Our blog has not been updated in many years...but we share it because it has some great information and resources.  If you have any topics you want us to cover, please just ask :) 

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.

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.

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.

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!

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!

Day 3 vs Day 5 Embryo Transfer

One of the most exciting moments of any surrogacy journey is the embryo transfer.  It is so amazing to be able to see your little embryos when they are only a few days old.  All clinics grade the embryos on a scale (this scale varies from clinic to clinic and often is a combination of letters and numbers).  Most clinics will share your embryos grades with you and explain why they are graded that way.  This analysis helps the RE chose the best embryo(s) to transfer.

Clinics choose to transfer on Day 3 vs Day 5 (some clinics Day 6) for many different reasons.  It is considered the most ideal to transfer on Day 5.  The philosophy is that the longer the embryos are grown in culture, the better the odds of choosing the strongest one(s) to transfer.  Some of the factors in the decision of transfer timing is the number of embryos, the quality of those embryos and the availability of all the parties involved.  I thought it would interesting to share a few pictures of some of Pink & Blue's embryos (those of our IPs).

The above photo is of two Day 3 Morulas.  They are graded fair, you can see the cells are even and there is no major sign of fragmentation.

The above photo is also two Day 3 Morulas.  One is graded very good and the other is fair.  You can see there are more cells in the lower embryo and it looks more even.

The above is a Day 6 Blastocyst.  It was graded excellent.  You can see it is just starting to hatch prior to transfer (unassisted hatching).  The embryo is expanded and even with a clear inner cell mass and a good trophectoderm.

The above are two Day 6 blastocysts.  One is graded excellent and starting to hatch (the right).  The second is starting to collapse prior to transfer.

The above is a Day 5 Blastocyst graded excellent.  You can see the same traits as above.  Expanded, clear inner cell mass and trophectoderm and no fragmentation.

The above is a Day 5 Morula.  It was graded fair.  There is some fragmentation, and it is obviously delayed in development.

The above is a Day 5 Blastocyst that was graded very good.  The inner cell mass was good, there was some irregularity in the trophectoderm.  

It is important not to put too much stock in the grading of your embryos.  I have seen picture perfect, amazing embryos that did not result in a pregnancy.  I have also seen less then ideal, poor grade embryos make the most beautiful babies.  Embryo grading is a tool used to help boost the odds, but it is limited and by no means a guarantee.  

POAS!

Answer Brand HPT

I know many of the POASaholics out there (myself included) are thinking to yourself...Finally!

Walgreen's Brand HPT (the dreaded blue dye)

For those of you who are not familiar with the lingo, POAS means Pee On A Stick (A.K.A. a home pregnancy test). Many women are addicted to this process and love to analyze every test.

Equate Brand HPT

Is there a faint second line?  What if I tilt it under the light?  Oooh, maybe I should scan it and invert the colors or tweek the colors.

Answer Brand HPT

Intended parents generally have different feelings on if they want to know about the HPT results or wait the dreaded 2 weeks for the beta test.  It is really personal preference, and most surrogates are very supportive and sensitive to their IPs wishes.

The beta test actually tells the amount of HCG in the bloodstream instead of just confirming the presence of the hormone.  Betas are usually run in a series (each test is spaced by 2 to 3 days).  The amount of the hormone is one component to the test, but the second is the growth of this number.  The general rule of thumb is that the number should double every 48 to 72 hours.

One of the many perks of my job is getting pics of HPTs, I have as much fun analyzing other people's tests as my own.

FRER Brand HPT

I thought it would be fun to share some of the pics that I have been sent for your viewing pleasure.  If anyone has any they would like to share, please feel free.

FRER

Internet Cheapies

Equate

The King of HPTs, the digital!

Note:  All of the above tests are positive and were confirmed by positive betas.

Let's talk about hormones

Let's talk about the good, bad and the ugly of Hormones.  Many Intended Parents, especially the Intended Fathers, have a lot of questions about the medications involved in surrogacy.  I thought it would be a good time to go over these (especially since I am seeing the light at the end of the Lupron tunnel).  The most frequent question is "Why does our Surrogate need hormonal supplement if she has a great pregnancy history?"
This is actually a very easy question to answer, because it is always the same answer.  To best explain, a biology lesson is needed.  Each month, when a woman ovulates, the follicle where the egg is expelled creates a small cyst.  This cyst secretes the hormone progesterone to support the pregnancy (if it occurs) until the placenta is large enough to take over around 7 to 8 weeks.  In surrogacy, we suppress the Surrogate's natural cycle and she does not ovulate.  Since she does not ovulate, there is no cyst to produce progesterone.  That is why the supplement is needed to sustain the pregnancy until it is far enough along for the placenta to safely support it.  Most clinics supplement until 10 to 12 weeks of pregnancy to be on the safe side.  Every clinic has a different protocol, they all use different medications, different doses and different calendars.  That being said, they all have the same goal.  Most protocols involve birth control pills, Lupron, estrogen and progesterone.  There are different ways to administer most of the hormones and it is important to work with the clinic to find the best option for each situation.

Intended Parents always ask why the hormones are needed, but the Surrogates always ask how they are administered.  The reason behind this question is because most women dislike needles.  It is almost impossible to do a medicated cycle without utilizing injections at some point, but there are ways to minimize how many are needed. Progesterone in oil is the biggest of the needles, it is a large intramuscular injection given once or twice a day in the hip/butt.  There are alternative to using PIO, there are vaginal suppositories and gels.  There is no needle involved with these options, but they tend to be messy.  Lupron is a daily injection giving with a small subcutaneous needle.  The injection is not very painful or intimidating.

The last important thing to note about hormones, is how they will make your surrogate feel.  It goes with out explanation that the medications will alter her mood.  She may feel sad, weepy, tired, hungry, moody, and angry.  Some women have very little side effects from the therapy and a few have severe side effects, but most fall somewhere in the middle.  The good news is that the effects are short lived (until the pregnancy hormones take over) and for a good cause.  It is important to be aware that your surrogate may be more emotional during cycling.  Acknowledgement of her feelings is very comforting during this stage of the process.

Team work!

On challenging days I am reminded how important team work is in the surrogacy process.  There are many levels of team work and they each are critical in making a successful outcome.  I think of the team as a pyramid.  Each level must be strong enough to support the next level.  The base is the intended parents, their relationship is the foundation and the most important.  If the intended parent is single, then their support network is their team.  The next layer is the agency and it is crucial for the intended parents to know they can trust and rely on their coordinator.  The third layer is the surrogate.  This layer is so important and it is the responsibility of coordinator to make sure the IPs and their surrogate have a strong working relationship.  Of course there are doctors, lawyers, escrow agents, family and friends on top of that.  As challenging as it can be to build a strong foundation, I see the rewards and benefits every day.  I would much rather put in the hard work and make sure that it is the right fit, then see it tumble down later.

Lupron = Grumpy

I have been wanting to post a new entry for a bit, but I have to be completely honest and say that the Lupron is making me totally grumpy.  I was going to wait for the effect to wear off and then post, but I realized that it is a part of surrogacy and I should share as many sides of this process as I can.  As much as I love surrogacy and enjoy being part of this amazing process, it does have some less then glamorous moments.  I generally handle all the bumps in the road well and do not think I am a complainer, but if you ask my husband right now, he might disagree.  He is being very supportive and labeling me as "sensitive", but I think he is being kind.  He is amazing and knows that this is a short lived side effect.  So I apologize for this lackluster entry, but that is all I have in me for today ;-)

Testing and Screening

Yippee....we are matched!  Now what?!?  That is a questions that I hear on a regular basis.  The testing and  screening phase is the less then fun part that falls between the matching and the legal phases.  After IPs have decided on a surrogate we move on to the screening.  This part can be a little complicated and hectic, but it is a very important step.  Every clinic has different requirements and testing required.  The first thing I do is check with them and get a list of what is needed.  Next, if the surrogate is not located near the clinic, we have to pick a location.  Depending on the situation, it may be best to have the surrogate travel to the main clinic for her testing, other times it makes more sense to use a clinic local to her.  There are several tests that seem to be universal among all the clinics, a saline ultrasound and FDA blood work.  The saline ultrasound is to evaluate the condition of the uterus and is a critical test.  If all the medical tests are passed we move on to the psychological assessment.  This requirement varies between clinics, some require personality testing while others just require a counseling session.  On the flip side all of the above tests (with the exception of the saline ultrasound) are also required of the intended parents.  It can be a lot to arrange and coordinate, but everyone is happy to graduate from the testing phase and move on to the next step!

Sending lots of Baby Dust and Sticky Vibes!!!

I love Spring!  It is a busy time with so much new life and growth, families included.  The next month is busy with egg retrievals, embryo transfers, and pregnancy tests.  I am so excited for all the potential and can't wait to hear the news of those + tests.

Step by step...

Surrogacy is a complex and intimidating process.  It can be overwhelming to consider all of the pieces involved.  Egg donors, surrogates, doctors, nurses, lawyers, escrow agents, psychologists, coordinators, intended parents, etc.  Whew, that is a lot of people to keep organized and moving along.  It is no wonder that most IPs have a panic attack once they decide to move forward with surrogacy.  What, when who, how???  All good questions running through their mind.  This is a moment I truly enjoy, when I am able to take them and guide them through the seemingly impossible maze and watch the relief and enjoyment from their perspective. They are able to savor their journey and release the burden that was weighing on them.  When they are holding their child(ren) for the very first time, I want them to look back on the whole journey with a positive light.  I enjoy the planning, organizing, scheduling, etc.  I can't imagine a better way to spend my days then helping amazing people grow their families.

Clinic Options

I have never put a lot of thought into the importance of clinic choice until recently.  I am shocked at how much variation is out there in clinic protocol.  I have worked with clinics all over the country and yet to see a real consensus between them.  There are major differences in who they will work with or deem eligible, the medications used and the dosage and duration, the way the embryos are created and grown, when and how they are transferred, how much they charge, etc.  For some IPs these factors are not important to them, they just want a great clinic with a good track record.  The details of how, what, where and when are a non issue.  For most IPs, the clinic choice is a really important detail, they want to pick the right clinic.  I am often a part of this choice and responsible for providing information needed to help IPs choose the right clinic for them.  I would say that cost, location and success rates are often the most important factors for IPs when choosing a clinic.  I think it is important for clinics to be accommodating in their scheduling, especially when we are working with so many active people in the process.  It can very complex and challenging to schedule and manage the intended parent(s), their surrogate, and possibly and egg donor and/or sperm donor (all of them most likely located in different locations).  I have come to have wonderful working relationships with many nurse coordinators and think that has had a very positive outcome on many of our journeys.

Renewed!

I just returned from a trip visiting my 1st surro-baby, S.  She is going on 3 and 1/2 and is an amazing little girl.  I was really excited for this trip for a handful of reasons.  I haven't seen her in awhile and was curious about how she would perceive our unique relationship.  Would she know who I was, would she understand about the pregnancy, would she be comfortable with me?  All of my doubts vanished the moment she greeted me at the door with a jump-into-my arms hug.  The huge smile on her face melted my heart and made me remember the very first time I met her parents.  I am thankful that I have such a wonderful relationship with my first set of IPs.  I adore them both and really enjoy the time I get to spend with them.  Our relationship has always been very natural and rather easy to manage.

I know that many IPs and surrogates do not feel this way about their relationships and struggle with the "walking on eggshells" tension between them.  I really believe that if you have a great match and it is managed properly, all those uneasy feelings disappear.  I am headed to visit my 2nd surro-baby, D, in a few weeks and feel like a I hit the jackpot.  I have an amazing relationship with her and her parents, and I am so happy to be a part of their lives.  I know they are grateful for the gift that I have given them, but I feel grateful to them as well.  They chose to let me be part of their lives and their amazing journey.  That is a huge honor to me, and something that I do not take lightly.  I think many people misjudge how many surrogates feel about surrogacy and the emotional ties.  It is a huge decision, but it is a mutual one.  When the relationship is mutual, it is balanced and often very successful.

Spending the time with S and seeing how happy she is and how well adjusted gives me a sense of pride and accomplishment that is hard to describe.  I certainly do not take credit for the person who she is today, that is all because of her parents.  Yet...there is a part of me that takes a little claim because she grew inside me and I nurtured her for those 9+ months.  Spending time with her also asserted my stand that children understand surrogacy better then adults.  The story of her pregnancy and delivery do not seem unusual to her, she has no predetermined sense of what a family should or shouldn't be.  I think that more adults need to keep an open mind about surrogacy and remember that if a 3 year can understand it, so can they ;-)

Balance

I am often asked by people outside of the surrogacy community how I am able to carry a baby for someone else.  I am also frequently asked how IPs can handle having a woman carry their baby and be comfortable with the situation.  I find that the easiest way to explain this unique relationship is that it is focused on balance.

I have yet to discover a situation where an extreme is a good thing and surrogacy is no exception.  Balance is a critical component to a successful journey.  It is not an easy task to under go fertility treatments and carry a baby for someone else, but it is equally daunting to have someone else carrying your unborn child(ren).  It is in this fine balance of emotions and logistics that surrogacy is successful and mutually beneficial.

Most, if not all, women who apply to be surrogates LOVE being pregnant.  There are many reasons women pursue being a surrogate, but this is always one of the main forces.  There is a "type" of woman that applies.  She is healthy and enjoys pregnancy and is not ready to be done with it even if her family is complete.  I have had more then one applicant tell me that she feels a little selfish because she is enjoying the pregnancy so much, that she feels too lucky.  Outside of the surrogacy community, it is hard to find someone who understands this pregnancy elation.  Many people, men and women, have told me that I am crazy to put myself through it and are beyond doubtful when I try to explain to them that I actually enjoy it.  I try promote awareness of the surrogacy community for the greater good, but I also just want people to think outside the box a little.

I can only imagine how difficult is must be to place your unconditional trust in a woman to "grow" your baby.  I see it every day, and it still amazes me on a regular basis.  It is my job to make sure that intended parents are provided with the best match possible, but it is always a huge leap of faith.  I have discovered many IPs begin this process have the philosophy to keep their eye on the prize and think about the end result...a baby.  Somewhere along the line, many IPs actually begin to enjoy the process and are able to experience the pregnancy and the joys it brings.

To be able to find the words to make a skeptic understand surrogacy is impossible, but to show them would be easy.  You can see it in the joy on any IP's face when they see their baby's first ultrasound or hear their heartbeat for the very first time.  To be able to share that with someone, to be part of that miracle, is indescribable!

Gestational vs Traditional

I am often asked to explain the differences and advantages of each type of surrogacy.  I try to be as honest and unbiased as possible, but that can be challenging at times.  Traditional surrogacy is when a woman is the genetic parent to the child and donates her egg in addition to her womb.  A gestational surrogate (or carrier) is someone who is not genetically related to the child(ren) they will be carrying, and only donates her uterus.

Not all agencies deal with both gestational (GS) and traditional (TS) surrogacy.  Pink & Blue does work with both, but the demand for GS is much higher.  It is hard for me to find reasons to guide IP(s) in the direction of TS, but there are situations where is is the best option.  TS is much more complicated legally and emotionally and has much more risk associated with it.  It also has a much more limited pool of women to offer their help, there are many more limitations with a TS.  When you utilize a GS you only have to evaluate her ability to carry your child(ren) safely.  When you embark on a TS journey, not only is she going to "grow" your child(ren), she is their genetic parent.  On paper, it is almost always best to choose the route of GS.  You are able to choose ideal components to ensure you best outcome for a successful and healthy pregnancy.  Most IPs that choose the route of TS are looking for a less medically invasive or mort economical route to having a child.

Only the intended parent(s) can make the decision and know what is the best choice for them, but it is my job to make sure they are aware of all of their options before doing so.  In both scenarios, the quality of the match is still a critical decision.

Organized and Flexible!

With each surrogacy journey I have come to appreciate these two characteristics more and more.  They are important for everyone involved in the process, and the more people involved the more important they become!  I find myself challenged, on an almost daily basis, to make sure to remind myself that surrogacy is a very fluid and dynamic process.  I try to reach out to IPs and be a source of support and a be a constant for them.  I want them to know that no matter the situation or changing circumstances, I will be there and that will not change.  I think this comfort can help them maintain the flexibility and accept everything as it comes at them.

Each time we begin to see the light at the end of the tunnel and the journey nears it's end, all the chaos and stress is always worth the end result.  The birth of the baby(ies) end the surrogacy journey, but start another amazing journey...Parenthood!  So in reality the surrogacy journey is an important tool and helps prepare IPs for the fluid and dynamic life as a mom or dad and helps exercise those important skills, organization and flexibility.

Families of all kinds...

Our society is overly focused on defining everything!  What I struggle with is who decides they are qualified to define anyone or anything.  I know that I feel comfortable deciding what is best for our family, but do not feel is my place to place these standards on other families.  I think these beliefs are reflected in our application process.  I am not asking intended parents to explain to me why they should be parents or even qualifying them as such.  It speaks volumes to me about someone just that they are preparing to embark on this journey.  Surrogacy can be emotionally and financially exhaustive, and if you are ready to start that journey...then you are ready to become parents.  Nothing in life is easy, having a family often falls into that category.  Instead of making these future parents bitter, they are driven to find ways to achieve their dreams.

Having a child never looks like a good idea on paper, they are expensive and extremely time consuming, (anyone with children reading this know exactly how much time and money is involved) and throwing surrogacy into the mix does not help paint a pretty picture.  What saves the day and our humanity is that children are the very best investment that we can make.  We can judge ourselves on how educated we are, how much money we make, how ofter we travel, but those are just a part of the puzzle.  The missing piece falls into place when you make that awesome decision to share yourself with a child.

There are all kinds of families in this world, how should we define them?  I don't think we should, that is what is so perfect about a family.  The only constant is that they are full of love.  We all need to remember this is how families are alike and not dwell on how they are different.