7) Surrogacy Soapbox

In my experience with surrogacy, people fall into one of four categories in their opinions:

A) Surrogacy is the most amazing thing a woman can do for another person and anyone who does it should be given a medal.  Or at least a huge hug. 

B) Surrogacy is pretty cool.  Good for you for doing it.  Those twins sure are adorable!  Is this next journey going to interfere with you coming to my wedding/executing my students’ IEP/helping with this project you said you’d do?

C) Surrogacy is kind of weird.  I hated being pregnant with my own kids; I don’t understand why anyone would want to do that again if she weren’t being forced by societal standards of motherhood.  Also, there are serious ethical dilemmas it raises, of which I haven’t entirely decided my opinion.  But to each his own.

D) Surrogacy is wrong; it’s human trafficking and takes advantage of poor uneducated women in a manner akin to sex slavery.  Gay parenting is wrong.  Have you read Leviticus?  You are now going to hell both for your part in the creation of unborn embryos and in promoting gay parenting, who will no doubt raise gay, dysfunctional children.

I have been incredibly lucky that the majority of my friends and family fall into the A and B category, with an occasional C thrown in there.  I only had one who could be classified as D, but being my grandma she is required to love me regardless, so we mostly agree to disagree.  Likewise, even acquaintances and random strangers have responded positively.  A few seemed perplexed, especially when the news came from my daughter, who, whenever the cashier or hairdresser or waitress would say something about her pending brother and sister, would quickly and loudly respond, “They’re not our babies.  We’re giving them to our friends.”  Always fun. 

Because this is my second journey, I’ve answered most of the who, what, where, when, why, and how questions to everyone I know. Because my previous IF was a politician in Israel, I’ve also been on the receiving end of the A and the D from complete strangers, who have no hesitations in either sending me heartfelt thank yous or calling me a baby-selling whore.  However, because I’ve moved (to conservative rural Oregon at that) and have a new job, I am expecting to have to explain the process all over again. 

So, once again, to answer the most common questions and comments:

How does this surrogacy thing work?

A gestational surrogate is a woman who carries the biological child of another person to birth.  The embryo is created from an egg donor (often times the Intended Mother, IM) and sperm (often times from the Intended Father, IF).  In gestational surrogacy, there is no biological connection between the surrogate and the baby.  The surrogate takes a series of medications prior to transferring the embryo to essentially trick her body into thinking it’s getting pregnant all on its own.  The embryo, usually when it’s three to five days old, is then transferred via catheter into the surrogate’s uterus.  If all goes well, the embryo sticks and about 38 weeks later a baby is born.  Prior to all of this, however, is the legal process, which includes matching the surrogate with compatible Intended Parents, and contracts to outline all of the details, compensation arrangements, and plethora of “what if” scenarios.   

Embryo of Baby A from my first surrogacy

Embryo of Baby B 

Along the way, you get to have really interesting conversations, both with strangers and your spouse.  Like this one:

Me: I’m kind of crampy.

Spouse: Are you pregnant?

Me: No!!

Spouse: Do you want to be (nudge nudge, wink wink)?

Me: Not from you.

Spouse: So you’d rather get pregnant from two gay guys?

Me: ….Yep.

Spouse: Can I watch?

Me: You can come to the embryo transfer if you want. 

Spouse: You are no fun.

Me: I told you I was crampy.

How can you give up the baby after carrying it for nine months?  Won’t that be hard to separate?

The canned surrogate response is this: I’m not giving the baby up; I’m giving it back to its parents.  I am just babysitting for nine months. 

My response is this: No.  It absolutely will not be hard.  I have three children of my own.  Three beautiful, amazing children whom I love very much.  But three children who even on our best days drive me bonkers and make me question my validity as a mother and decent human being.  All three are out of diapers (even out of night-time pull-ups as of last week!!!), sleep in their own beds more nights than not, and can easily access the snack cupboard and open up their own granola bars and squeezey applesauce.  It’s a beautiful thing.  I love me some baby snuggle time, and I’ll be grateful to hold this one as much as I can.  But I have absolutely no desire to ever again spend sleepless nights nursing a baby just to have him spit up most of it down my back twenty minutes later.  Gestational surrogates go into this process knowing that the baby isn’t ours, genetic or otherwise.  Seeing my first IFs hold their babies is the third most amazing feeling in the world—preceded only by holding my own babies and watching my husband hold them.  I can’t wait to give that same experience to J & A. 

I can understand a completely altruistic surrogacy for family or close friends, but being paid for having a baby is human trafficking.

Surrogacy compensation is for the pain and suffering of being pregnant, not for the baby.  Have you ever been pregnant?  If the answer is yes, then you know how much pain and suffering is involved—regardless of if it was an easy pregnancy like mine have been.  There are drugs and shots and unbelievable hormones.

IFV drugs: Delestrogen, Progesteron in Oil, and Progesteron vaginal capsule.
FYI, getting shots in your ass is way better than putting a capsule in your vagina.  

Then you're pregnant and there is morning sickness and heartburn and sciatica pain and ligament pain and stretch marks and tiredness (Ain’t no tired like first trimester with twins tired!!).  Then there’s the actual labor—pushing an eight pound moving object out of a relatively tiny hole, or, in my last case, having your abdomen cut open and your bladder set on top of you as they physically rip the baby out.  If you already have kids, that pain and suffering extends to your family, in the form of being too tired to cook or clean, not being able to pick up your younger children, having to put up with your excessive moodiness, and ensuring that the freezer is adequately stocked with both Ben & Jerry’s and Talenti Gelato, because you never know what mood I’ll be in.  Your attention is focused on the baby and that impacts your family.  So let me reiterate:

1) The contract is very clearly outlined that it is for the pain and suffering of being pregnant.  The amount of compensation received is for that and is not dependent on the outcome of a baby.  Every contract is different, but overall an ethical surrogacy contract will compensate based on the amount of time pregnant.  Unfortunately, just like any pregnancy, surrogacy pregnancies do not always result in a live birth, and regardless the surrogate is compensated for the time she was pregnant.
2)The baby is wanted.  The baby is loved.  The baby is going to a home with parents who have been cleared through a psychological evaluation, which is more than can be said for most babies brought into this world.  The only trafficking this baby is going to be doing is from my hometown to its new home in San Francisco.

Surrogacy takes advantage of women living in poverty, forcing them to make a choice no logical woman would make if she wasn’t constricted by financial needs.

Surrogacy in developing countries and surrogacy in the United States are two different situations, entirely.  Because I am not as familiar with the processes abroad, I will only speak to surrogacy in the US. 

I am not living in poverty and I made that choice.  Most of the women I know love being pregnant.  They can’t imagine their lives without their own children and want to help someone else have that.   Most whom I know are in similar financial situations as myself—they’re making ends meet, paying the bills and having some fun, but not living the high life.  Some are better off.  Some are worse off.  But none are living in poverty.  In fact, most reputable agencies do credit checks and won’t accept surrogates who receive government assistance, because one, living in poverty is stressful and excess stress doesn’t do well with pregnancy; and two, surrogacy should not be a job.  Although there is absolutely nothing wrong with being compensated for surrogacy, it shouldn’t be necessary for financial survival.  A successful journey is not guaranteed, and it is not a good idea for a woman to be reliant on the total compensation.  Surrogacy is emotionally and physically demanding, and financial compensation cannot be the only reasoning.

Compensation can be one contributing factor in the decision-making, but it should not be the only one. For most women I know, myself included, the compensation is helpful in achieving some goals that might otherwise be just out of reach.  Paying off student loan debt.  Down payment on a house.  Family vacation to Disneyland.  Upgrade on a car.  Moving your family and small business across the state and furnishing your new house.  These are things most people could live without, but are nice to have given the means.  For me, surrogacy can be that means. 

Of course, lots of people understand the compensation aspect, and in so feel compelled to say things like “Man, I bet you got a lot of money for that!”  To which we surrogates like to respond, “Yes, and how much do you make?”  For the record, surrogacy compensation is no secret and if you really want to know, head over to the NWSC website and check out their compensation schedule.  It’s comparable to the state average.  At first glance, it is a lot, but if you break it down that the average surrogacy journey is about 18 months, then the average comp is about 1800/month.  That’s not peanuts, but it’s not making anyone rich, either.  If you want to get technical, and just consider the time that a person is actually pregnant (so take out the additional fees and use only the base comp), with an average pregnancy of 38 weeks (266 days, 6384 hours), that’s $4.70 per hour—about a third of what my babysitter makes. 

Here’s how I look at it: I get paid to teach.  Teachers do not make enough considering what they contribute to society, but if you break it down with benefits, it’s a decent living.  Most of us don’t do it for the money—we love teaching and love our students.  However, most of us wouldn’t do it for free—if we won the lottery and didn’t have to work, maybe we’d volunteer part time or work with an educational non-profit, but not just full-time teaching without pay.  But my receiving a pay check for my work does not mitigate me as a teacher.  It does not signify that I care less for my students.  It means I have bills to pay and I like to eat, and that teaching is something that warrants being paid for.  In those financial aspects, it mirrors surrogacy.

The other aspect of this argument implies that I, as a woman, am not capable of making this grand of a decision on my own.  Surely I need a man, in the form of the government, to tell me what I should and should not do with my body.  Perhaps when I was 19 I allowed a man to pressure me into his ideals of what I should do with my body, but guess what—not now. One key aspect to feminism is the right over my own body.  Margaret Sanger, in discussing a woman’s right to determine her own path to motherhood, stated, “No woman can call herself free who does not own and control her body.” I believe this quote holds true for surrogacy as well. 

I have three college degrees.  Although I am still living paycheck to paycheck (or paycheck to the week before paycheck) I have a house and a car and clothes and food and we need for nothing.  I have no shame in being compensated for carrying someone else’s baby.  But I in no way, shape, or form was forced into this decision.  Surrogacy is amazing.  It’s not for everyone, and luckily we live in the United States and not some real-life version of The Handmaid’s Tale and if you don’t want to be pregnant, you don’t have to be.  But I want to be, and can’t wait for one last round. 

6) FAQs

In sharing about my new journey, the concept around the surrogacy itself was inconsequential.  My friends and family are fully aware of how passionate about surrogacy I’ve become and have heard all of my soapbox proclamations about the how and the why.   However, they had plenty of questions and comments about how J having HIV would play into it all, the following being the most prominent:

• Have you really thought about this? Are you sure you know what you’re doing?  What about your family?

Yes, I have thought and researched this thoroughly.  Admittedly, when I began my first surrogacy journey, I did less research than I should have and was seriously underprepared for all it would entail.  I have learned my lesson.  I have researched multiple clinics and studies online.  I have spoken with people both at my surrogacy agency and at the reproductive clinic.  I have spoken with other surrogates who have gone through this.  I have spoken with a woman whose husband is HIV positive who underwent this process of IVF fifteen years ago.  We will not go through with the process if at anytime along the way any of the doctors at any of the clinics believe for any reason that it is not a good idea. 

However, I live by the motto “Hope for the best, plan for the worst”.  Our contract will have a fair amount of added precautions and coverage for all of the various added “what ifs”.  What if I am the FIRST PERSON EVER to contract HIV from this process?  I’ll ask then for all subsequent related medical expenses—insurance premiums, copays, prescriptions, etc—to be covered by J & A.  Most surrogacy contracts already include a significant life insurance premium, but with this particular journey, I’ll ask for that amount to be increased, and again IF I was the FIRST PERSON EVER to become infected through this process for them to cover my premium indefinitely. 

Originally I considered adjusting the base compensation as well.  That comp is for the pain and suffering of being pregnant.  The pain and suffering of being pregnant includes the stress it causes, both for the pregnant woman and her family.  I thought this particular journey might bring with it added stress.  However, the more I research, the more I find that it really isn’t that big of a deal and there really isn’t much to be more stressed about.  Sure, I’ll have a couple extra doctor appointments and have to meet a couple extra requirements, but overall I’m not any more concerned than I am just with the general idea of being pregnant for a fifth time.

• Are you crazy?

Okay, no one has come right out and said that, but I’m no dummy.  I know what some of them are thinking.  Yes, I think it’s been well established since I was about thirteen that I am crazy. However, the psychologist that evaluated me says that I’m fit to do this, so I’m taking her word for it.  I don’t think I’m any more crazy for doing this than I am for teaching special education at an alternative high school in rural Oregon.  Or for moving back to Klamath Falls.  Or for having three of my own children.  Or for sticking it out with my husband.  There are lots of reasons for a person to consider me crazy; doing a second surrogacy for a serodiscordant couple is probably on some people’s list.  But all those things that make me crazy also make me pretty awesome.  Life is too short to not do crazy things that bring joy to you and your family.

• What precautions do I have to take prior, during, and after pregnancy?

I am still figuring this part out.  Prior to the embryo transfer, there is a process, as explained in an earlier post, to wash the sperm.  Essentially, the semen is tested for HIV, and if it is undetectable, the sperm is “washed” where it is separated from the semen (as the virus lives on the semen, not on the sperm) and that clean sperm is used to fertilize an egg.  During and after the pregnancy, I will be tested for HIV multiple times.  This includes a blood draw.  With my last surrogacy, I had about eight thousand blood draws from the time I started the medical eval process to the time I had my six week post-partum check-up, so I don’t see how I’ll even notice the difference this time.  I’m also curious about the possibility of being asked to take Truvada, a form of pre-exposure prophylaxis, or PrEP.  Truvada is a preventative drug for people at risk of becoming infected with HIV.  For heterosexual serodiscordant couples where the male is HIV-positive but undetectable, it is now common practice if they want to conceive for the woman to take PrEP for a period of time and then have unprotected intercourse during ovulation (I know, the technical jargon of getting pregnant in these scenarios is not as sexy as it should be).  The CDC has issued guidance on this, but I have not yet found substantial research on it in regards to IVF, where the woman is already taking a significant amount of medication.  I should be talking with the SPAR program doctors in July and will find out more then.  I’ll let you know. 

• When you’re HIV-positive, you just don’t get to have biological kids. 

Well, actually yes you do.  Maybe twenty years ago that was true, just logistically.  But science and technology and medicine have come an incredible way since we first discovered HIV/AIDS, and incredible strides have been made in assistive reproduction as well.  Once we start determining who is and who is not able to benefit from that technology, we cross a very dangerous line.  Women who have, for one reason or another, lost us of their reproductive organs are able to have biological children via surrogate.  Men and women who have various other medical concerns, some much more dangerous than treated HIV, are able to have children.  While I absolutely agree that a surrogate has the option to carry or not carry for certain populations and I would absolutely never expect a surrogate to carry for someone that did not fit within her moral framework, it is not up to us to determine who is able to reproduce given the means. 

Quite frankly, there are lots and lots of healthy heterosexual couples out there making and raising babies who probably really shouldn’t be making and raising babies.  But, The Universal Declaration of Human Rights, Article 16, states Right to Marriage and Family.  Those are universal rights—meaning for everyone, not just whom you think should.  If we put restrictions on HIV-positive people having children, where then do we draw the line?  Are people with cancer out?  What about mental illness?  Diabetes?  Of course not.  I’ve no doubt that J & A will be amazing parents regardless of their sexual orientation or their HIV status.  Maybe even more so because of, considering all the recent research indicating that children of gay parents are doing just fine. And, from what I can tell, the HIV thing is not too much of a parenting issue, which leads me to the next question.

• What precautions do the dads have to take after baby is born and throughout her life?

I have searched and searched and tried to find some research on this topic and keep coming up empty handed. Everything I find is about parenting a child with HIV, not caring for a child as a parent with HIV.

The other day I was virtually introduced to a friend of a friend who works in the assistive reproduction field and had heard about my journey and blog.  She reached out to me and we had a really great conversation.  Her husband is HIV-positive and she went through this process and IVF to conceive their children fifteen years ago.  When she asked about what questions I had, this was one I posed to her.  As I talked with her I realized why it was that I was unable to find any research on the topic: there is nothing to research.  The HIV virus is found in blood, semen, vaginal fluid, breast milk, and saliva.  Although it is found in saliva, it is not able to infect new cells through saliva and is therefore not considered a means of transmission. 

Now, those of you who are parents: With the exception of breast milk, which is its own conversation and frankly not one of concern for J & A who for obvious other reason won’t be breastfeeding their child (although I’ve offered to pump for a period of time), how often has your child come in contact with any of those fluids of yours?  How often has your child been exposed to your blood, semen, or vaginal fluid, with the real chance of it mixing with their own bodily fluids?  If the answer is more than never, there is a serious problem with your parenting.  The woman I spoke with said her husband gets occasional nosebleeds, and that he is especially cautious of disposing of the garbage.  Although I suppose he is more so than we are, guess what: I also try to make sure my kids don’t play with my bloody tissues.  Additionally, she said that they are particularly careful with his razors and make sure they are out of reach.  Well guess what: I also try to make sure my small children don’t get ahold of and play with our razors. 

The exception to the previously stated saliva transmission is if there is blood mixed with the saliva, which can happen when we brush our teeth.  I have heard of HIV-positive parents being cautious with kissing their children immediately after brushing their teeth.  But I gotta say, I can’t recall a time my saliva mixed with my kids’ saliva when we kissed.  If you are regularly mixing your saliva with your kids’ when you kiss, you might consider taking a step back on your level of family intimacy. 

Even so, when suppressed (when the viral load, the presence of HIV particles, is below 200 copies per ml), transmission is minimal, if at all.  A recent study indicated in the two years it’s been conducted thus far, the risk of transmission is about 4% for anal sex and 2% for vaginal sex.  By faithfully taking ART medication and keeping the viral load down, a person with HIV has a very, very low chance of passing the virus to anyone else. Oregon Health & Science University is in the beginning phases of an HIV vaccine clinical trial.  This is a fascinating breakthrough with immeasurable impact if successful.  If successful, I imagine little surrobabe would be first in line for the vaccine. 

In addition to some precautions, there is some concern about the parent’s ability to care for children due to an increased likelihood of illness and premature death.  While this is certainly the case in developing countries without access to medical treatment, that’s not so in the US.  The life expectancy for a person with HIV is about 13 years less than the average life expectancy, and only 8 years lower for those who started treatment early on, including J.  It’s only 6 to 7 years lower if the person does not have a history of hepatitis B or C, or drug, alcohol, or tobacco abuse.  The CDC sums it up nicely: get diagnosed; take medication; live about as long as anyone else.  In 2012, there were 13,700 AIDS related deaths.  Since 2005, it is the least-common cause of death reported by the CDC, at 2 per 100,000 in 2014.  Anxiety and other mental health disorders also negatively impact a person’s life expectancy by at least six years.   In 2014 there were 42,773 suicides.  But no one has ever questioned my husband’s innate right to have and raise biological children. 

There are some Opportunistic Infections (OIs) that are particularly harmful to a person with HIV.  I did some preliminary research on living a healthy HIV-positive lifestyle.  Multiple studies and websites indicated you should eat healthy foods low in sugar, fat, and oil.  Exercise and keeping fit is encouraged.  Getting adequate sleep and reducing stress is important.  As well as having a strong support system.  All of which sounds exactly like what is suggested for Every. Single. Person. Everywhere. 

Of course, I don’t by any means want to minimize the importance of not transmitting HIV to your family.  As much as medicine and technology have progressed in regards to HIV prevention and treatment, I don’t think anyone wants to have it or to pass it to someone else.  But, when undetectable to actually pass it on is not easy, and the prevention of it is not something that needs more than just some basic precautions. 

As we progress along in this journey, I’m sure my family and I will have many more questions, and I’m sure J & A will as well.  But so far it’s been an interesting learning experience for me.  With a bachelor’s and two master’s degrees and working in education, I consider myself somewhat of a career student.  This is just one more way to feed that need.  One with a much cuter outcome than a paper diploma.