothers Online (SMO), have classified ads where both surrogates and IPs can outline the type of person they're looking for and the type of journey they want to have. Surrogates and potential intended parents (PIP's) scan the ads, and if one begins to tug at their heartstrings, they can send an email and begin learning about one another. Both parties have complete freedom from start to finish in learning about each other and there is a greater sense of control over what happens through the process. A con to an independent journey is that it leaves both the PIP's and the surrogates more open to scammers who are not true to the heart of the matter - having a baby and respecting all parties involved in the process. With an independent journey, there also is no third party there to handle uncomfortable situations between the IP's and surrogates, so they have to handle any problems that may arise by themselves.
Which route is better - independent or agency? The answer to this question is purely a matter of personal preference and comfort levels. People who do no feel like they are good judges of character or have difficulties handling interpersonal conflicts might feel more comfortable with agencies. People who like to hold the deck versus having the cards dealt to them might prefer going indy.
In all surrogacy situations - GS or TS, independent or agency – prospective intended parents have many other things to consider before even attempting to find a match. How much (or how little) will you feel comfortable paying your surrogate in compensation and related fees? How much contact do you want to have with your surrogate before, during, and after the birth of your child/ren? How do you feel about selective reduction, and in which circumstances would you (or would you not) reduce or terminate? There are no right or wrong answers to these questions, but in order to have a good match, it is imperative that you know where you stand on these issues, and on which you have room for flexibility or none at all. The key to a good match is finding someone who shares the same mindset as you on as many issues as possible. Matching with someone who has polar opposite views on some of the heavier issues could potentially be a recipe for disaster.
Matching with someone who inherently shares a common vision is essential, so you shouldn't make the foray into something as challenging as surrogacy if you don't even know what to look for in the first place. The best advice I can give to anyone even considering surrogacy either as an intended parent or surrogate is the old adage "look before you leap." There is much to learn before you begin, and even more to learn after you begin. Sometimes, experience is not only the best teacher, but it is the only teacher.


Questions? Post them in the comments, and I'll either answer there or I'll let you know if I intend to cover your answer in more depth in a future post.

You’re also welcome to email me at SmartOneKym AT gmail DOT com.


Kristin said...

Great and informational article. Thanks for the education.

Melissa G said...

Absolutely FANTASTIC post.

Thank you both for posting this.

Quiet Dreams said...

Great post. Kym always brings the brilliant.

jingle said...

and beautiful!

cool blog.


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