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!