10) Contracts

I’m glad that J & A chose to go with NWSC.  I had them as my first agency and was nothing but happy.  They’ve made some improvements, including a more structured support system for surrogates, which I really appreciate, and hired additional staff.  Although there are some other great agencies in the Portland area, and throughout Oregon, I had no reason to go through another agency.  It’s nice to be working with the same people I did before and I like that I am familiar with them all.

If the matching process is done correctly, then the draft contract should not require too much alteration.  IPs start the process, working with their lawyer to go through the contract line by line to make any suggestions.  Then I’ll meet with my lawyer to go through their red-lined version, making my own suggestions and agreeing with or altering theirs.  Ideally this process takes no more than four weeks; realistically, because people have lives and lawyers have more than one client, it’s more like six to eight. 

NWSC sends out a pretty generic draft contract, with the main points we’ve discussed included and altered, including number of embryos to transfer, termination, verification of SPAR participation, travel restrictions, social media, insurance, and of course compensation. 

J & A requested a couple changes, including a clarified stance on social media.  It’s common to have a social media clause in contracts, stating that both parties will provide written consent prior to identifying each other on social media.  Some are more strict, stating that one or the other party will make no reference to the journey at all on social media.  Surrogacy is a very personal issue, and one which the person involved should have control over sharing.  I remember when a friend of mine posted on Facebook that she was going to be an aunt again, before the mom publicly posted her pregnancy.  And although she didn’t name any names, it wasn’t too hard to figure out who was having baby number two, and she was pissed.  Surrogacy, I think, is even more personal than a traditional pregnancy, and many intended parents choose to keep it on the downlow until pretty far into the pregnancy.  It’s an amazing time for them, but you’d be surprised at how much crap people feel is okay to say out loud to people regarding their reproductive choices, in addition to surrogacy journeys not always going as planned.  Because I am writing a blog about this, and especially because of the stigma around HIV status (here’s a great piece on the topic), J & A added an additional paragraph regarding social media. 

They also added a pretty standard clause for IPs to insert: additional life insurance with benefits going to them.  The thought there is that if something were to happen to both the baby and the surrogate, the IPs would be able to recoup some of their losses.  It sounds a bit morbid and crude, but definitely makes sense.  Although pregnancy related deaths are relatively low in the US, about 600 per year, it’s wise to be cautious.  In my contracts I have requested an additional amount of life insurance, on top of what I already have for myself, to be paid by my IPs.   The likelihood of us needing that is low, about, but I’m a fan of insurance and prefer to err on the side of caution.  Should something happen to me, the last thing I want my husband and kids to worry about is how they’re going to pay the bills. 

 

Filling out life insurance paperwork is tedious.
Nothing less than Stumptown will make it bearable.

Most of the changes I’ve requested for the contract are around compensation.  I strongly believe in being compensated for the appropriate aspect of the journey.  The base compensation has gone up since my first journey, and as an experienced surrogate, it’s even a more.  Honestly, I feel like it’s a little too much, so I’ve reduced the base comp. I have, however raised some of the incidental fees, including the med start fee, cesarean section fee, and the monthly compensation. 

Med Start Fee:  The IVF meds were easily the worst part of the whole experience last time.  For the beginning you’re required to take the birth control pill, which turns me into a crazed irritable lunatic.  Luckily the other meds didn’t effect me that way, but regardless shots are not fun.  Nightly routines had to be altered to ensure my husband and I were both home around 7 every night.  Yes, there are surrogates more awesome than me who give themselves the shots, carrying them around in their purse to be able to stab themselves in the ass in the back stall of a Red Robin bathroom.  Sorry, not me.  I can barely steady myself to pull a sliver out of my foot, let alone stick a three-inch needle into my  backside.  Although the lurpon shots into the tummy aren’t bad, and my middle child who wants to be a doctor enjoys helping with them, the progesterone in oil is atrocious.  It’s nice and thick, and goes into your muscle, often times causing golfball sized knots.  And last time we hit a nerve somewhere and my lower back was numb for about six months.  All of this, however, is better than the vaginal suppositories of progesterone, which I feel like only half of is absorbed into the body while the other half leaks out and ruins your underwear (lesson learned: invest in pantyliners and granny panties).  During all this time, intercourse is off the table, so you have to resort to other means of intimacy.  But even my husband, who still has the libido of a sixteen year old, avoided me like the plague while I was taking those because the smell is disgusting and the taste is even worse. 

 

IVF Meds

Cesarean Section Fee: Although we’re strongly hoping for a VBAC, as there is absolutely no reason for me not to deliver a singleton via unmedicated vaginal birth, shit happens.  With my own three children, I was up and moving around the same day as delivery.  I went to Target with each of my children when they were five days old.  I went to my grandmother-in-law’s 80^th birthday party when my first was only  a week.  I had no problem showering myself, going to the bathroom myself, cleaning my own house, making my own dinner.  Aside from sleep deprivation, it was as if nothing had happened.  Fast forward to the twins’ c-section.  Most Painful Recovery Ever.  For two days I laid in the hospital unable to move on my own.  A nurse gave me a sponge bath, not only because I was dirty and smelly, but because of the anesthesia (which I have NEVER had any of before), I was so incredibly itchy but couldn’t move enough to even scratch where I could reach, let alone my back.  At my two-week check up I begged my doctor to let me go back to work, at least part time.  She refused.  A week later I knew why.  I’d get to feeling good and do something like sweep the floor, then thirty minutes later the pain set in and I had to take a nap.  I’d rather be pregnant for an additional month than experience the recovery of another c-section again. 

Monthly Stipend: The monthly stipend is to cover any incidental costs, including things like missed work, parking, and gas for routine appointments, and the additional ice cream required to maintain sanity.  Last time when I had to take half a day off for a doctor’s appointment, my lost income was more than half of my monthly comp.  Because I have three children and a steady job, I feel like the monthly incidentals are a little more for me.  I spent about a month of the first trimester so tired that I went to work, came home and took a nap while my children watched TV, got up to eat, then went to bed with my kids.  Most nights we ate pre-made dinners from Costco or take-out.  While delicious, this gets expensive for a family of five.  Had I made it past 32 weeks with the twins, I imagine it would have been similar during the last month of that pregnancy.

Maternity Clothing Allowance: In this contract I actually reduced the maternity clothing allowance.  Again, I believe the compensation should be used for the appropriate aspect.  After my third was born, I knew I was done with kids and in a fit of “Good God, I am never doing that again!” I gave away all my maternity clothes.  Which means last time I used pretty much my entire clothing comp, and then some, on clothes and slide on shoes (because when you’re six months pregnant with twins your ability to bend over to tie your shoes is nil).  While I’m sure I could easily spend the whole allowance on clothes—shopping has never been a problem for me—because this will be my last pregnancy I don’t plan on buying more than just a few key pieces, and it seems irresponsible to ask J & A to buy me clothes just for the hell of it. 

Last surrogacy I splurged on some Birkenstocks.
Comfortable slip on shoes are a necessity in a summer pregnancy.

Which brings up an interesting point about surrogacy contracts: it’s a curious combination of “Oh, this will save them $75 dollars—do it!!” and “When you’re spending $100,000 to have a baby, what’s $800 more?”  Although I feel very strongly about being compensated for my time, energy and stress, and any monetary losses I may have—including time off work, and purchases made—it’s heartbreaking to see how much IPs pay to be able to have a baby and my intent has never been to make it more than absolutely necessary, at least in my category.  If I can save them $250 by not buying as many maternity clothes, I’ll do it.  But at the same time, I have to ensure that my health and the wellbeing of my family are taken care of throughout this journey as well. 

In addition to those few monetary changes, I also added language around the insurance for HIV provisions—in case I was the FIRST PERSON EVER to contract HIV through this process.  There’s not a single part of me that thinks that will happen, but regardless I am a “Hope for the best, plan for the worst” kinda person.  And it makes my husband feel better about the whole thing.  I also added coverage of copays for alternative care like acupuncture, chiropractic, and massage (fifth pregnancy, sixth baby, makes for some seriously stretched out hips), and asked to extend the travel restrictions an extra two weeks.  And I extended the period of time that IPs cover medical coverage from the standard eight weeks to sixteen weeks.   Although the standard check-up appointment is six weeks post-delivery, it’s common for there to be effects and complications long after that.  After the twins were born, everything was all good at that first check up.  Fastforward to my first period and I thought I was going to bleed to death.  Even with three natural deliveries under my belt, I have NEVER had that heavy of a period, which happened again the next month.  In addition to all the blood, I passed a tampon-sized super disgusting fleshy…thing…and was certain my uterus was imploding and expelling itself out of my cervix.  Along with all this, my hormones were out of control, I was on the verge of divorcing my husband, and my children thought I had become Mommie Dearest.  Three vitamins, cancel the birth control pill, two blood draws, and one ultrasound later I balanced out.  But only after I paid my $500 deductible and 20% copay out of pocket. 

Because we had talked about most of these things beforehand, at least in generalities, the process went quick and we agreed on everything.  Having those tough conversations early on is important, and is mentioning basic compensation changes you might request.  Lawyers are expensive and there's no need to go back and forth if you could have decided some things earlier.  And, a lot of surrogates and IPs get emotionally attached even before the contracts, so it's hard when things fall apart during that time.  From first read to signatures, we were able to complete in a little over five weeks.  Now we're officially ready to move forward and start the baby making.  Finally!!

9) SPAR Consults

Things are finally starting to progress.  It’s an interesting time in the process, a time where the surrogate is finally starting to allow herself to be excited that it’s starting and where the IPs are just beginning to process the idea that it’s actually happening and are freaking out just a little bit.  In the past few weeks, a lot has happened.  1) IFs went to Boston to meet with the SPAR Program, which means 2) I had my consult with the SPAR program doctor.  3) IFs officially signed with NWSC, which means that 4) our contracts have started.

Because we’re in the middle of contract negotiations, I’ll start with SPAR.  A quick reminder: Special Program of Assistive Reporduction, a research project through Bedford Research Foundation Clinical Laboratory that “washes” the sperm by separating it from the semen and doing advanced HIV testing to ensure the sperm used to create the embryo is not infected with HIV.   J & A spent a week in Boston meeting with the SPAR program.  I spent the week stalking their Facebook pages and being extremely jealous of every meal they ate.  I’m thinking seriously about drafting a letter to the clinic urging them to implement the practice of having the surrogates meet them in person as well.  I want to go to Boston.  During their consult, J had to give three separate semen samples on three separate days, each of which was tested for HIV.  In order to meet the requirements, it has be considered undetectable, or contain fewer than 40 to 75 copies in a sample.  Even though he is not infected with HIV, A also had to provide two samples for testing.  Both J & A’s sperm was washed and separated from the semen to provide sperm for the embryos.

Shortly after they had completed their process and were approved, I received in the mail a packet from the SPAR program explaining the process.  While it was thorough and informative, it wasn’t anything I hadn’t already read online or discussed with other people. 

I take that back.  There was one new aspect.  SPAR, and the Bedford Research Foundation Clinical Laboratory, is completely privately funded. Because of the nature of the research they do, none of it is funded by public dollars.  It includes not only HIV research (parenting assistance for HIV+ men is not a national concern) but also research including stem cells, which, due to legislation is not able to legally be funded by tax dollars.  Later on J & A and I talked about it and, as they explained it, the SPAR program is more of a “side gig” to the program, whose focus is much more on finding a cure for HIV. 

Side note on that: Oregon Health & Science University, right up the road from me in Portland, is soon starting a clinical trial for an HIV vaccine.  If you are a healthy non-pregnant person living in or around Portland, you should check it out.

About a week after that, I had a phone consult with Dr. Keissling.  She explained the process, asking multiple times if I understood the process and the risks.  She explained that she is unable to tell me that there is NO chance of my contracting HIV through this process because the pool of people who have gone through it is too small.  But, once again, to reiterate, again, NO ONE has ever become infected through this process.  Once J & A have chosen their egg donor and the clinic is ready to create the embryos, SPAR will send J & A’s sperm to the clinic.  There is some FDA regulation around this, regarding the transferring of human tissue.  I’ll be honest here, that I really don’t completely understand this aspect of it, despite my best effort to find some clarification.  Basically, when they’re ready to send the sperm, everyone has to sign consent that we understand that we’re transferring human tissue from one place to the other.  The program is not messing around with regulations.  So much so that J told me he had to sign consent for his doctor to give him the results of his own tests from there.

Dr. Keissling and I spoke some more, her explaining the process, and also once again verifying that I understood, both the SPAR program and surrogacy in general, and that I wasn’t being coerced in anyway into this process.  She advised against twins, as many doctors do, and was glad to hear that we were only transferring one embryo and also, I think, that I had previously been a surrogate and knew the ins and outs.  Dr. Keissling did have one new aspect to share with me, regarding privacy and my medical records. She explained that I had absolutely no obligation to tell anyone, my doctor included, that the IF is HIV positive.  She gave me great caution about checking my medical records to ensure that this information was not documented anywhere in my records.  The concern around this is that if it’s noted, it can easily appear as though I have been “exposed” to HIV, which we are all going through great lengths to ensure does not happen.  Once that exposure notation is in your medical records, according to her, your treatment will be very different, as would the baby’s once it’s born.  There is still a great amount of stigma and misinformation around HIV/AIDS, even within the medical community.  There is no reason to cause undue stress or concern with my medical team around this.  Of course, considering that I’ve pretty much already told everyone I know, and that I’m writing a public blog about it, it’s not like it’s a secret.  Obviously the team at ORM knows.  When they send my records to my new doctor (ORM takes care of the medical treatment from start to about 10 weeks into the pregnancy, when I am then released to my own doctor, pending a successful and healthy pregnancy up to that point), I will request them to be sent directly to me so that I can read them over and ensure there is no notation of HIV in the record—then I can give them directly to my midwife. 

This conversation with Dr. Keissling just illustrates the idea that the majority of the general public is not aware of how far we’ve come with HIV/AIDS, and how much bigotry and ignorance still surrounds it.  I should not have to be concerned about what is in my medical records, or that I would be treated differently if I had been exposed to or was infected with HIV, especially by the people who are supposed to take care of me.  In talking with my acquaintance whose husband is HIV-positive, she noted that her husband is frequently asked how he contracted HIV, while their gay friends who are infected are not.  The assumption, of course, is that gay men must have contracted it through (unprotected promiscuous) sex, but that it must be more difficult for a straight man to contract it.  It’s true that according to studies the risk of infection is greater through anal sex—about 1.4%, or one in 71 for receptive and 0.11, or one in 909 for insertive—as opposed to vaginal sex—about 0.08% or one in 1,250 for receptive and 0.04 or one in 2,500 for insertive.  I, however, don’t believe this to be a good enough reason to make assumptions and discriminate against a group of people.  Not to mention the fact that straight people also engage in anal sex, and contrary to popular belief, gay men engage in other sexual acts besides just anal. 

I also believe there is a tiny bit (or maybe a big bit) of concern that the straight man might have contracted it through gay sex because sometimes straight men have sex with other men. 

*gasp* I know, I know, it’s only okay for straight women to have sex with other women—especially if it’s for the pleasure of a man watching—but NEVER the other way around.  But reality rarely matches societal expectations. 

The fact is, how J—or anyone else for that matter—contracted HIV is absolutely none of anyone’s business and is completely irrelevant in our relationships.  Am I curious?  Absolutely—I’m a human and curiosity is in our nature.  Do I care enough to ask or think that it is in any way appropriate for me to do so?  Absolutely not. 

Moving on…Dr. Kesissling also explained that throughout and after the pregnancy, I will be expected to send three blood samples, taken with a kit they will send me, which they will test for HIV.  She reiterated that this is not because they are concerned with my contracting it, but for them to collect data for their research.

Once the embryos are created, J & A have decided they will do genetic testing to determine if there are any genetic abnormalities with any of the embryos and will be able to chose the best quality embryo for transfer.  How exactly you determine embryo quality, I don’t fully understand either, but apparently it’s a thing.  It has to do with the rate and form in which the cells split from the time the sperm meets the egg to five days later, the point at which they implant the embryo.  Fewer than half of embryos created make it to day five to become a blastocyst.  Any additional embryos created that make it to that stage will be frozen for use at a later time.  I have the right to request documentation that the embryo has tested negative for HIV, which I’ve no doubt it will have.  Also at this time, J & A have the option to know the sex of the baby.  Since you’re looking at chromosomes, you can see if it’s XY or XX.  I was excited when J & A told me they don’t want to know and they’ll wait until the 20-week anatomy ultrasound to find out.  With so much of this process being planned and methodical, it’ll be fun to have a little bit of surprise around it. 

Now that this consult has occurred, we have officially started our contracts and are still looking at a mid-October transfer.  After six months of talking about it, we’re finally on our way!

8) The Spouse Factor

As a surrogate, I’ve received great praise from a number of people, from strangers to friends and family, to my IFs and their families.  Of course, as the surrogate, we do the majority of the work being the ones to take shots, be pregnant, and go through labor.  Often overlooked and undercredited, however, is the spouse.  Being a surrogate is a great undertaking, a huge stressor, and the spouse often takes on a significant portion of that. 

Going into this the first time, I knew this.  Being pregnant is taxing.  Although we live in an industrialized country with reasonable healthcare, there are possible complications with any pregnancy, which are frequently increased with IVF.  My husband experiences significant anxiety as it is, worrying about things I don’t even stop to think about, so having a pregnant wife is mentally exhausting for him.  He and I have talked about this before, and I genuinely appreciate his willingness to do another journey.  The motivation is different for husbands, at least for mine, who have a hard time understanding why you would choose to go through that again.  Evan sees, and hears about, the struggles of being pregnant, but doesn’t get to actually experience how amazing it really is.  I think it’s hard for a man to grasp that.  He doesn’t enjoy telling strangers about how embryos are made, how both dads get to have biological children, how—no matter how many times you ask or rephrase the question—the child is not and never will be biologically related to either one of us.  Although he thought it was cool and understood my desire to do it, it wasn’t until A & A arrived from Israel and walked into the NICU to see their babies that Evan really got it.  I’m so glad that he was there to see the looks on their faces when they held their children for the very first time.  After seeing that love, he told me it finally all made sense to him. 

Things are starting to move along in our journey (update on that soon!) and for the first time Evan had to actually do something.  I printed off the representation agreement for our lawyer and asked Evan to sign it. 

“So, if I don’t sign this we can’t move forward?”

I’ll paraphrase the rest of the conversation:

Me:

What.  The.  Fuck.  We are not having this conversation right now.  If you didn’t want to go through this again, why didn’t you say something before?

Evan:

I did say something before.  I thought I made it pretty clear that I did not want to do this. 

Me:

No.  You said you weren’t excited about it and it’s really stressful, but that you supported me if I did. As usual, you pussyfoot around instead of just coming right out and saying what you mean.

Evan:

It was pretty apparent that you were going to do this regardless.  And I know you really want to do and how much it means to you.  I’m not about to be the one to tell you not to.  I’m not going there—I know better than that.

Awesome.  Now I’m the a-hole who just does whatever I want to with no regard to others’ feelings or input. 

As we did before, and like married couples do if they want to stay married twelve years going, we continued our discussion, we listened to each other, and we met in the middle. 

Sometimes I feel like an ass about it, realizing that I am pretty stubborn and that if I get in my head that I’m going to do something, that something is going to happen regardless of what anyone else thinks.  Sometimes I remember that I make plenty of concessions for my husband, that I put up with a lot more shit than the average wife would be willing to, and that in the grand scheme of things we’re probably pretty close to even.  Sometimes I remember relationship advice that you can’t spend your time tallying everything each person does trying to make the list even (e.g.: I moved across the state—leaving a job that I loved and my family—because you wanted to, so now you have to go through another surrogacy journey for me) This is not best practice, nor even relatively healthy.  Marriage is not tit-for-tat, quid-pro-quo.  Most certainly it’s give and take, but we can’t keep count of the gives and the takes.  In this instance, my happiness, the gift of a family, and the compensation make up for the stressors for my husband.  Perhaps the quid is not equal with the quo, but it’s enough for this time. 

However, in all this discussion, another topic came up, one which Evan and I have glazed over before, but that I didn’t realize was so impactful. 

“I don’t want to share you with someone else again for another year.”

There.  It’s out.  Being a surrogate has a lot of impact that seems pretty apparent.  Altering your daily schedule for shots—doable.  Frequent pit stops on the way home for whatever I’m craving, or at least whatever will stay down—no biggie.  Back rubs, listening to me whine about ligament stretching, tying my shoes in the last trimester—he’s a pro by now. But this commitment to another couple should not be overlooked.  Although there are surrogates who go through without being attached to the IPs, that is not the case with many of us, myself included.  You become immersed in their lives and them in yours.  Of course, as adults, we are immersed in a lot of things that take us away from our families: Jobs.  Friends.  Hobbies.  Our damn phones and Facebook.  But few of those things hold with them the same level of intimacy as carrying someone’s child.

Think about your own pregnancies.  Think about how much that impacted your day-to-day life, how excited you got about feeling the baby move, or how you craved certain foods, or how you had aches and pains you never knew were possible.  Think about how you spent your evenings telling your spouse all about it, maybe texting throughout the day.  How you sat closer so he could keep his hand on your belly to feel the baby wiggle and kick.  Now put all that excitement and communication and attention and give it to someone besides your spouse.   I still get excited when I get a message—and especially a picture of those beautiful twins—from my first IFs.  Even now, I get a little butterfly flitter when I get a text from J or A. Carrying someone’s baby can bring an incredible bond between two people.  In talking about the postpartum experience of surrogates, many of my friends have lamented not about the loss of the baby—we were expecting and prepared for that—but of the loss of the presence of the IPs now that their child is with them.  Watching me share that connection and experience with someone else was difficult for my husband the first journey, and will be again this time.  Obviously there is no sexual attraction going on in either direction (I like to think myself a good enough catch to turn someone straight but alas, I have yet to do so; and while they’re both quite attractive, they’re a little too…gay for my taste).  But the emotional connection is there, which can be even more threatening to a spouse.  For a year or so, I’m going to have an open emotional affair with J & A, all while my husband sits and watches.  I can understand his hesitation. 

My husband was incredibly supportive throughout my entire process and pregnancy, helping with shots, coming to major appointments, keeping me well stocked with ice cream, and making periodic stops to Burgerville for my plain cheeseburger with a side of spread.  I know that he will do the same again this time.  I know that I have placed a huge emotional burden on him, and my family, and I am adjusting accordingly with what other actions and requests I make.  Evan has yet to meet J & A in person, and I am hopeful that when he does he’ll love them as much as I do and a little bit of his anxiety around this will be eased and his excitement about helping them become fathers will take over. With jobs and three kids, Evan and I are stretched for alone time as it is.  Especially with this new journey, I need to make an additional effort to improve that.  We’ll try to sneak away a little more frequently, re-implement the weekly date night and maybe a weekend getaway or two, and will hopefully do an adult-only vacation when it’s all done.  In the meantime, I will give him a little more gratitude for all of his care and support, have a little more patience during those moments he’s not being quite so amazing, be just a little more loving.  Because, as much as he deserves it any other day, he especially deserves it right now. 

 

San Francisco's Pier 39

Update: Our family recently went to San Francisco, where my husband and kids got to meet J & A.  As I expected, they loved them.  Although still not as excited as I am, my husband’s anxiety has lessened knowing what an amazing couple we’ll be helping create a family.