Wednesday, November 14, 2012

The Long Road

Often when we begin a surrogacy journey, we are very focused on the goal...a baby.  Everyone involved is very excited and anxious to be successful and create new life (or two) to bring into the world.  There is a lot of planning, coordinating and organizing that goes on for this very complex process.  The average journey takes 12 to 18 months, if there are no complications.  Most matches will experience some bumps along the way.  Wow...such a long time, right?  I have thought a lot about this and and have come to the conclusion that it is a short wait to start the amazing journey of parenthood.  Parenthood is permanent, there is no going back.  Having some time to focus on the initial steps and the patience that the process takes, is really good practice of more to come.  I have been a parent for almost 13 years, and a surrogate for over 5...patience is a very important trait to master.




With each match that is made, patience has come easier to me.  I understand that things will come up and we will work as a team to solve them and move forward.  The biggest challenge about this is that while I may have the experience, the intended parents and their surrogate do not.  It is my job to manage these potential road blocks and keep everything moving as smoothly and quickly as possible.  Some days this is a very easy aspect of my job, other days it is a challenge.  All of the experienced carriers that I work with have a favorite saying.  "Surrogacy is a hurry up and wait process."  A very simple saying, but it holds a lot of truth.  Ironically I find myself often encouraging baby steps.


I am a very optimistic person and I think it is very important to be a cheerleader for those I work with.  I know that there is a chance that we will run into obstacles, have a failed cycle, or other issues.  I am not going to focus on those because I believe is positive thoughts.  It does not mean that I am overlooking the negative possibilities, but I choose not to focus on them.  Many of the intended parents I work with have had a lot of negative things happen on their journey to parenthood, and it is my mission to help them have a positive experience.  We will cross each bridge together and take baby steps until we have reached our goal.

Tuesday, June 5, 2012

Fresh vs. Frozen

It has become more of a debate recently on the advantages of a fresh transfer vs. a frozen transfer.  Both have pros and cons, and it can be very challenging for some IPs to choose the best option for their cycle.



Historically, fresh has always been significantly higher in success then frozen.  Freezing techniques have improved in recent years, and vitrified (vs. slow freeze) embryos do very well.  There is also an inherent flaw in the statistics.  Traditionally the best embryos are transferred first (fresh) with the remaining embryos being frozen.  So we are not really comparing apples to apples.  Would we see a significant difference in success rates if we are evaluating comparable quality embryos?  In recent cycles, the answer would be no.  In fact, a majority of our frozen transfers have been successful (when using vitrified embryos).

Why would you choose to transfer frozen over fresh?  The answer...convenience.  It can be challenging to coordinate a surrogate and egg donor or intended mother on the same cycle.  Let's face it, we all have lives and finding the time can be near impossible for some people.  I have had this issue come up much more frequently the past year and a majority of intended parents have opted to freeze all the embryos for a future transfer.




Another advantage is knowing you have embryos to work with.  It can be stressful cycling a carrier knowing that their might not be any embryos to transfer at the end of the cycle.  By cycling the donor or intended mother first, parents have a sense of relief in knowing they have embryos banked.  There is the obvious financial advantage to this approach as well.

I think that no matter what any statistics say, fresh will always hold an advantage over frozen.  That being said, with technology improving, the margin will continue to diminish over time.  My advice to all of my clients is to choose the method that is best for you and your carrier, and sometimes frozen is the better way to go.


Thursday, October 6, 2011

Let's talk about eggs!

It all starts with an egg!  There are so many things to consider when starting a surrogacy journey, it is easy to overlook such a tiny thing.  Tiny, but amazing, and a very critical detail in the process.  For some couples or individuals, the egg source is a non-issue.  They are able to use their own or have a close friend or family member willing to donate.  Many intended parents do not have the luxury of their own healthy supply of eggs and need to rely on yet another amazing woman, who is generous enough to donate a handful of her eggs.



Choosing an egg donor can be a relatively simple or very complex process.  Everyone has different traits or characteristics that are important to them.  The more restricted the search becomes, the harder it can be to locate an ideal donor.  The first major decision is to match with an anonymous or directed (known) egg donor.  There are pros and cons to both options, but it is important to know how you feel about the choice before moving further.  I have worked with both types of donations and seen, first hand, how they both work amazingly.




It is generally faster and more cost effective to use a clinic based anonymous donor program.  This choice is good for many intended parents.  The main drawback is the lack of information about your donor.  You will know the stats and family history, but not a sense of personality.  You often are only allowed to view childhood pictures of the donors.  For some IPs, this is not enough information to make a choice.  For those, directed or known donation may be a better fit.  More recently, semi-open donations have become more popular.  This way IPs are able to see more photos, possibly speak to or meet with the donor.  They still may not know her last name or her identifying information, but they get to have a better sense of who she is.  The problem is that it is much harder to find women willing to donate under this arrangement.


No matter what route is chosen, it is important to be realistic with your expectations and during the search.  Once your egg donor is chosen, it is time to celebrate!  
Congrats and on to the next step.

Wednesday, August 31, 2011

What makes a good surrogate?

The magic question that is asked all the time, but it is difficult to answer.  The reason that it is so challenging to answer is because the right answer is different for each intended parent.  What makes a good surrogate for A does not automatically make a good surrogate for B.  Obviously there are traits and characteristics that are important for each potential surrogate to possess, but the finer differences of each person are just as important to factor into the big picture.



So there are a few items that are automatically needed to be considered...
  1. You must be between 21 and 40 years old
  2. You must have given birth previously (no more then 3 previous C-sections)
  3. You must have no prior pregnancy complications or early deliveries (prior to 36 weeks, with the exception of multiples)
  4. You must not abuse alcohol or drugs, including certain prescription medications
  5. You must be a non-smoker and reside in a smoke free home
  6. You must not be on public assistance, including medical benefits
  7. You must have reliable transportation and childcare
  8. You must have access to all your previous medical records (including labor and delivery)
  9. You will have to undergo medical and psychological screening (if you are married, your spouse will need to undergo screening as well)
  10. You will have to pass a criminal background check
    Have medical health insurance that covers pregnancy and delivery costs and that does not have a surrogacy exclusion (you will have to provide a copy of your policy and exclusions)


      So outside of these requirements there are traits that I look for...a love of pregnancy, a sense of compassion, a maturity about life and a realistic outlook about surrogacy and the commitment it requires.  Any experienced surrogate will testify that surrogacy is a serious commitment of time and effort.  The commitment is not only required of the surrogate, but of her spouse and family.  The responsibility is not one to be taken lightly.  IPs invest so much in their surrogate, financially and emotionally.  I can not forget to mention that an open mind and a sense of humor are undoubtedly a necessity!

Tuesday, July 12, 2011

Contract Time

One of the least favorite but most important part of any surrogacy is contracts.  It is generally a stressful time for all parties involved.  Even though most IPs and Surrogates want to get through contracts as quickly as possible, it is important to make sure everyone is protected and on the same page.  I have found success in the contract phase of surrogacy by making sure all key issues and financials are agreed upon prior to engaging the attorneys.  It is never a pleasant experience to have to negotiate through lawyers and it can be damaging to a very new and delicate relationship.


It is critical to go into the contract knowing that everyone is in agreement on major issues like selective reduction, termination, number of embryos to be transferred, financials, etc.  It is also very important to work with an attorney that you like and are comfortable with.


I have worked with surrogacy attorneys all over the country and have learned a great deal from each and every one of them.  It is reassuring to have a diverse network of experienced, educated resources available.  Signing and executing a surrogacy agreement is truly an occasion to celebrate.  It gives a sense of security and a reality of everything being official.  The next step after signing on the dotted line is always a favorite.....cycling!