SART Fertility Experts - Gestational Carrier and Intended Parents

The information and opinions expressed in this podcast do not necessarily reflect those of ASRM and SART. These podcasts are provided as a source of general information and are not a substitute for consultation with a physician. Welcome to SART Fertility Experts, a podcast that brings you discussions on important topics for people trying to build a family.

Our experts are members of SART, the Society for Assisted Reproductive Technology, an organization dedicated to ensuring you receive quality fertility care. Hi everyone, this is Dr. Bill Petok. I'm a psychologist from Baltimore, Maryland, and I've been working with people building families for about 38 years now.

This is an episode of SART Fertility Experts, and it's brought to you by the Society for Assisted Reproductive Technology, where we know that IVF success starts with SART. Today, I'm going to be speaking with a couple who have used a gestational carrier and their gestational carrier, and we're going to talk about all of their experiences so that people who are considering using a gestational carrier will have an idea about what you might expect. Let me first ask Meredith, what were the circumstances that created the need for you to use a gestational carrier? Hi Bill, we're so excited to be a part of this because this has been such a wonderful experience for us and has created our family.

I didn't think that I would be a mom unless we did this, and I think that it would be really great for other families to be able to realize their dreams of having a family if they use a similar program. Because I was a cancer patient, my husband Chris and I got married when I was 28, and we hoped to start a family right away. Just four months after our wedding, I was diagnosed with a rare form of uterine cancer called gestational trophoblastic disease.

Unfortunately, that type of cancer is a pregnancy-based cancer, so while we were trying to become pregnant, instead I got cancer. And I was sick for a little bit first, six months of what I called little girl chemotherapy, where I didn't lose my hair and I just had a shot of chemotherapy, an injection of chemotherapy, and after six months I was well. So we thought that that was behind us.

They said I couldn't try to get pregnant for a year, and then we would try again. So that's what we were thinking we'd do. That was the plan.

And then after two and a half years of still not getting pregnant, on Groundhog Day of all days, I thought I was pregnant, and we went for an ultrasound, and it turned out my cancer had recurred, which is very rare. So then I was very sick. So for a year and a half, then I went through intensive chemotherapy.

I lost my hair. I was very sick, and I had Mediport and IV chemotherapy. And at one point I was looking like I might not survive, and I did then have a hysterectomy.

So they removed my uterus at, I was then 32 years old. So I looked at my husband, I said, we don't have any babies yet. And he said, well, you can't be a mom if you're dead.

So let's just focus on keeping you alive, and then we'll worry about that later. And that was a devastating day, but made sense, and we just moved forward. So by the grace of God, I'm alive.

And one doctor ordered the one test that nobody else ordered, and she found that a little cancer had traveled to my lungs. We removed that cancer, and a week later I was cancer-free. So it took a long time to get through all of that.

And even after that, we really needed to take a breath, both me to get my health back, and us as a couple to just sort of regroup. Our marriage was not what we had thought it would be, and we needed to just sort of reassess. And after some time, we looked at all of the options for becoming parents.

I did still have my ovaries, but I had so much chemotherapy at that point, Bill, that they had said to me, your ovaries are probably dead. And that was disheartening. And were they? They were not.

So when I started doing, and it was a day-by-day process even then, that I started doing the hormone injections to see if there were any follicles for an egg retrieval. And again, just by the grace of God, they were alive and started bubbling, and we did an egg retrieval. And I retrieved 11 eggs, and we fertilized them, and we ended up with three normal embryos.

Wow. So you've been through quite an experience. And Chris, I would imagine this was quite a, I don't know what the right word to use.

It's quite a shock, quite a excruciating journey for you as well. Yeah, Bill, just as Meredith has described, it's been a yo-yo. I mean, we've had our ups, we've had our downs.

And at the end of this whole process, we weren't sure if we were ever going to be able to have children. And after all the chemo that she's been through, we were concerned that she wouldn't be able to provide eggs. And the fact that this worked out, and we were able to retrieve eggs, and not only that, but then get viable embryos from those eggs.

And then beyond that, to find Angela, who's a saint, it's been unreal. Thank you. I appreciate that.

All too often in these experiences, the man is sort of left out. He's a necessary component, but we tend to interview the women who are involved, especially when it's a gestational carrier, who is providing that most, in your case, Meredith, the missing piece, truly missing, because it was removed. Angela, let me ask you a question.

How did you decide you wanted to become a gestational carrier? So I ended up having my son pretty young, I was 19. And growing up, my mother had a lot of infertility issues after having me. So after having me, when she married my father, they went through about 13 years of infertility, going through IUIs, IVF, name it.

And unfortunately, they had recurring losses. And they did not end up having any more children. That was also before surrogacy was more mainstream and more talked about.

So after I had my son, and that was a little bit unexpected. I decided to look into possibly egg donation and things that could help in that way. However, I was not qualified for egg donation, because you have to know all of your genetic background in order to do so.

And unfortunately, there's some missing pieces for me. So because of that, they were like, you can't do that. But have you ever thought about surrogacy? And at the time, I never thought of it.

So I took some time to look into it. My son was still young, he was around one years old. But the more I looked into it, the more I was like, I think I can do this, like I should.

So I ended up reaching out to the agency that we all met through, and we started the process of it while I was still thinking about it. And the more I looked into it, the more I got invested into it, the more I convinced myself that was the right direction to go. So it's, it's, that's, that's, of course, one avenue in which people meet through a matching program or an agency.

And I wonder if Meredith, you and Chris had looked at other ways of finding a surrogate. Oh, yeah, we did. Well, so I do.

I have, I was looking at anyone with a viable uterus. I have, I have two sisters, neither of whom had offered, which is fine. It's not for everyone.

It's okay. It is. It is.

And I did have, I do have a best friend who offered as well. And we had done some of the testing, and we had done some initial meetings, too. And there's a lot involved.

And it's, it's hard, because it's both an emotional relationship, a medical relationship. There are a lot of pieces to it. And we had like sort of dipped our toes in that water a bit.

And then, and then we pulled back from that. And again, highs and lows that I would have taken anyone on two legs with the uterus or on one leg with the uterus. But it was important.

And Chris has, like, I wouldn't be alive today, if it wasn't for Chris, like, he had actually saved my life three times when I was sick. And then I needed a really good compass when we were doing this, because I think I was so desperate for motherhood that I needed some clear focus and clear thinking to just guide me to a good choice. So it was great to have Chris as a partner in this, because when we even did go to the agency, you know, they ask you for some parameters.

And one of ours was geographic, just because we wanted to be close. And that was one of mine, too. When they asked me, I was like, I want them to be able to come to the appointment, I want them to be able to do that.

So that was one of the same ones I had to. And that's a really important concept, I think, you know, for some people that and clearly for you all that that was really critical. That's, that's, that's a good thing to bring up.

Thank you. And in the beginning, though, they had offered, the agency had offered, I think, two different one, the first option, and the second option, and one of them was in Alabama, and we live in Pennsylvania. And I was like, Okay, Alabama's great.

I can get on a plane regularly, we can I can have frequent flyer miles. And Chris looked at me and he was like, No, this is this is okay. This is not our fit.

This is not our match, we can pass. But I remember passing. And then it was still months, months before we got another potential candidate.

And that is really hard for intended parents. Every day is like one more day that you're not a parent. So you really have to trust in the process because we knocked it out of the park when we got Angela.

Angela, did you have a similar experience of having to wait? Yes and no. So there were several months of doing the preliminary stuff, like the stuff, the psychological screening, the financial, the financial screening background, all of that. So that took several months.

And once that was done, they asked me for my, what my parameters were. And there were some that were a little bit more like conservative for myself, that I was told that that will limit your, you know, the base that you're that you're looking at. And I was like, that's fine.

But I, I feel like, you know, as a gestational carrier, you have to set those limits, you know, for yourself. So I was like, No, you know, I want them to be close. There was, you know, certain opinions I had on termination and like other things that I had to agree upon with another couple.

So they, I was told that I could possibly have to wait a while because of those decisions. I really only waited about a month or so before they told me that, you know, I could meet with Meredith and Chris online. But that was, we didn't like decide on the match until about, I think, December.

I see. So when I meet with both intended parents or gestational carriers, one of the things I usually say is one of the watchwords of IVF and reproductive technology is hurry up and wait. Because there's a lot of that going on.

And when you think about how complex it is to put two people, three people in this case, four people really, together, who are going to have a very critical relationship that is going to be at least 10 months long. You want to do a very careful job of making that happen. You don't want to rush into things.

So you first met online. How long, and this is pre-COVID. I want to make sure that everybody understands that we are recording this still during COVID.

So there's not a lot of face-to-face going on these days, initially. So you met online first and then how long before you actually met face-to-face? I think it was about two months, if I'm remembering correctly, because I think in October we had the Skype call. And then they ended up deciding, taking a little bit of time and deciding.

And then December, I don't know when in December, I got an email asking about going out for dinner to discuss it in person. And so how was that dinner? Where did we do that? We did that in, it was down in Maryland, no, it was in Gettysburg, which is our halfway point. Don't you think that's, is that ironic or is that the, so Gettysburg is the halfway point between our houses.

And we met at, I think it was Angela, TGI Fridays. I think so. Yeah.

I remember the food and it sounds like a TGI Friday. What did you think getting out of the car and going in? I mean, I was very nervous. Getting up and sitting down and just, I was afraid she was going to look at us and be like, oh no, I don't want to be with them and turn us down.

So it was very on edge at first. But Angela is a very giving and loving person and she made it seem just so natural to sit there and just open up conversation. I mean, we actually had a very good time.

Angela, how about for you? What was it like walking into that restaurant? I think I had the same feelings, but in the reverse, because I also was a little bit younger on the side of gestational carriers, because a lot of them have already finished, have completed their families, which is a very good idea for people to do. But I was at a point where I was younger and I felt kind of the opposite where I was thinking that maybe we would meet in person and they would decide, okay, maybe we shouldn't proceed with her. And I did really enjoy our conversations on Zoom, but obviously in person completely different.

And I did bring my son and my mother to there. So that way we could all make sure everyone's on the same page. I think that was really smart.

Clearly your mother supported you in doing this. And it was pretty clear that your son was going to know if you went forward with this, you're going to be pregnant. And it would be important for him to know that the baby was not coming home with you.

He's pretty good on that now, especially with a second pregnancy. He's pretty certain on that. And I feel like if that ever changes, he's going to have an opinion.

That's something I neglected to mention early on is that Angela is currently in a second journey with Meredith and Chris. So it appears to have worked out well. Um, there are a lot of things that have to be decided in doing one of these journeys together.

And part of that is creating a contract that specifies many different things. And I wonder from the point of all of you, what were the most difficult decisions you had to make as you got ready to put all of that on paper and then do the next step, which would be transfer the embryo? So I would say from the outset, um, the termination, um, question I think is often the biggest one. And then, um, I, I think once the, um, couple is clear on the intended parents are clear on what they would like.

And then that conversation is, um, worked out with the gestational carrier. I think that that's a really big hurdle. And then a lot of stuff can filter from there.

I also think that we're, we were really clear with, um, Angela's life is of utmost importance. If Angela is not alive, then there is no baby. So we, she is, this is a gift that she is providing us and her, um, life and care is, it needs to be there.

Plus she has a family. She is a mother and we have to make sure that she's there for David for his life. Um, so that, you know, her, her, um, her life counts the most.

And then when we are talking about, um, the health of the baby, Chris and I, um, just have a strong pro-life standpoint. And while we had had tested embryos, it was important to us that the carrier wouldn't be interested in terminating for a whole variety of reasons so that we were willing to welcome a child, um, with any sort of disability, um, or if there were problems even along the way so that we wouldn't terminate, let's just say unnecessarily. And, um, when Angela agreed, um, to that as well, I thought that that was, those were the big issues right from the top.

Angela, what, what sort of thoughts do you have about that? Um, I think that some, when I first saw the contract, the first, you know, during the first journey, I think the, the thing that shocked me the most, I wouldn't say shocked because they did like, I wasn't, you know, Merrill did review that it was going to be in the contract, but seeing it on paper about like things that can be used to sustain your life. If the baby's not viable, are you okay with that? Things like that where I was okay with it, but seeing it written on paper and signing that paper is a little bit different. Um, so I feel that those things, and then also signing life insurance documentation, um, and insurance for your reproductive organs, especially because I'm, I was at a point, you know, when I was younger, as well as now that I didn't know if I wanted future children or not.

And that is a big consideration in this because anything can happen. So I had to, I had to make that realization with myself that if something were to happen, I have to be okay with that. And in like, know that I'm going into this, knowing that with the possibility and that also, you know, signing life insurance stuff for my son and all that information with a little bit of a tough pill to swallow, but it's the reality of it.

Sure. I would, I would add for, for listeners that, um, the, there is a contract, um, that's created that says, here's what the gestational carrier is willing to do. And here's what the intended parents want to have happen.

And that there are agreements about things and that there are, as both of you, all of you have alluded to some difficult clauses in there because the contract has to cover almost any possibility of what could happen with the notion that some of these things happen with a very, very, very small frequency. However, it's important to make everyone aware that something could go wrong. And if it does, these are the steps that would be taken.

So, um, Meredith and Chris have, uh, as you said, a strong pro-life component that you were willing to have a child who might have down syndrome or something like that, I'm assuming. Um, but that the most important thing was that if caring to term was going to jeopardize Angela's life, that would not be acceptable. And, you know, these are the things that, um, people don't think of when they wonderfully make love to their spouse and get pregnant.

You don't sit down, uh, you know, when you get home from dinner, a little tipsy and you roll into bed with a 25 page legal contract and you go through all these things. Um, but it's, it's interesting to have to be really, uh, really have that forethought, but it also shows for all the intended parents and all of the gestational cares out there. It shows the love with which you put into these babies because it's so much work and so much thought.

And you think about these minuscule possibilities with great care and great time. And you, and you debated in your house and you might have a fight or scuffle about it and you, and, and, but it's really, you're really doing it with great purpose. And you're, you're putting a lot of love and attention into creating these families that some other people don't.

So the baby should know, like just how extra love they are. Well, you know, you raise a really good introduction to another question I wanted to ask. Now your, your son, your, your daughter is four years old, right? Yes.

Tomorrow. Oh, we're getting ready for a birthday party. That's very cool.

Um, how did you discuss or how have you discussed Angela with your daughter? What, how have you described this person who helped bring her into the world? So I have to tell you, I went through a lot of counseling during the surrogacy and, um, which was really important to me. Um, so I felt really comfortable with how, um, it was going, um, with Angela. Um, one of the things that I did not totally prepare for was answering questions from a child.

And while even Angela prepped David really well, her son, um, he referred to our daughter Ren as the belly when he, she was in, uh, in utero cause we didn't know if it was a boy or girl. And, uh, so, so Ren was the belly. Um, but when what actually just happened in our, in our family, as Ren was about three and a half, our neighbor across the street was, was, um, really pregnant.

And she gave birth to our, our little neighbor, baby called baby Logan. And Ren was like, Oh, she's not pregnant anymore. The baby is out of the belly.

And so she got it, which is cool. And then she said to me, like, I came out of your belly and I was like, Ooh, like that record scratch, you know? And I go, but wait, you didn't come out of my belly. You came out of Angela's belly.

Now, Angela and Ren have a great relationship. Angela is part of our family and she's come to all the birthday parties. We exchange presents at Christmas.

We've seen each other a ton. So they know each other, but, um, the concept and we, we've said she's the surrogate, but the concept for the child didn't really click until then. So Ren's also seen pictures of me bald with no hair.

So she knew that I was sick and I say, my belly was broken and that Angela carried you and you were in Angela's belly. And now it's totally a thing. And as a four-year-old about to be four, the concept is really sticking in there.

And I'm proud that she's okay with that. And I am calmly pleased that it's okay. And that like, I can, we can do all of that without crying me mainly crying because, because during the pregnancy and the surrogacy process, like that would that the idea of that conversation would have set me to tears.

Do you think she's good with it? Yeah, she, she, uh, she comprehends it. You know, she, she understands it now. Yeah.

Um, and she, you know, she'll mention that every so often she'll say, I came from Angela's belly because mama's belly was broken. And, and, you know, it's, it's, it's, it's tear jerking sometimes, but she, you know, she does, she, she understands it. And she, she, uh, uh, she's been fantastic about it.

But part of the reason that this, this, um, program, your podcast is so meaningful is because there are not a lot of resources out there. Angela and I are without a doubt going to write some books after this, you know, when we take a breath, when we have five minutes to ourselves, but there are no children's books, either a very few, there are very few children. And one of them is really great, but it's from like, in theory, Angela's perspective, Angela's family's perspective, the kangaroo pouch, and it's great.

And we read it about like the baby being in the kangaroo pouch, but it's not our family's perspective. So there are some resources available, but we would love to them to be more mainstream. I think it's a great idea.

Um, are there things that I was normally, I would say, how has your relationship evolved, but clearly it is, it has grown very close. Um, so close that Angela's doing another journey for you right now, as we speak. So, um, it must've worked out just fine, um, or, or better.

Um, are there things that you think prospective gestational carriers should know Angela, um, as they consider going into this? Um, I feel that if you're looking into being a gestational carrier, you do have to look at everything in the big picture, because most of the time when you're going into being a gestational carrier, it's because your last pregnancy or pregnancies beforehand were very easy. You usually don't go into being a gestational carrier if you had terrible pregnancies. Correct.

But every pregnancy is different. And unfortunately you go into it and you may think, oh, I'm going to have no issues. I'm not going to have issues with childcare.

I'm not going to have issues. I'm not going to have issues with, you know, health wise or anything else, but then things can come up. And I think a lot of the time, you know, they may go into it without thinking about the things that, you know, the negative aspects that can happen, which are very seldom, very rare, but they do have to take those into account because they're on documents that you do sign.

So I think that it's important for you to, you know, to think about that. Chris, what would you add from the, from the intended parent's point of view, things that you think other people would benefit from knowing in advance? I think two things, like say what you need to say and ask the questions that you feel like might even be uncomfortable. I remember the one question on the first, you're laughing cause you know, the question that I asked the very first time we all met, the two couples met Angela's husband was on the Skype.

And I said, I, can I just ask you a question? I said, your wife is going to be pregnant with our child. I feel like you'll probably have less sex with her next year because she's pregnant with our child. Is that going to impact your marriage? And he was like, we've considered that.

And, you know, it's part of the process and perhaps it'll be, you know, totally fine. You know, we've talked about that because that worried me, you know, I don't want, I don't want, you know, there to be marital strife over something that somebody is doing, you know, for us. So, you know, ask those questions because that's the logistics of what you're doing.

I think, you know, you bring up a really good point that yes, there's a connection between two couples usually, but it goes farther than that because there are parents of the individuals. There are coworkers of the individuals. And when you are carrying someone else's child, it's not a very private sort of thing.

If you have to interact in the public, people will see that you are pregnant and they will ask questions as they inevitably do. And having answers that are reasonable becomes important. Chris, you've got that look on your face, like maybe you thought of something you wanted to add.

Yeah. You saw it. No, I guess my, my recommendation to potential parents would be get an expert in this field.

The expert, the lawyer that we had who helped arrange for Angela and us to be together also helped arrange the contract and everything. She knew so much about this and, you know, like thought of every, every possible outcome. And that really made me feel comfortable because we had somebody who really knew the business really knew, you know, what this is about and knew how to protect each side of the, of the, the contract.

And that made me feel good. I appreciate that. I think, I think you're right.

Having somebody who knows how these arrangements go and what's going to have to go into them, it's certainly people do private arrangements, but eventually you wind up having to get down to that contract. And if you've got somebody guiding you, there's, you know, what to anticipate better. Yeah.

Any Angela, any last thoughts you might offer about how it was telling your son about what his mom was going to do? So during our first journey, my son was young, so he was two and a half when Ren was born. So he really just understood that the belly would kick back if he, you know, if he was pushing in on it, like he didn't really comprehend that if I, you know, normally if I were to have a baby that it would come home with us. So it was never really a conversation because he didn't quite comprehend that.

So and he, you know, but now that he's now six. So with this journey, he had a lot more questions than he did last time. And the conversations have, have gone really well.

I've discussed it in the same way with him. He does sometimes ask, you know, when it's going to end so that way I could rough house with him again and stuff like that. But, but other than that, he's excited for Ren to have siblings, like he's all for it.

But I think it's because he vaguely remembers the pregnancy with Ren, considering that he was like two, almost three. We read the kangaroo pouch to him. He, he understood it pretty well.

And I think that it will help him when he's older, understand that there's many different, I would say kind of unconventional kinds of families. And I feel like I'm kind of just showing him that a little bit more and maybe giving him just maybe a tad bit more empathy. I would agree with you.

I think one of the things I expect that children of gestational carriers learn is that there are many ways to be a helper in the community. And that this is one of the greatest gifts that somebody could give because it's somebody, as in Meredith's case, who wasn't able to for a very logical and unfortunate reason, but very much she and Chris wanted to have a child and the helper that you are allowed that to take place and is allowing it even as we speak to take place again. Any, any last thoughts that any of you have before we wrap this up? Angela's name is meant to be, she is our angel and our daughter is wonderful and we are so blessed and so lucky to have her.

And we're so thrilled that Angela has given us this gift. Now, again, just to reiterate, if you're thinking about doing something like this, you really do want to consult the professionals in the field and get their input and their help in planning the whole process because it is very complex. I appreciate that.

And I think Chris, what people will find out is when you go to a SART clinic, hopefully SART clinic, the, before you get to the transfer, there's an awful lot of paperwork that must be completed. And that includes this very significant contract, which pretty much makes it clear that all of the things that we've been talking about today have been thought through and that there are contingencies in place for it. So working with somebody who can guide you with a good deal of knowledge would be very important.

Well, I would also add, I'm sorry, just one more thing, please. I would also add, be advocates for yourself, both as an intended parent and as a gestational carrier. If you have chosen to do this, be strong in your belief that you're making the right choice and know that while surrogacy is on the rise, it is still so far from mainstream that in instances where you're walking into an appointment, people might have no idea what's going on just by the outset.

They might not know that the pregnant person is not the parent of the child and advocate for yourself and explain the situation. Hey, I walk in with Angela and I say, these are my babies, or this is my baby in the belly, or look, she's pregnant with my daughter, because they don't know. They just clearly assume that it's Angela.

So I wear it on my sleeve and I want people to be as excited for me as, and know that I'm the mom, as Angela is the gestational carrier. When they say to Angela, oh mom, how are you feeling? I don't bristle because of course they assume that she's the mom, but that can really hurt an intended parent's heart when you're not referred to as the mom, even though you biologically are. So you can advocate for yourself.

We went to one appointment where the woman asked me to step out of the room because I think she thought that I was trying to poach Angela's baby from her, as if Angela was a young mother and maybe giving her baby up for adoption. And she wanted to make sure and ask Angela some questions about her safety by herself without me there. And Angela's like, no, no, this isn't even my baby.

This is genetically that woman's baby who you just asked to leave. So it is good to advocate for yourself and stand up and let people know this is a surrogacy. Have you ever done a surrogacy before? Or is this your first time? Is this your 25th time? Great.

What are your policies? This is what we'd like to do because it is still new, but it is your process. So you're allowed to ask for what you'd like. Very good.

Well, I want to thank all of you for participating in this. I think it's incredibly important information because as you have alluded, families are built in many different ways. And this is one way that the advances in reproductive technology have made possible.

In the past, it would not have been an option for somebody like Meredith to have had a child that is hers. However, that is hers and Chris's. And today, with the assistance of a large number of other people who were able to arrange for the parts to get together so that they could be transferred to Angela, who could then do the nine-month job of bringing that baby into the world, this is now more possible.

In fact, the last year we have data that the Society for Assisted Reproductive Technology produced. Of the 78,000 or so babies that were born through IVF in the United States, 7,500 were with gestational carriers. So about 10%.

That's a very significant number of children who were brought into the world with the assistance of someone without a genetic link to them. So that's, as you said, it's relatively new, but it is a growing experience for many families. So once again, I want to thank you for participating with the SART Fertility Experts Program brought to you by the Society for Assisted Reproductive Technology.

Thank you again, and good luck with this next journey as you're halfway through it. Yes. Thank you.

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