More Discussions, More Decisions, More Waiting

 Spring Break is almost here! Another couple of months have passed in the life of this stork, and as usual, they have been filled with constant activity, decision making and change. When we last caught up, Ellie and Matt were in the process of grieving the loss of their second and last embryo, and I was in a state of uncertainty about where that left us on this stork adventure. A couple of weeks after my last post, the three of us sat down on for a Skype chat to discuss where we were at and what direction we were going. Ellie and Matt had a call with the RE earlier in the week and were able to ask all of the questions that they had to try to wrap their minds around how they got to this point. In my second-hand version of that conversation, it sounded like the RE told them that they were victims of bad luck. He told them that the success rate of PGD normal embryos is about 70%, and that he didn't see any reason for the two failures other than being unlucky enough to fall into the 30% group both times. He offered to perform a wide range of testing on me if it would make them feel more comfortable before the next transfer. I later was able to have a call of my own with him where he told me that he thought such testing would show that there's no definable explanation, but rule out any fears that they may have about my ability to carry. As I understand, the testing is quite expensive, but I told Ellie and Matt that I would be on board with any testing that they may want the RE to do. They told me that they wanted to take some time to consider all of their options. When they started this journey, they never imagined that it would take more than one transfer to get pregnant. When the first transfer failed, they were certain that the second one would succeed. So when the second embryo miscarried, they found themselves in a situation that they had not at all expected or planned for, emotionally or financially. They asked me if I was willing to wait a few months while they investigated other clinics and protocols, and saved some money for future retrievals and transfers. Later in the conversation, Ellie eluded to an estimated November or December transfer which was a bit longer than I had anticipated.

Afterwards, I was talking to Scott and wondering if I would go stir crazy waiting nearly a year for the next transfer. In the meantime, I received a call from my previous agency asking if I was currently working with any IPs and suggesting a couple that they would love to match me with. Omph! Here was a tough decision. I love Ellie and Matt, and want nothing more than to help them build their family. But as you know, I was not blessed with an abundance of patience. I decided that the best way to determine the next steps was to open the topic up to Ellie and Matt to see what they thought. I wasn't sure if they really were hoping for a December transfer, or wanted more time but were afraid that I wouldn't hang on for longer than that. I presented them with the idea of terminating our current contract and reactivating it when they are ready with 12-18 months in between where I could help another couple in building their family. After thinking about it for a while, Ellie let me know that she and Matt agreed that it would be a good idea for everyone if we went that route. Rather than terminating our contract though, we are amending it to be on hold until we reactivate it at a later date.

That brought me to a point of deciding which couple I would be working with. The agency had called me about a specific couple, but I really would like to work with a couple that is at the same clinic that Matt and Ellie use so that I don't have to repeat the medical screening and psychological evaluation. I also would like to work with IPs that have frozen embryos and are ready to transfer quickly. I found a couple that are very kind and sweet with 4 high quality PGD tested frozen embryos. My first instinct is that I would love to help them, but they are very set on their clinic on the East Coast. I dipped my toes into the water to see if their clinic would at least accept my medical screening and/or psychological screening from the previous clinic. They were not open to that, so I am a bit reluctant on this match, although I did send in my records for review with their clinic. As I understand it, their clinic is extra picky about the surrogates that they approve in order to maximize their success rates. This also makes me a bit reluctant in thinking that we could get a couple of months into this process only to have the clinic decide that they won't work with me for some reason. In the meantime, I connected with a set of IPs with 9 frozen PGD tested embryos at the clinic in TransferCity. I spoke with them over the phone and had a pretty good conversation. In the following week they were in touch to say that they would really like to match and move quickly, but only if I was willing to pay for expenses incurred at the IVF clinic because my insurance wouldn't cover them. I politely bowed out of the matching discussion and wished them well. This week, the agency called me to say that they have another couple that they would like me to meet. This couple is local, and we had a great phone conversation last night. At this point, I'm not sure if I'm leaning more toward the local couple or the East Coast couple, but I'm going to have to make a decision and go with it soon. I'm keenly aware that the longer the matching process takes, the longer the break is for Ellie and Matt.

To Be or Not To Be

That is the question on this very important day. Today is July 23rd; the last business day before July 24th, the all-important first day of cycle medications. This is the day that all paperwork must be completed by in order to be on schedule for the transfer on August 26. For all of you out there making bets on whether it would really get done and signed in time, the final answer is.... kind of.

A full 9 days ago, I optimistically hoped it would be done in 48 hours... and then the gods laughed and laughed and laughed. It was a week of little to no news, pacing, nail biting, calendar watching stress. The nurse coordinator from the IVF clinic emailed me yesterday nervously asking if it was done yet, and I passed along the anxiety in kind to my attorney to see if she had heard anything from Ellie and Matt's attorney yet. While there was no official response, the nurse coordinator went ahead with sending the medications, and we all slept uneasily on it for another night. This morning I received a somewhat panicked email from Ellie and Matt that they had received the final version of the contract and were ready to sign it, but the one and only representative from the surrogacy agency that has to witness their signing and notarize the contract, unexpectedly went out of town and won't be back until Monday the 28th. Did I mention that dealing with this agency makes my teeth itch? Regardless, we have the finished contract in hand, and that's a win all on it's own. In the meantime, Ellie and I came up with a plan where my husband and I will sign and notarize the contract today, send it back to the attorneys this afternoon, and then Ellie and Matt will have it in their possession while waiting on the agency rep to return, allowing them to execute their portion. This was agreeable to the nurse coordinator in terms of starting the medications tomorrow and will keep us on schedule. As I said 23 days ago: coo coo cachoo, we have a completed contract... kind of.

Now comes the fun (?) part. I'll be giving myself an injection of Lupron in the abdomen once per day starting tomorrow for the next 28 days. I've rationalized that it's a tiny little insulin needle, and I've built up a nice "protective layer" over my abs, so this shouldn't hurt a bit. I'll let you know how that goes. The Lupron is very important though, as it will quiet my ovaries and prevent me from releasing an egg of my own during this process. We want to be VERY sure that the only little storkie in this adventure is Ellie and Matt's! So tomorrow is day 1, the beginning of an exciting and highly anticipated stork adventure. Let's do it!

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.