Discuss Times report, The Surrogate

[Carrie Pratt | Times]

A seven-part series running this week chronicles the exhaustive efforts of a career surrogate mother from Bradenton as she tries to get pregnant one last time.

Are you curious about how it all works or do you have questions about the series? Join a live discussion with a Tampa fertility doctor and reporter Leonora LaPeter Anton from 10 - 11 a.m. Thursday.

Post your questions or comments now.

***

This is Dr. David Keefe, from USF IVF.  I'd be happy to address any questions you have about this story.

I agree adoption is a wonderful option.  However, it's not for everyone.  Some couples are considered by adoption agencies as too old to adopt.  In many cases it's not any less expensive either. Adoptions frequently require tens of thousands of dollars in legal and administrative fees.  For many couples the genetics are less important than the fact that the baby will grow in the uterus of a woman, the surrogate, who will take the same precautions in terms of eating healthy, avoiding smoking, alcohol and drugs as the intended mother herself would take if she were medically able to carry the baby. At USF IVF we discuss all options, provide the pros and cons of each, and help couples decide what works best for them.  For some couples surrogacy is the best option.

Screening the surrogate is a very important part of the process, not only to ensure the treatment works out for the intended parents and the resulting baby, but also that it is the right choice for the surrogate herself.  The surrogate meets with a therapist who is highly experienced and knowledgeable about surrogacy specifically and infertility in general.  In addition, before training in Ob/Gyn and Infertility at Yale, I trained in Psychiatry at Harvard.  The goals of this evaluation are to ensure the prospective surrogate understands the implications of carrying a baby for another couple.  Does she live a healthy lifestyle?  What will it be like for her to give up the baby to the intended parents at birth?  Have the intended parents and the surrogate decided what relationship the surrogate will have with them and the baby after birth?  We discuss boundries.  We like to understand what makes the surrogate tick, to make sure serving as a surrogate is the right choice for her. Next, I obtain an extensive medical history, especially about her prior pregnancies.  How did her prior pregnancies and deliveries go?  Did she need a cesarian section?  Did she develop any medical problems during pregnancy?  We help her understand how each pregnancy can be a little different. We perform an extensive battery of blood tests to make sure her body is ready for pregnancy, and we ensure her uterus is healthy enough to carrry the baby. We perform a drug screen.  And we do a back ground check to make sure the story fits and that there is not history of criminal behavior. 

Selfish is not word I would use to describe the couples I have known who pursued surrogacy.  My experience is the opposite- they want to give all their love to a baby. Many for one reason or another cannot adopt.  Others want to create a baby with their husbands.  Many of us take for granted the ability to have a child. 

The number of embryos to transfer to a surrogate is one of the most important discussions we have during the process.  Bottom line- the more embryos we transfer to the surrogate, the better the chances for the attempt will lead to a pregnancy, but also the greater the chance of twins or more.  At USF, we rarely transfer more than two fresh embryos, because we fear the complications of a triplet or quadruplet pregnancy.  Triplet and quadruplet pregnancies can create major and sometimes lifelong complications for the baby (e.g. cerebral palsy, lung and eye damage, etc) because they almost always deliver prematurely.  Complications to the surrogate also arise from these higher order multiple pregnancies, so we try to transfer one or two embryos.  The key is to have an efficient program to freeze and save the extra embryos.  We use a new method of freezing which gives almost the same success rate to frozen thawed embryos as to fresh embryos. This puts less pressure on everyone to transfer multiple embryos during the fresh cycle.

The success rate of the surrogacy cycle dpends largely on the age of the woman (typically the intended parent) providing the eggs, because the effects of reproductive aging are felt first by the eggs.  The uterus doesn't age very rapidly.  Many 50 year olds remain physically fit and emotionally ready to care for a baby, but unfortunately their eggs rarely hold up.  There are exceptions- my own sister was conceived when my mother was 47.  Many women in their mid forties onward use an egg donor.

Success rates with fresh embryos are higher than with frozen thawed embryos. The age of the woman providing the eggs is the single, biggest determinant of the success rate of frozen thawed cycles, as it is with fresh embryo transfer cycles.  The technique and skill of the IVF laboratory freezing the embryos, however, also plays a big role.  The best technique to freeze embryos is vitrification.  Vitrification avoids formation of ice within the embryo.  Embryo have lots of water inside them, and therefore will crack from ice expanding once they are cooled.  Vitrification adds a kind of natural antifreeze to make sure no ice crystals form in the embryo.  The embrylologist doing the freezing has to have deft hands, advanced training and great focus to perform vitrification properly.  At USF IVF, vitrification of embryos from young women produces embryos which deliver a 40% pregnancy rate once the embryos are thawed and transferred.

Egg donors ideally are younger than 35, healthy, drug, alcohol and tobacco free, with no major medical problems, reliable, and not over- nor underweight.  They also need to understand all that is involved in donating eggs to another woman.  They need to feel comfortable that their genes will contribute to a baby who will be raised by someone else.  We also like to find a donor who looks something like the recipient, so the baby will feel like he/she fits in.  We need to know that the donor is stable emotionally, and motivated to go through the entire process, because dropping out can be devastating to the recipients and discouraging to the donor herself.  She undergoes a psychological evaluation and physical, genetic and laboratory exams.  There does not seem to be any major difference in success rate from the egg donation cycle if the donor has made a pregnancy previously.  Finally, boundries for the relationship between donor and recipients have to be discussed and agreed upon before the cycle. 

Comments

[Bump]

I know this is an old thread, but to "Oh Really". There is a world of difference between a traditional surrogate and a gestational surrogate.

[Carolyn]

THANK YOU SOOOO MUCH Lakewood Ranch High Student!!! Your kind words and support are very much appreciated!! <3

[lakewood ranch high student]

I think Mrs. Zinn is a blessing to many (now) proud & grateful parents.

It is in no way a selfish act to earn money, she's giving the gift of LIFE and much joy that comes along the way.

God Bless her! :)

[Don]

I'd have no problem helping young attractive women that wish to have children, make that possible. They can just email me for my help. (include a photo)

[oh really?]

Another perspective:
http://sonofasurrogate.tripod.com/

[Carolyn]

You are correct Rosary.. people do not understand and will nor they... Thank you again for your support and I wish you the BEST with your new surrogacy!!! I hope you will have good news to share soon! Hugs
Angel... You are a doll.. You are right.. they are not bad people... and I am sure there are those that simply cant think outside the box.. so, I guess that is why God created woman like us... or there wouldnt be anyone to help! Thank you again for your support and all your kind words! hugs

[Marilyn]

Just well to do people custom ordering infants. Whatever. Call it anything that makes you feel better about what you are doing.

[Angel]

I'm glad my words brought you some comfort. It must be kind of shocking to know some people feel such anger towards you when they don't even know you. Unless they have been in your shoes or the bio-mom's, many people are unable to think outside their own circumstances. I think it's a lack of imagination that keeps some people from being empathetic. It doesn't mean they are bad people, of course. But no one will never be able to explain in a way that turns on the lightbulb for them. I wish you luck and blessings in all you do.

[Rosary Boyle]

Carolyn,

So far I've only read the comments but after all the negative some people are writing I can tell they have NO idea what a surrogant does for a couple in need. I will be reading the article and will give my opinion, what ever thats worth, because like you I think what WE did was a good thing.
I have been a surrogant for a couple in New-York giving birth to twins in Dec 2006, and I am now trying to conceive for another couple. Oh yea, does it matter that I've given birth to 6 of my own children then 2 for another couple, does that say that "I've been cranking them out or what??"
Some people need to grow up

[Nancy]

So you are just listening to what you want to hear and ignoring everything else. Sad.

[Carolyn]

Angel, I have to thank you from the bottom of my heart for your post. It was nice to read such positive and accurate thoughts... THANK YOU! As I have said.. I know there are quite a few nice comments and I am so grateful for the support... but it saddens me at the amount of negative comments. I really did not expect such a controversy. I continue to try and convince myself, that I KNOW why I have done this and it truly is an altruistic desire. When I was first introduced to the idea of surrogacy many years ago.. I had no idea what was involved... however I KNEW that it was something that I truly wanted to do and a gift that I could give... and what better gift is there... than the gift of life?! So, that is exactly what I set out to do! It took seven years to accomplish it, BUT I DID IT!! And I will always be proud of that! :o) I had no intentions of being paid for carrying a child.. I simply wanted to help! It wasnt until my first couple explained their need to compensate in some way for the ultimate gift that I was giving them. They felt that there was no way that they would ever feel they could really put a price on what I was giving them. This is what made me realize that compensation was not totally a bad thing and did not mean that I was doing it for the wrong reasons. It is a form of living expenses to assist the surrogate and her family during the nearly year of time that is spent devoted to bringing that child/children into this world... and if you think about what the doctors and attorneys charge for their services in these cases... it is really sad that it is the surrogate that gets so ridiculed. We are the ones that are truly doing the selfless act and requiring the most time and dedication.. and please know that is not a complaint of any sort.. simply a fact.. .if it were up to me.. I would continue to give life for many, many more years to come... money or no money.. however I understand my body has its limits and I will eventually have to stop and I will rest pleased and fulfilled at the fact that there are five precious lives with wonderful families that love them so much... and they would not be here if it werent for me!
I was also pleased to hear your have had three c-sections as well and you have not been told to stop. That was encouraging. :o) and your compensation comments were awesome!!! I am sorry Angel for the extent of this post.. it was not meant for you.. I am so appreciative of your support.. I just wanted to shed a few more of my views and your post aided in just that! Thank you for taking the time to read my story and especially for taking the time to post. I hope your thoughts and views help others to understand. God bless you!

[Angel]

Oh BTW, Tia, you need to breathe, woman. It would be far more selfish for someone to adopt special needs kids out of desperation for a child when they can't provide the care special needs kids require. Not everyone can handle that kind of responsibility. You can-goody for you and all the kids you have. Stop acting like you are such a saint-yes, it's wonderful that you can do that. I would do it if I naturally had a child with special needs, but I don't have the time to purposely choose a child with issues. Call it selfish if you will, but I am thinking of the four other kids I have, the full time college schedule I have so I can provide them with a college education when the time comes, the full time job providing parenting coaching for at-risk families that I need to provide food for them. If that is selfish, then I am happily selfish. And you just go on with your martyr-self since it makes you feel so good to build yourself up and knock others down. In my part of the bay, we cal that a bully.

[Angel]

I got aggravated at the first few comments. If it is selfish to choose surrogacy over adoption, then you must agree that choosing to not adopt under any circumstances, even if you CAN biologically bear your own children, is selfish. Which, clearly, it is not, so your argument there is moot.

I think everyone is entitled to an opinion, however, the judgmental holier-than-thou nonsense is irritating. There are people. Real people. Some who want a child they are sure was cared for in the womb the way they would if it were their own. Some who want to give others a chance at raising a child they are biologically linked to and emotionally attached to even before conception-just like those of us who are blessed enough to have no infertility issues are able to do with our own children. There is not a damn thing selfish about either of their choices. What is selfish is demanding that the entire world conforms to YOUR values, with no regard for the differences among us.

Carolyn, I have had three c-sections, and no one has told me I would be at risk of uterine rupture if I got pregnant again. Natural labor and vaginal birth are riskier, but not a pregnancy itself. That doc is a fool for making a blanket statement without even examining you. Some people will never understand. And that's sad, for *them*. I'm sure there are things in their lives that you would never understand, but they are content throwing stones because they didn't have the courage to publicly discuss their personal choices in an attempt to inform people, as you did. There are five children being loved and cherished because you had a hand in bringing them to their families. There is nothing selfish, wrong, or dirty about that.

What is far more troubling is the number of people who bring unwanted children into this world and abuse or neglect them. People need to focus their ire in the direction of people like that who deserve it.

As far as the money goes...are you serious? People get handed a million for living in a deserted location for 40 days and not getting voted off, and you have a problem with a woman's living expenses being assisted with while she provides a safe, healthy place for a fetus to develop for 40 weeks? The bottom line is, if it were simply for the money, Carolyn would be donating eggs. Not that I think all egg donors do it *simply* for the money, but it's a much faster turnaround time, much less complicated and risky, and far less likely to cause emotional issues with separating from the newborn you nurtured into existence.

[Carolyn]

I understand what you are saying and I am appreciative... however, as I stated above, I feel you must look at each case individually... the doctor that stated that has never seen me nor worked with me. I have full faith in the Lord and he will tell me when I am to quite. And yes, I may be finished now and I am totally at peace with that... I am extremely proud to have helped create five little lives to two beautiful families and for that I will be forever grateful!

[Clara]

First of all - Carolyn - your body is telling you to stop. The article itself said that another doctor though you were at risk. You should not continue to do this. You are risking your life. You refuse to see it. You need to think of your health and your family first. If something happens to you because you refuse to see this then your family will suffer and the family you are trying to help.

JA-"Broke the mold"? In that case why not just have your husband cloned since no one seems to be able to live up to your impression of him. You live in a fantasy world. I pity any kids you have because they will never live up to your standards. I pity people like you.

[JA]

Many people have a limited field of vocabulary, so I think the word selfish was probably chosen without much thought. Maybe infertile women are introspective. The meaning is "to examine one's own mind and thought process." It takes lots of soul searching and discussion to decide which route to take when the "infertile" diagnosis is made.

I devoted fifteen years of my life to caring for ill family members and put myself last in seeking help for infertility so that I could ensure that I would always be available for those family members who needed me.

When I finally sought help,
doctors were mean spirited with no viable suggestions, other than in ways to fill their own pockets with large sums of money. Frankly, I was fed up with dealing with lots of people. The most private way in my mind was to choose a discreet agency and surrogate who could help me in a manner that allowed me to stay close to home to help my extended family and not have to travel to Russia or China and deal with the various government rules. Plus, would it be fair to adopt a child of a different nationality and not be able to share his/her heritage with them? Learning a foreign language is not easy when you are near midlife.

I believe that every infertile couple would take the route of IVF and surrogacy if it became more affordable.
As far as designer babies, if a woman is not fortunate enough to use her own eggs, there really is not much of a selection in donors. My choice boiled down to choosing the healthiest of the dozen women profiles I was shown. You are lucky if you get to see one picture of them and it is usually a photo from their childhood. So, there really is no way to tell if the young lady grew up to be what society deems to be pretty. Intelligence level (IQ)was not regulary offered along with the donor's statistics. So, in regard to getting a "designer" baby, that is not the case. What is important is that the baby is biologically my husband's. This is worth more than any adoption could possibly be. When this man was created, the mold was certainly broken. He has a spirit that can never be broken and is a great human being. Superman doesn't have the problem solving skills of this husband of mine. Surrogacy in my opinion is a special choice for those couples that truely value their spouse and want some of their wonderful traits to be perpetuated in this broken world of ours, which includes angry, intolerant people such as the ones who have posted here.

Have a good day.

[Carolyn Zinn]

I wish to take a moment and address a few things... the serious mental issues, taking such a risk to my/baby health and are addicted to being pregnant comments...
I do happen to LOVE to be pregnant however I dont feel its an addiction to pregnancy as much as an addiction to helping couples to fulfill their dreams.. seeing their faces when those babies are born... watching them grow... KNOWING that I played such an important part in their lives. NO ONE can even imagine what that feels like and how AWESOME it truly is unless you have been blessed and privileged enough to do so. To this day (after 9 wonderful years during my journeys) I still thank God every day for allowing me to be able to do what I have done and giving me the families and the relationships that I have been so blessed with.. its EXTREMELY PRECIOUS! I LOVE each one of those babies and their families so much and are very proud and would not trade it for anything in this world!!
I have been reading the comments throughout this past week and I thank each of you that have supported the issue and your kindness and warm sincerity. I can only pray that those of you that were so negative will continue to educate yourself on the issue (Sharon has provided wonderful information and facts above... THANK YOU SHARON!) and take to heart the feelings that I convey here. I know that you base your comments on what you read and the information you are provided with, however... there is much more to the story than can possibly be published in seven short series. It would take months to convey in writing all the details as well as the emotions that each of us involved have endured.. the pain, struggles, tears, desires,anticipation, needs, hopes, fears, excitement... (I could go on and on) but I would NEVER do this if I felt it were going to put myself or the baby at risk. remember.... my desire is to be able to bring children into this world not take them out... I also have so much to live for.. I have a wonderful family of my own that I love VERY much (they have ALWAYS been so supportive and loving throughout all of this) and I have ALWAYS thought of them and the impacts these surrogacy's have placed on them. (the triplet pregnancy was a true test to that!) Do you not think for one moment that I did not SERIOUSLY consider the complications and the risks that were involved with not only this last surrogacy attempt but with each surrogacy/pregnancy prior?... Do you not think I talked at length with my OB to get his true feelings and opinion? He knows my body literally inside and out because he has been through ALL of these journeys with me and has preformed each c-section... he is very familiar with me, how my uterus looks and was yet confident in telling me that it would be safe one last time. I dont believe he would put me at risk if he werent quite certain. I know doctors dont know everything and cant predict the future.. but they can recommend based on their education, knowledge, and personal involvement with the situation... so I think its important to look at each case individually. I know more than one woman that has had 4 c-sections and did just fine. So, please know that I have done my "homework" on this issue and based on these facts and my very strong faith, I am comfortable and confident with my decision to continue. And I can truly say that after all these past failed cycles I have developed an even stronger desire to continue helping couples. Before, I could only imagine the heartache and pain of trying to have a baby time after time after time.. where unfortunately now I have personally experienced it. Those of you who have never gone through that heartache and pain of infertility can not even begin to appreciate what they are trying to achieve. Not only was I suffering the heartache and pain for myslef in a sense.. it was even worse to think what it/I was doing to the couple and that in some sort of way, I was responsible... even though I did everything in my power to do everything right.. it was ultimately me and my body that was not getting pregnant and letting them down. That is very difficult to endure and then to have it happen time after time... you have no idea!
Please know, I am not ignorant to the fact that there will become a time that I will no longer be able to continue and I am willing to listen to the professionals and their opinions.. as I have done thus far. I just truly pray I am able to give the gift of life one last time before I must cease.
I am so proud to have been able to share this story and I thank Leonora and Carrie for following me and helping me to portray my journey... I think its important for infertile couples to know that they can indeed have their own biological child and it can be an extremely beautiful journey in doing so. It is the hardship that you endure that provokes our strong desire to help. Please dont ever give up, keep your faith strong and focus on your dreams.. it can and will happen. I sincerely wish you the best!

[Maria]

This woman's body is trying to tell her to stop. Yet she wants to continue risking both her life and that of the baby. She is addicting to being pregnant. She needs help.

[Jen]

Ok...don't shoot me. But...couldn't laws be made in this country to require those who put kids up for adoption to atleast leave a basic medical history? It would not have to say names/ages, but could read something like:
- Osteoporosis runs in the family.
- Parents and grandparents health history (paternal grandfather had heart problems at age 55)....
You get the idea. This would keep both the identity of the childs birth parents secret, yet give a family health history at the same time.

[ed]

shouldn't this story be at the supermarket checkout counter?? not in the newspapers for anyone, especially children, to be able to read!!!!

[ed]

shouldn't this story be at the supermarket checkout counter?? not in the newspapers for anyone, especially children, to be able to read!!!!

[Cora]

Before anyone detracts from this - yes I spelled Carolyn's name wrong.

[Cora]

I just finished reading the story. Caroline has serious mental issues. She knows she will put herself at risk if she gets pregnant yet keeps trying to do it? It is over. You did something to help others now help yourself! What happens if you were to die? How would your family feel? This woman should be seriously evaluated again.

[TC]

Sure..as a "bitter and lonely person" (LOL) I'll agree that I disagree with you.
selfish selfish selfish...thank goodness for people like Tia and I that adopt children that othewise would not have the advantages of these made to order children.

[sjn]

TC - you are a bitter and lonely person. My final words to you are let's agree to disagree on the surrogate issue.

I wish everyone luck in fulfilling your dream of a family whatever path you may take.