Lights, Catheter, Action!

Surrogacy can turn you into a professional wait-er. Even when there's a lot of fun stuff going on, the in-between is filled with more waiting. We're currently in one of the most difficult waits: The embryo has been deployed and everyone holds their breath until the bean signals back that it has accomplished it's implantation mission. With this being my third transfer, I am definitely handling the wait differently than I did after the first two transfers. Maybe it's the acupuncture; maybe I'm just getting older and developing a touch of the patience, but I'm really feeling a lot more zen about it, and the days are passing at a more normal speed.

Last Thursday, I packed up and flew out to the East Coast. It was a pretty easy travel day with no difficulties or delays. When I landed it was already evening, so I was able to grab a little dinner and settle into bed early for the 5 am wake up call that was coming the next morning. Although I didn't quite make it to the clinic at 6 am as planned (wrong clinic, Google!), I was able to quickly get my last pre-transfer blood work and ultrasound done, and head back to the hotel for a nice breakfast. The clinic called me back just before lunch to tell me that my labs and ultrasound looked perfect, and that we would be transferring at 1:00 pm. When I arrived, they made me comfortable in a procedure room, the acupuncturist came by to work his magic and somewhere around 2:00 pm, the RE and crew rolled in with an ultrasound machine and an incubator with this adorable little embryo. About 10 minutes later we were done and everyone rolled out as quickly as they rolled in. The acupuncturist came back to do a second round of sweet relaxation goodness, and I was out the door. The nurse gave me the usual instructions (assume you're pregnant, don't do dumb things), but I was pleasantly surprised to receive instructions for walking activity throughout the afternoon. With all of the recent research that strongly indicates that post-transfer bed rest is counterproductive, I'm very happy to be working with a clinic that is so responsive to the research data. After a leisurely afternoon of shopping and exploring the area around the hotel, it was back to bed in preparation for another full day of travel.

Saturday morning was very easy paced as well because my flight didn't leave until 1:30 pm, but I decided to get to the airport a little extra early to allow plenty of time for any TSA shenanigans that might come my way like the last time. Instead, I breezed right through security and to my gate an hour and a half before my flight time. As luck would have it, on this one isolated incident of my prompt timeliness, my flight was delayed due to a faulty aircraft. The airline had to find a different plane for us and kept pushing our flight time back until they were able to locate one. In total, we ended up being 3 hours late. To my advantage, it was a direct flight for me, so I didn't have a connection that I was missing due to the delay. I spent quite a bit of quality time with my Kindle and Hulu; thank goodness for technology.

It's now been almost 3 days since I got home; 4 days since the transfer, and we continue to wait. I have moments that I feel certain the transfer was successful, and just as many moments where I feel absolutely nothing at all. That is the true torture of the post-transfer wait. It helps to know that we'll have a clear answer in 6 days, and yet, it will only bring on another wait. This is the life of a stork, a professional wait-er.

More Monitoring, More Results

We've progressed to pre-transfer monitoring, round 2. At this point, we are 16 days into the medication cycle and exactly a week after the last monitoring appointment. We will have one more monitoring appointment in 3 days, and then we'll transfer in a week and a half (June 12).

As with each monitoring appointment, they drew a vial of blood and did another ultrasound this morning. The things that have changed since our appointment last week are that I finished shedding old lining, the RE cut my Lupron dose down to 5 units per day instead of 10, and added oral estradiol at 1 mg twice a day. After the first three days of that change, he upped my estradiol to 2 mg twice a day. The effect that we hoped to see at this appointment was increased estradiol levels in my blood, my endometrium starting to thicken up (goal thickness at transfer is > 8 mm) while the ovaries should still be quiet (no follicles over 10 mm) and progesterone levels should still be low.

Results
Endometrial thickness: 9.3 mm
Right ovary: 6-7 follicles < 10 mm; 0 follicles > 10 mm
Left ovary: 8-9 follicles < 10 mm; 0 follicles > 10 mm
Additional findings: Small pocket of fluid in the uterine cavity
Estradiol: 228 pg/ml
Progesterone: 0.5

Things look great. My lining is already past our goal and we have no rogue follicles trying to impede our progress, so we're in great shape. We're going to keep plugging along toward our next monitoring appointment on Friday. The RE didn't say anything about the small pocket of fluid, but I'm hoping that it'll be gone by the time we do the next ultrasound.

Sneak Peek

Today was our first pre-transfer monitoring appointment. This is an aspect of IVF that I really enjoy and look forward to in each cycle. When couples are trying to conceive naturally, there are a lot of days that pass with no news or no indication of what's going on down in the land of babies. The two week wait is notoriously excruciating because of the lack of information. In the IVF process, however, doctors are getting all up in our business on a pretty regular basis, so I'm very up to speed on how things are progressing during each cycle. I like knowing things. In spite of the magic wand they have to use, this state of knowing things makes me happy.

The routine is pretty much the same at each pre-transfer monitoring appointment. They draw a vial of blood to be tested for the pertinent hormones of the week, then I head to the ultrasound room for a quick look at my inner girl bits. First stop on the magic school bus ride is the uterus where they measure the endometrial thickness (lining) and look for any pockets of fluid. Next they head on over to one of the ovaries, count the number of immature follicles (less than 10 mm), document and measure any developing follicles (greater than 10 mm), and check for any cysts. They repeat that procedure on the other ovary and we're done. I put some pants on and head back to work to await the results.

At this first appointment of the cycle, the goal is a thin lining (around 3-5 mm), two quiet ovaries (no follicles over 10 mm) and low estradiol and progesterone levels.

Results
Endometrial thickness: 5.9 mm
Right ovary: 6-7 follicles < 10 mm; 0 follicles > 10 mm
Left ovary: 8-9 follicles < 10 mm; 0 follicles > 10 mm
Additional findings: None
Estradiol: 34 pg/ml
Progesterone: 0.6

Stork 951, This is Ground Control, You're Cleared for Take Off

I think I've kept you all in suspense long enough. A month ago I was on the fence between the local IPs through the agency or the independent match IPs on the East Coast with the picky clinic. After much discussion with Scott and the East Coast clinic, I decided that the independent match was the way to go, and the medical screening date was set. The IPs, Mandy and Wes, already have 4 frozen PGD tested embryos, so once we traverse the gauntlet that is screening and contracts, we'll be ready to transfer.

After a thorough review of my records, the clinic called to schedule the medical screening. Scott and I flew out there last week with 3 of the 4 kids in tow. We met up with Mandy and Wes on the first night that we arrived and had a wonderful dinner together. This was the first time meeting in person, and they were as sweet and wonderful as they were over Skype. I'm really quite happy to be working with such a wonderful couple. While still in their early thirties, they have had multiple unexplained early losses that led them to visit a few reproductive specialists who determined that several auto-immune factors were to blame for the losses and that Mandy would not be able to successfully carry a pregnancy. That prompted them to act quickly to locate a surrogate to carry the embryos that they had already created. Those efforts led us all to the clinic last week where their RE did a saline sonogram of my uterus, took 7 (yes, SEVEN) vials of blood, and we all sat down for some psychological evaluations and group discussions. It really was an interesting day, and we all enjoyed seeing each other again. As we left, Mandy gave me a box of the medications that she had been sent in preparation for her own transfer prior to learning the results of her infertility testing.

When we got back to the hotel, Scott asked me how we were going to get the box back with us because it was full of needles and we had only traveled with carry-on luggage. I decided to ship it rather than deal with it at the airport - seemed simple enough of a solution. After printing the shipping label and preparing the box for shipment, we took off for the airport. Not being natives of the East Coast, we were unaware that we really couldn't get off of a turnpike once we got on it, and this particular turnpike dropped us at the airport. No problem, there had to be some FedEx drop box somewhere in the airport, right? Wrong again. At this point, we only had a little over an hour until our flight left, so my options were to carry it on or check it. The airline counter was swarming with passengers checking bags, so I asked if I needed to check it based on the needles, or if I could carry it on. They told me that I could carry it on as long as there were prescription labels on the medications. Great!

Off to security we went with 5 rolling bags, 3 kids and a suspicious looking box. At every opportunity, I told the TSA agents "I have medications including needles, how do you want me to proceed?" They were all great, said "No problem" and scanned everything as usual. We passed through the metal detectors to the swabbing area where everything that was swabbed was normal except the box of medications that lit up their machine like a Christmas tree. The agent, again, very nice, did a full pat down on me, swabbed me and the box again, and came up with the same electrifying result. Awesome. She then tells me that the protocol dictates that they call in the explosives expert who arrives about 10 minutes later. He goes through the course of events with the TSA agent, explains to her that there are certain medications that will produce a false positive, then tells me that he has to do a full search of my luggage and person.

While he removed and photographed every item in my bag, the TSA agent did a very thorough body search, then they sent every item through the scanner again. Interestingly enough, they never opened the box of meds and actually looked inside - only scanned it twice. Once he had everything documented, he thanked me for my time and sent me on my way. We ran for the gate where we saw the last few passengers boarding. Whew, we cut it close on the time, and am I ever glad that I did the online check-in the night before!

A week later, we're home and back to our regular routines. The clinic called a few days ago to say that everything came back negative/normal, and we're ready to go once we have a signed contract. Lest I bore you all to death with the tedious details of the contract process, suffice it to say that Mandy and Wes' attorney doesn't have the same sense of urgency with the contract drafts as the rest of us do. We finally decided that the best way to make progress was for the three of us to have a long conference call to make all of the final decisions on the modifications that had been proposed, and then send them to their attorney to incorporate as the final draft. We did that 3 days ago, and are now waiting for her to send it back to all of us for final approval and signatures. Here's hoping we have a signed contract next week. If so, we'll be right on track for a transfer in the last week of May.

Round 3 - Ready, Set, Go

It's that time again - needles, syringes and vials by the fistful. I started the third round of meds this past Monday, so today is day 5 of Lupron. The last time it took about a week before the side effects kicked in, so we'll see in a few days if the hot flashes, insomnia and weight gain will return with this cycle. Today I met a brand spanking new side effect that didn't pop up last time; nausea. To be fair, nausea is my catch-all 'something's off in my body' symptom. Some people get headaches, I get nausea. Especially when hormones are involved; even your run-of-the-mill birth control pills will make me nauseous on a daily basis. When we did the first round of meds in July and August, I was actually pretty lucky that the nausea side effect didn't show up until we added the Estrace and then it was pretty intense. I cursed the Estrace a bit for it, but I guess there's a chance that the Lupron was equally to blame. On the bright side, I didn't need to hold onto those extra calories I ate at our office holiday lunch anyway.

So we're about a week into the cycle with exactly 4 weeks to transfer. I'll go in for a baseline monitoring appointment next Wednesday and if everything looks good, we'll start the Estrace on Friday and work on building a nice thick lining for the next monitoring appointment in December. Scott and I are going to sneak a nice little Caribbean getaway in between to get some rest and relaxation in before I get called up for stork duty. We're now 2 weeks away from vacation, and I'm looking forward to a fruity drink in my hand and some sand in my toes. Here's hoping that the tropical sun will help clear my hormonally-induced pukiness.

Houston, We Have a Problem

As you may have guessed from my estradiol-induced grumpiness in my last post, Matt and Ellie decided to go ahead with the October transfer, so meds were started on September 16. I was very happy to hear from the nurse coordinator that we would not have to do Lupron in this cycle because it's a frozen transfer and we are starting so close to my own cycle day 1. I quickly learned that Estrace alone with no Lupron to balance it out did not love me. I have been irritable for the past 3 weeks straight - God bless Scott for putting up with me! But I can certainly put up with some irritability to get to our transfer and find the success that we've been waiting for in this stork adventure.

My first monitoring appointment to gather baseline information was on September 15. Ideally, we want to see a somewhat thin lining (2-5 mm) and little or no ovarian activity. My baseline for the August transfer was perfect, so I was hoping to hear the same at this one. Unfortunately, the ultrasound technician pointed out a follicle on my left ovary that was developing quite well, already 13 mm. A mature follicle will ovulate when it's grown to somewhere between 20-30 mm, so this one was well on it's way. As I've said before, this is a problem because we want to make sure that Matt and Ellie's bun is the only one baking in this oven. The number one rule of being the stork and not the mommy: DO NOT OVULATE (unless you do natural cycles and are into that kind of thing). The RE looked over the lab results later in the day, noted that the follicle wasn't producing high-enough amounts of estrogen on its own, and reassured me that the high-dose estradiol would stop that little booger from getting any bigger. So, like the first round, we all kept busy with work and kids while the days passed.

My final monitoring appointment before transfer was on October 1. Ideally, we would like to see a thick lining (8-12 mm) and little or no ovarian activity. However, based on the previous ultrasound, I knew that we would have some ovarian activity, so we hoped for at least no growth. I watched intently as the ultrasound technician did the lining measurements: 7.74 mm. Hmm, that isn't quite what we were looking for. Although she rounded it to 8 mm, my final lining check before the August transfer was 10.24 mm, so this one is considerably less, and borderline for what the RE wants prior to transfer. She then panned over my right ovary; nothing there, as expected, so on to the left one. I literally held my breath until she moved the transducer to the right spot, and the image was undeniable. She hadn't measured it yet, but that was one of the biggest follicles I've ever seen in real-time.
I started to ask questions so quickly that the words were getting jumbled. I knew that nothing good could come from this. It measured 25 mm, and she pointed out the haze on top of it that is indicative of imminent ovulation. So much for the estradiol stopping it from growing. Un-freaking-believable.

I called the nurse coordinator on my way out of the clinic to see what our options were. She didn't answer so I left her a message. I also sent Ellie an email of the findings. She had been worried about this exact scenario. We played arm-chair MD all morning and afternoon looking up all of the possibilities. We were both hoping that the RE would allow the follicle to ovulate and then transfer 5 days later in a quasi-natural transfer. I warned Scott about this; We have a live round in the chamber so he must not even make loving gestures in my general direction. When the nurse coordinator finally called back just before 5 pm, she told us that the RE had looked over the labs and found that my circulating hormone levels didn't match up with what they would expect for pre-ovulation, and that it was likely that the lining had already begun to breakdown. Not wanting to take any risks with the one embryo that Ellie and Matt have frozen, we had to cancel the October transfer and look ahead to the next opportunity. I stopped taking the estradiol that same day, and depending on when my cycle occurs naturally, we'll be able to put together a new medication plan for the next transfer. Without a doubt, the next one will include Lupron. That was the long, expensive, painful lesson that we all learned with this round.

Hormones and Needles and Tests - Oh My!

We've put another six weeks of the stork adventure under our belt, which was full of injections, pills, and anxious waiting. Of all of the parts of the process to date, this has been the most active in a day-to-day sense. From they day we left off of the last post, I've been on a constantly changing regimen of leuprorelin (Lupron), estradiol (Estrace), and progesterone in oil (PIO).

Now I'll be the first to admit that I can be a little OCD sometimes, and I take far too much pride in accurately following directions and doing a good job. But this ever-changing menagerie of dosages and drug combinations over a 4-week period is enough to make my head spin, and my subconscious constantly wonder if I took the right medications at the right time. To calm my inner Monica Geller, I found this nifty little pill organizer on Amazon, filled it with my oral medications for the upcoming week, then put dummy markers in each appropriate slot to remind me to do an injection on that day and time. The over-achiever in me beamed with pride.

It's probably time to address the elephant in the room: "How bad are the injections... really?" The Lupron was in a small insulin syringe with a tiny little needle (the small one in the picture). As long as the needle isn't dull in any way, you really don't feel it going in, and I really didn't feel the Lupron dispersing for the most part. The tough part about the Lupron injections is watching myself stab it into the skin. Even in the last few days of doing those, I would catch myself hesitating, hovering over the pinched skin, and have to talk myself into it. So all in all, the Lupron injections weren't terrible. The Lupron side-effects, on the other hand, were not as kind. I started with 10 units per day, and within a few days I had hot flashes and a slight headache. After a week, I was in a full-on battle against the INSANE weight gain, and I was noticeably slower in my thought processes. Lupron seriously made me dumber. By the time I stepped down to 5 units, I was in a hate-hate relationship with the drug, and threw myself a little party on the last day that I had to take it. That happened to also be the first day that I took the infamous PIO.

PIO gets a bad rap in the IVF world because it comes with (comparatively) HUGE needles, has to be delivered deep into the muscle, and is in oil - not a great solution for dispersion into the muscle. I read some great tips online from other IVFers before attempting any of the PIOs, and my dear, sweet husband, Scott, watched some very helpful YouTube videos with some professional tips. As most people recommend, I warmed the oil in the syringe to help it disperse once it's injected.

Buzzy Injection Pain Blocker

I also applied ice and vibration to the injection site for about 15 minutes. Ellie and Matt purchased a Buzzy for me to help with this part, for which I love them dearly! The rest of the work is Scott's to deal with. I place myself face down, he finds the right spot on my tush/hip, delivers the medication and does a wonderful job of massaging the area with the heating pad afterward. I've concluded that this is true love; someone that is happy and willing to rub my bum to keep it from hurting me the next day. What a catch. :)

Not all injections go according to plan, or with the luxuries of home, however. Shortly after starting the PIO, Scott and I had to attend an evening dinner party out of town, and we didn't have time to stop at the hotel to do the PIO injection first. Instead, I found myself with my pants dropped in the backseat of his pickup, because, well, you gotta do what you gotta do. While slightly more painful without ice or heat, Scott still did a great job, and I didn't end up with a bruise or a lump afterward. In fact, the only lump and bruise that I've gotten from the PIO injections came at the hands of our IVF nurse immediately following the transfer. Scott wasn't able to go with me, so she did the injection before I left the clinic that night. I knew it was going badly when I felt her pinch the skin instead of pulling it taut, and again at the end when she said "Wait here and hold very still. It's bleeding quite a bit, so I'm going to grab some tissue and a band-aid." I was thinking "BLEEDING??? Scott never makes me bleed!?" As I type, some 15 days later, I can still feel the distinct lump from that injection. If ever in that situation again, I think I'll take my chances and do the PIO on myself.

Did someone say "transfer"?? Ah yes, there was that exciting little event stuck in there in addition to all of the medication fun. :)  In fact, Matt and Ellie flew into town early in August to prepare for Ellie's egg retrieval. As we went through August, she had multiple visits to the clinic to check on her egg production progress, and I had two visits to ensure that the oven was fully pre-heated and ready to bake a sweet little bun. All of our appointments went great, and by the day of Ellie's retrieval, we were getting good news left and right. The RE ended up retrieving 9 eggs, 8 of which were mature, and all 8 fertilized into embryos through intracytoplasmic sperm injection (ICSI). We continued to be encouraged by day 3 when we learned that 6 of the 8 were still doing well.

On day 5 there were 5 excellent embryos, so Matt and Ellie decided to do preimplantation genetic diagnosis (PGD), and we pushed the transfer back a day to allow results to come in. On day 6, I traveled to the clinic in my lucky green shirt and my shamrock socks. I arrived with a full bladder as instructed, and was informed that the PGD results were not in yet. So I settled into the waiting room, only to find that the other woman in the waiting room was also a gestational carrier waiting for PGD results in order to transfer. We struck up quite a conversation over the 2 hours that we waited, trying to ignore the pain of the bladders that were ready to explode. Finally the results came in, showing that Matt and Ellie had 2 normal embryos from the 5 tested; 1 boy and 1 girl. We proceeded with the transfer of the best looking embryo of the two, and froze the other one. Thus began our intense wait.

Four days after the transfer I took a home pregnancy test, but nothing showed up. I retested on the fifth day after transfer and there was a faint second line - woohoo! Ellie and Matt were very encouraged to hear the news, while I was working hard to hold down my breakfast each day. Day 6 post-transfer brought the same faint second line, which made me a bit nervous. I was expecting it to get darker, but, as you all know, patience isn't my forte, so I chalked it up to being over-anxious to see progress. I tested again the next day, knowing that on the 8th day after the transfer we would have our first beta HCG blood test. The line was exactly the same as the previous two days, and as the day wore on, I felt less nausea than I had in over a week. I reported everything I knew to Ellie and Matt, so we were all cautiously optimistic going into the blood test. When the clinic called with the results of the blood test, it was only 2 mIU/ml, which is barely pregnant. If the pregnancy was viable, it should be have been above the single digits, so the clinic told me to stop all medications and allow my body to reset for a new cycle. Of course, Ellie and Matt were heartbroken, and I found myself in a combination of sad and mad at no one in particular. I was mad that we had all done so much work, did everything "right", received great news at every check point, and transferred a PGD normal embryo, only to have a failure on our hands. How does that happen!?!? The question is rhetorical of course, but that was the level of frustration that I had reached. I went home to tuck all of my medications and IVF supplies away in the closet, and found that Scott had brought me sushi, my favorite amber ale, and espresso ice cream to help me feel better. Have I mentioned that he's quite a catch? So Matt, Ellie, and I decided to Skype a few days later to discuss what happened and start to plan our next step. Based on our clinic's schedule, our options will be to transfer the one remaining frozen embryo in early October or mid-December. Regardless of which date is chosen, may the fertility odds be ever in our favor.

The Nightmare on Agency Street

What a very interesting few weeks it has been since my last check in here. After many more emails and Skype conversations with Ellie and Matt, I can confirm that they are outstanding people, and will be wonderful parents. I really look forward to the opportunities that we have to talk and catch up on how things are going in each other's lives. We are all starting to do the mental projections of time, how pregnant we will be when the next holiday rolls around, or what we'll do the next time that they come to town. It's all very exciting. What's not so exciting is all of the tedious red-tape that has transpired in the past few weeks, and we are very much looking forward to that part being over. As I left off of my last post, I surmised that we would have navigated the jungle of paperwork and be looking at some dates on the calendar for the IVF transfer. The great news is that we have a target transfer date - August 26. I'm thrilled about this, and even have my calendar of medications that will be introduced, ramped up, phased out, etc. as we approach the transfer date. I met with the parents' reproductive endocrinologist (RE) last Friday, contributed 5 vials of blood and a cup of urine, did an ultrasound of my uterus, and went on a magic school bus ride into my uterus to ensure that baby will find the accommodations acceptable. The RE determined that my uterine lining was a little over 10 mm, which is fantastic given that we were shooting for 8 mm or more. Moments after cheering about exceeding our lining goal, the full force of the 20 ml of saline that was injected into my uterus hit me. As the wickedly funny RE noted: That can be a real humdinger. I'm here to confirm his assessment: It was, indeed, a real humdinger. But, alas, everything went splendidly and looked great for the incubation of stork baby. Great news for our goals and the timeline that we have planned. We'll spend the next several weeks finishing up the contract, and I should start the first medication on July 24.

The less pleasant news comes from the jungle of paperwork, and the agency on the other side of that jungle. As you may recall from my previous entries, I started out on this adventure with an agency I really liked, and ventured into some independent communications in order to find the best possible match. When I found that match in Ellie and Matt, I had to make a decision between sticking with the agency that I had been working with or going over to the agency that Ellie and Matt had contracted. I felt like it was asking too much of them to switch to my agency, given the amount of money that they already had invested in deposits and fees with their agency. So as I dove into that jungle of paperwork, part of the enormity of it was in catching up on the information and documentation that they normally would have had pre-match, had I been working with them from the beginning. Although there was a lot of paperwork, Ellie and I had hoped that it would move quickly because the match had already been made, and a lot of the agency's work had been done for them. We would later find out that it did not come as a relief to them to do less matching work, but more of an insult, as you'll see.

We spent the first couple of weeks pulling basic items together like the application, consent forms for medical records release, an agency-surrogate agreement, information for background checks for my husband and I, and setting up the psychological evaluation. As the days passed, I checked in regularly with the co-director of the agency to ensure that everything was progressing in order to stay on target for the August transfer that we were shooting for. I was a little nervous when I found out after a couple of check-ins that the medical records hadn't been requested, and that they were expecting me to request them. But once I found out, I jumped on it, and got the requests faxed over to the clinics and hospitals.  I was also assigned a surrogate coordinator who contacted me to welcome me to the agency family. She was very sweet and bubbly, however, in her second email she made a statement alluding to a situation with my intended parents that didn't have a positive outcome. I was very uneasy about her sharing the information that I thought should come to me from Ellie and Matt, if they chose to share. I decided to avoid any further communication with her, as it seemed like it would only be filled with drama. At a later point in time, in one of our Skype calls, Ellie and Matt did share with me what had happened, and it certainly was not as big of a deal as was alluded to in the email. So we continued to move forward with our to-do list.

My husband and I had a great conversation with the psychologist that did the evaluation, and then we waited. About a week later, I checked in with the co-director to see if all of the records were in, the psychological evaluation results were in, and the background checks were complete. She said that everything was going fine. After another week passed, I got a call from one of the clinics that they hadn't sent my records yet, but were going to the next business day, so I checked in again to see where each of those items were in the process. The co-director responded that everything was fine and that I didn't need to worry about it, but I was a bit nervous about our timeline, given that one of the medical records hadn't been sent yet. I emailed back to say that I was frustrated because I hoping for a status update for each of the items to ensure that we stay on track for our timeline, and that a phone call may help to clear the air. I did receive a phone call, but it did not bring the progress that I was hoping for. She was defensive and demanding, so we came to a common ground and found a quick end to the conversation. The next morning I received an email from the surrogate coordinator that I hadn't heard from in weeks, asking how I was doing with all of the waiting that is involved in surrogacy. Her email was quite obviously prompted by the co-director, so I was frank in my response, saying that everything seemed to be moving along well, and that my only obstacle was in getting information from the co-director. Little did I know what a storm of anger and hatred that would incite!

The tone of the emails from the co-directors of the agency.

The next morning I received an ugly email from the co-director stating that she had removed the coordinator from my case and that she would be doing all of the communicating with me, then she proceeded to chastise me for asking questions and telling the coordinator that she was not responding to the questions that I had previously asked. She suggested another phone call involving the other co-director and the CFO, which looked to me like a verbal flogging was headed my way. Now I'm not one to try to rock the boat, and in general, I work hard to make peace, even in the most difficult of communications, but I'm also not one to tolerate being talked down to or treated badly. So in my response, I noted that I didn't appreciate the tone of her email, that I found it unprofessional, and that I would be glad to have a conference call so long as it was focused on a positive and productive outcome and didn't further deteriorate the working relationship. After several scheduling emails were exchanged, the other co-director sent me an ugly email about my lack of availability and being, in her opinion, overly involved in the process. She included several thinly-veiled threats of refusing to allow me to work with Ellie and Matt. All throughout this flare up of negativity, I was in regular communication with Ellie and Matt, who were completely shocked. They were also confused because the agency was giving them very limited information as to what was transpiring. I forwarded the last email to them, copied the co-director and simply stated that I thought that it would be a good idea for all of us to discuss this together and openly to improve communications. I was met with an immediate response from the co-director stating that I had been terminated from their program. This came as quite a shock and surprise to Ellie and Matt, who were beyond frustrated and exhausted at this point. They wanted to find a way to move forward with me and the agency, and I suggested that we modify our communications such that I didn't want to be in contact with either of the co-directors. Some communication occurred between them and the agency, and I received an email from the co-director stating that Ellie and Matt wanted to continue working with me, so the agency would need a HIPAA authorization form signed in order to move forward.

At this point, I had zero trust in these women, and now she wanted me to sign a form stating that they would have full access to all of my medical information, past, present and future, and that the information gathered could be re-disclosed at will. I was pretty sure that the co-director was getting ready for an awesome witch hunt to find a way to prevent this process from going forward. I decided that I would make a couple of minor changes to the form that would limit the scope of the authorization to the medical situation at hand. I emailed the co-director to ask how she wanted changes made, and she responded by demanding to know what changes I wanted to make and why. In the mean time, she communicated to Ellie and Matt that she would no longer work with them if they continued to use me as their surrogate. As this was the day before my appointment with the RE, it was uncertain whether or not the medical check was actually going to happen. I made the decision to complete the authorization form without limitations in Ellie and Matt's names only, allowing them free access to the information, and sent it in. They were in financial discussions with the agency and emerged to tell me that they had found a way to move forward, and to plan on attending the appointment with the RE. As of last Friday, when I saw the RE, he relayed that he had received an email from the agency stating that they were no longer working with me, Ellie or Matt. He reassured me that we would be fine in working toward the August transfer, regardless of the agency's involvement, which was a huge relief for me as well as for Ellie and Matt.

In the 6 days that have passed since that appointment, I have been working closely with Ellie and Matt to finish the details of the contract, and they have passed them along to the CFO at the agency. It appears that the agency is working with Ellie and Matt to complete the legal and financial aspects of the process, and I've been able to remove myself from their line of fire. I hope that they continue to work toward the goal that Ellie and Matt have put in front of them and paid them for, and I'm truly optimistic that the worst of it is behind us. My final thought on the agency from hell is this: I now have an even greater appreciation for the kindness of the agency that I started with, and hope to work with them again in the future.

There are many stories of unfathomably terrible experiences in surrogacy, of which, this pales in comparison. For that reason, I fully expect to see much greater legal regulation of surrogacy in the not too distant future. Surrogacy is becoming more common in the U.S. and abroad, and is a relatively unregulated market here with an overabundance of financial transactions closely tied to emotional decision-making: A recipe for disaster. I wouldn't be surprised to see the U.S. adopt legislation similar to Canada that prevents surrogates from receiving money or gifts outside of intended parents paying for directly related pregnancy and delivery expenses. From an ethics standpoint, I think it's likely necessary to keep the surrogacy market from entering a tailspin of ugly experiences with money and greed at the core of the motivation.