Under the Microscope

journeyThink of the most invasive question that someone could ask you… Now imagine ten pages worth of them.  Yep, I don’t think there’s a chance of ever repaying Jen back.

After our dinner together, I smiled and let Jen know that, guess what?? I already booked her an appointment to go to the clinic for literally the next week.

As it was her first appointment at the clinic, I wanted to go with her.  That meant she had to do a lot more planning than most for simple appointments.

Next came the forms… The clinic had handed me a form for Jen to fill out and bring with her to her first appointment.  I didn’t really look at much initially as we had to first sit down with each other to discuss all the logistics.  After the dinner, I actually had a look at the forms.  Ummm… Maybe I should have given her this thing right then and there.  It pretty much asked anything and everything.

I called her and warned her about the form.  Then I start reading the questions.  It started out innocent enough asking about her cycles- When did they start?  How many days do they last?  How is the flow?  For how long? Any pain?  What type of PMS symptoms, if any?

Then it moved on from there.  Us, being us, decided to fill it mostly out over the phone.  I’d BBM her the questions, she’d send back the answer.  The questions got more invasive the further through the form you got.  How many sexual partners in the last year?  Did any of them have an STI? Did any of them have a blood transfusion?  Did any of them do illicit drugs during this period?

How about you?  Do you use illicit drugs?  Do you, or have you been paid to have sexual relations with someone?  Do you, or have you exchanged goods for any sexual relations?  Do you smoke?  Smoke what?  How often?  Ever?  Where do you live?  Who with?  What type of water is your home one- city, cistern, or well?

The questions continued…  Most of which we just laughed at.  Seriously, if Jen was a closet prostitute or drug addict, I’m pretty sure I wouldn’t be asking her to carry our child.  But still, the fact that they ask all of the above means that someone, somewhere during this process answered yes to some of these questions… sketchy!

Back to Jen- Her pregnancies:  How long did it take for her to conceive?  Was she on any medications during the pregnancy?  How long did each pregnancy last? Any miscarriages? How long was the labour?  Vaginal or via C-Section?  With medications of without?  You get the picture.

Some of my favourite questions included, “Do you suffer from any nipple discharge?”  (Is that actually a thing?)  “Did the intended parents offer you any money or other goods in exchange for your services?”  (If I did, I don’t think she’d check yes… duh.  But no, fertility clinic, we are following the rules.)

The hardest part of the form was the section with basically a chart.  It had every medical condition or symptom you have EVER heard of and then had a chart to check off if you, your siblings, your parents, or grandparents had ever suffered from the following.  Well, the self, siblings and parents parts are easy… but add in a zillion questions involving 4 grandparents that you really weren’t intending on telling this whole story to until it was for sure, life gets a tad more complicated.

The chart was finally finished and we walked to the clinic the following week. We sat in the first waiting room chatting.  No one chats in the fertility clinic waiting room.  That is basically forbidden.  Screw it- we’d be through enough and I was breaking all of the unwritten rules.  We were just two best friends catching up on life.

We get called in and I stand up to go into the room with Jen.  The nurse kindly tells me that this was personal, and to wait in the waiting room.  Jen laughs and says, that I filled out most the form, so I can come.  Onwards we go into the little room waiting to be grilled.

The doc got there and asked a couple questions about who we were to each other, and how we got here.  He then said that we’d be going over a very detailed family, menstrual, sexual, health, and personal health history and asked me to leave.  Jen, again, said that I was more than welcome to stay.  I believe her comment was something to the effect of “If her baby is going to grow in me, then she needs to know what in this form too!”.  His eyebrow raised slightly, then said ok and we went over the entire form verbally.  Jen barely squirmed once under direct examination about her sexual and health history since the day she was born.  She deserved a medal.

Next he says is the pelvic exam- umm… Jen asked me what would be involved, I said just questions… she’s gunna kill me.  I winked and said that we’re close enough so I didn’t think I needed to see the inside of her uterus.  We agreed.  I waited back in the waiting room.

After a couple of minutes, and with everyone’s clothes back on, I got called back into the room.  They said that based on the information given today, they had a small concern about a family history item and that they wanted to refer her to specialist.  The theory here was that they wanted no additional risk put on Jen.  Fair enough, but we laughed that she had made it through 2 great pregnancies of her own…  Regardless, off to the specialist she was to go.

From there, the RE explained the process.  She was to do a whole pile of tests including a sonohystogram, a full panel of blood work, and day three blood work and ultrasounds to check on her hormone levels.  After all the above tests come back, along with the ok from the specialist, we could come back and review.  Then if she passed the test, we’d be on to step 2: the Pysch appointments.

I cannot believe this is actually happening!

My puppies.  They have nothing to do with this post.... but they do keep me sane. :)

My puppies. They have nothing to do with this post…. but they do keep me sane. 🙂

 

 

 

 

The Family Meeting

babyWell it’s official.  We are seriously thinking about surrogacy.

After our hearts stopped pounding, and we digested the ridiculous price tag attached, I felt this glimmer of hope.  Hope.  A word that I haven’t used to describe us in this situation for a very long time.  Hope that we will one day have a family of our own.

In our excitement after our appointment where we got approved, I got a little ahead of myself and actually booked Jen for a consult the follow week at the clinic.  She said she’s be interested in this… but it was technically pending a whole lot details getting sorted out first.  We called Jen and figured the best way to chat about this all was to meet and go over all of our concerns and questions.

From there a dinner date was set.  Milestones was the pick and we had about three days to try and compile all of the questions we could think of to discuss to make sure we were on the same page.  We had both done research independantly, but now it was time to sit down and actually work through how this would work.

We decided to make independent lists then go over them together at dinner.

Two days later, and one day before our dinner date, we had compiled all of the questions we could think of.  We scoured the internet for as much information and blogs to read about the process and the tough questions the clinic would be asking us.  I called Jen that night and told her our questions were done.  She laughed and said her were too…  We decided to exchange questions so that we could prepare and think about our answers before we actually met tomorrow.

It turned out about 90% of our questions and concerns were identical.  Ok good.  We are definitely on the same page.  Well, sort of.  We have the same worries, but we may not have the same answers.

I couldn’t sleep all night thinking about all of our conversations and trying to read what was really going through her mind.  I fully believed that she thought she was going to do this… but I kept waiting for the “it’s just too much” talk.  The very fact that she even offered to look into this is incredible… but the more we learned, the more complicated things got.  This was most definitely not just a simple offer.

I spent the entire day debating how tonight was going to go.  I called Dan even more than usual just to say hi and to ask him if he was nervous about tonight.  To him, this was like any other day.  To me, this was the biggest day ever!  I sometimes hate how nonchalant he can be about everything.  He just has this ‘everything will work out’ mentality.  I keep reminding him that so far, nothing has worked out.  But he still smiles and continues on.  When I don’t want to kill him for his continual positive outlook, I love him even more.

It was almost dinner and I started getting the butterflies in my stomach… I could not believe how nervous I actually was.  And more than that, I was internally freaking out that tonight was going to awkward.  Jen and I don’t do awkward.  In fact, I tell her everything- the good, the bad, and the very ugly.  But suddenly our friendship was about to be tested in the wierdest way yet and I almost felt it was a business transaction.

The three of us got a table and sat down together.  We ordered then both pulled out our lists… Jen and I expected that we would do all the talking.  But Dan, to our surprise, was right in there.  We figured, let’s do this.

We went down  our lists.  We started easy (ish).

Timing- what was she thinking? Did it matter?  Not really… she knew I didn’t want to wait another 12 years.

How many times do we try?  Three sounded like a good number. We could always change it later.

How many embryos do we transfer at once? One.  Less risky for Jen and the babies.

What doctor would we use (OBGYN)? Jen liked hers, but I want to deliver at the children’s hospital because of potential issues with a bleeding disorder.  We agree.  We’ll pick together but someone who works there.

Who would attend the appointments? We both agreed that we wanted it to be as if I was pregnant.  So if Dan would normally attend with me, then we’d both be there.

*Cue Jen nervously laughing here*… Uhhh, so I need to know.  Who will be in the delivery room- cause if Dan is, I need to start preparing for that now!  We laughed.  Yes, Dan wants to be there… if that works.  Dan pipes in- he has no plans to move from the head area.  Wonderful….!  LMAO

The questions continues with some basic stuff including life insurance, benefit plans, how expenses would work, how we’d like to pick lawyers, how the procedures would go, what medications did we think she’d be on etc.  I guess I shouldn’t have been that surprised.  We know everything about one another… and our answers were always on the same page.

I think the poor waiter got more than he bargained for if we was listening in on our conversations, but we just continued to fly through the questions and talk about all the logistics.  Insert a couple of hilarious and inappropriate jokes here and there… We were having a good time.  This was as far from awkward as could be.

We moved on to some of the harder questions.  The legality of everything.  We were well within the law doing this, but we also knew that once Jen gets pregnant, that any and all decisions about the baby were legally hers.  This brought us into difficult decisions.

Abortion- under what circumstances would we want to abort the pregnancy- Dan and I had had so many conversations about this.  All of the what if’s.  We knew that if something was wrong with the baby, it was still our baby.  We would have no intentions of ending the pregnancy.  We also knew Jen’s mentality was the same.  While this was a difficult conversation, it was an important one.  We all agreed that the only reason that we would consider termination of the pregnancy was if Jen’s life was in imminent danger.  Her health had to come first.  Ok, one hard one down… a couple to go.

Selective Termination- reducing the pregnancy if multiple babies- After the above conversation, we all knew we were on the same page.  We were only going to transfer one embryo, so the chances of multiples were very low, but we had to chat about it regardless.  Again, we agreed that the only way we would ever approach this was if Jen’s health was in imminent danger. 

Prenatal Testing- Dan and I knew that regardless of the results, we would want to go ahead and test the baby for potential issues.  Our rationale was that if we were to have a child with Down Syndrome, we would want to do the research ahead of time to learn as best as possible about our child.  Jen agreed.  But she was worried about the possible harm to the baby if we proceeded with an amniocentesis. This was something that she was not prepared to do.  To be honest, I think Dan and I, if we were in that situation, would need all the information we could get to make our decision.  But if this was her bottom line, this was not something that concerned us.  We respected this decision and agreed that under no circumstances would we proceed with an amnio. 

Ahhh… and my favourite.  Confidentiality- Who were we going to tell about all of this? I had just started writing my blog about a month before this meeting.  She knew that I was enjoying writing it and had an incredible out pouring of support from friends, family, and complete random people.  We decided that we would keep everything fairly under wraps until we actually decided that we were, for sure, going to be going ahead with this.  We decided that we wanted this pregnancy to essentially mirror exactly the same things that Dan and I would do if the baby was growing in my belly.  This would include belly pics and Facebook updates.  She was ok with this.  She was a little urked out by the idea of complete strangers knowing everything about her… so we decided to change her name on my blog.  This worked the best.  We agreed to a no-press rule.  Sounds silly, but as these things don’t happen all that often, they sometimes draw the attention of the media etc.  Nope, this was our arrangement- not something for entertainment. 

Dan was worried about what this might do to Jen and I.  We both laughed and said that was the lmarksast thing to worry about.  We’d been through some tough stuff, and we were confident that our friendship would make it through anything.  Jen wanted to talk about potential jealousy.  She had read a lot of blogs etc of woman having a hard time dealing with the other person being pregnant, not them.  I told her straight up that I hoped that wouldn’t be an issue- but at the first sign of turmoil, I’d be heading to counseling to work through everything.  We agreed.  We wanted to be as prepared as possible, but couldn’t anticipate everything.

After about two hours of laughing and joking about what we were about to get ourselves into, our dinners were finished, and so were our lists.  We had a good idea of the other persons concerns and worries… and felt like we were ok with moving one more step forward.  I told Jen about the doc appointment I booked and we made arrangements the following week to both go.

This was really happening….

 

 

Surrogacy 101

surrogacySurrogacy: my egg, Dan’s sperm, and Jen’s uterus.  Well… it’s a tad more complicated than that.

In researching surrogacy, we found that it is something that is vastly different depending on where you live.  In some places it’s completely illegal like in Italy.  In other places, it is illegal to take part in commercial surrogacy- when you actually pay the surrogate for her services- like here in Canada.  And in other places, both altruistic and commercial surrogacy is well within the law- like the USA and Israel.

So being in Canada, where commercial surrogacy is illegal, and altruistic surrogacy is ok, I was surprised to find out that dependent on your Province, different rules apply… More on that later.

However, this whole surrogacy thing is actually a lot more complicated than you could imagine.  So I thought I’d do a quick (?!)  run down on how it works for us, here in Ontario along with the costs.

 

Step 1: Be Barren. ($$$$- All the fertility costs up until now)

– check

Step 2: Find a Surrogate (Free if you find one yourself… unknown fees if you use an agency)

There are actually three main types of surrogacy in Canada.  A traditional surrogate is a person who would use their own egg, plus the intended parent’s sperm, and carry a baby to term.  The second type involves donor eggs and/or sperm with the use of the surrogate’s uterus to carry the baby to term.  The third, and most common type, is called a gestational carrier.  This is where the baby would be biologically related to the intended parents, and use a surrogate’s uterus to carry to term.  That’s us.

Now to finding a surrogate.  ha…  Well think for a moment, how many people do you have in your life that are willing to volunteer?  I would hazard a guess that the number is fairly small.  And wait a moment until you read the whole list below about what’s involved and then ask yourself again, would they still volunteer if they knew all of the below?

So in case you don’t have anyone jumping at the chance to put their life on hold, endure invasive testing and actually bare you child, well you do have options.  There are surrogacy businesses in Canada that assist in linking you to a person who would be willing to be a surrogate.  Now remember, these potential surrogates cannot be compensated for this (other than their expenses) so as you can guess, the number is quite small of people volunteering.  However, these types of amazing strangers (angels!) do exist believe it or not.

So now you have yourself a volunteer….  (Insert Hunger Games joke here about volunteering to be a tribute)

Step 3: Get Approved for Surrogacy by your Clinic (covered by OHIP)

It apparently isn’t as easy as just asking.  Because of the potential harm and risk to the surrogate, clinics in Canada aren’t jumping at signing anyone and everyone up to do surrogacy.  In fact, many clinics do not facilitate surrogacy whatsoever.

We were lucky that our clinic did.  Not something I looked into in my initial research for a clinic, but was very helpful in the end as we got to continue with the same doctors, medical team, and it was close (enough…) by.

I wrote previously about our clinic not being overly excited about approving us at first, however, we were approved at our next appointment and on we go.  Read more about that part here: One Step Forward, Two Steps Back and Hoping for the best, Preparing for the worst: The Clinic’s Final Decision

Step 4: Get your Surrogate Medically Approved ($$- Every test and ultrasound is paid out of pocket ~$2000)

A logical next step.  We need to ensure the surrogate is in good medical health and able to complete the process without any undue harm.  However, I was surprised to find out how much testing they do.

The clinic requires the a whole pile of blood work that tests for anything and everything including STIs, HIV, mineral and vitamin deficiencies etc.  Next up is the Day 3 blood work and ultrasound- tests done on the third day of the surrogate’s cycle to ensure that all the hormone levels are where they should be for Day 3.  Next is essentially a full physical including a pap smear etc.  With this appointment comes the longest and most invasive list of medical questions you could imagine.  Lastly, if anything comes up in that, then she would need to follow up with specialists for clearance prior to proceeding.

Step 5: Get your Surrogate and Yourselves Psychologically Approved ($$ – ~$600-$1000)

Yep.  Next step is for you and your partner to sit with a psychiatrist to determine if you are able to go through with this process.  It isn’t easy for anyone, but there are also huge social, moral, and legal implications.  Have we thought everything through?

Once that is passed, it’s your surrogates turn.  She gets to sit on the hot seat and have a psych doc evaluate her mental capacity to ensure she is up for the task.  One hour of answering tough questions about how, why, and what is about to happen.  If your surrogate has a partner, the partner must also be included and pass the above testing.

Once you and the surrogate have the official ok that as separate parts you are sane enough to move forward, you then have the final appointment- An hour session with all included parties to discuss how we feel about moving forward, how it will work, ensuring we understand each others needs and clarify that yes, we are sane.

Step 6: Legal ($$$$- Two laywers btw $5000 – $10,000 total)

Next up- find a surrogacy lawyer who will draft a surrogacy contract.  This is a necessary step required by the clinic prior to initiating any procedures.  This contract will clarify a bunch of the detailed information such as the maximum amounts for expenses, what the medical agreements are, how many embryos, how many tries, when would we terminate the pregnancy, when would we selectively reduce, what tests and pre-natal care is expected, who will attend appointments, who will attend the birth… etc etc etc

We draft the initial agreement with our lawyers.  The surrogate gets an independent lawyer to review the agreement with and amend as necessary.

We go back and forth until it is acceptable and protects both parties- then it is signed off.  The lawyers then confirm with the clinic that it exists and is signed off.  Giving the clinic the go ahead to move forward with any procedures.

Step 7: Get your Cycles Synced up and Review your Protocol ($$$- Admin fees NOT including medications here are about $2500)

In order to get your cycles synced up, the surrogate needs to start a birth control pill to allow the clinic to ‘control’ her cycle.  The pill is the same dosage each day and she needs to continue on it until told otherwise.  In the meantime, the intended mother (aka me) needs to get everything in order to start a new round of IVF to grow and get the eggs to fertilize.  Signing off of medical consents with the clinic happens here.

Step 8: Start synchronized cycles ($$$$- This would be a round of IVF for me and a round similar to Frozen Embryo Transfer for our surrogate PLUS medications, so for us it would be anywhere from $20,000-$35,000)

in vitroA normal process would look something like this:  Surrogate starts injections to put her cycle on hold (yep- she’s now stuck poking herself with needles too…), then incorporates estrogen pills (orally and/or vaginally) to try and get her lining to thicken up to receive the embryos.  In the meantime, I’d get started with injections to stimulate the follicles, take a shot to mature them, have them extracted then fertilized.  Wait between 3-5 days while the eggs grow and then transfer them into our surrogates uterus.

All well and good, but the timing has to be perfect.  The surrogate’s lining has to be a perfect thickness in order to take the embryos… which means the intended mother’s IVF cycle has to be carefully planned to coincide with it.  Which is going to be very interesting (to say the least) in our case.

Step 9: Pray it worked (Do I include the cost of anti-anxiety pills here??)

Wait for two weeks until beta day to find out of the embryos implanted… if not…

Do not pass Go.  Do not collect $200.  Begin again at step 7 and repeat.

If it works!  Congrats!!  Now you’re pregnant… well she is, with your kid.

Step 10: Realize that legally you have no say into anything during the pregnancy. (Cue anti-anxiety meds again)

In Ontario, once the surrogate is pregnant, the law considers it her child regardless of it’s biological origins.  So if the surrogate decides to take up whiskey, pot smoking and moves to China… We have no say.

Now you’d ask why we spent thousands on a legal agreement if it means nothing?  Well… because that’s the process.  And the process sucks.

We have to have an agreement to start, but the agreement really doesn’t mean anything once she is pregnant (it wouldn’t hold up in court as the fetus is legally ‘hers’).  The only thing it would mean is if the surrogate directly violated the contract, the intended parents could withhold the expense payments.  Woop-di-dooo

So this means if the surrogate so chose, she could abort the pregnancy at any time or selectively reduce the pregnancy at any time (aborting one or more fetuses if there are many for medical reasons for the children or mother).  You get the picture.  This next 9 months is where it is incredibly important that in Step 2 you found a good surrogate who you completely and absolutely trust.

Step 11: Expenses ($$$$ For us, capped at a total of $21,000 plus any lost wages capped at $14,000)

Now is the part where you cover the surrogates expenses incurred during the pregnancy. And so you should. The basis of this legal principle allowed in Canada is based on the fact that this person, who is carrying you child for purely altruistic purposes, should not incur any expenses as a result.

Expenses can literally include almost anything if it related to the pregnancy. The easy ones to think of are maternity clothing, mileage to and from appointments and check ups, pre-natal vitamins, and covering babysitting costs if necessary to get to appointments. The ones you probably wouldn’t think of are covering life insurance premiums (at a minimum coverage rate), any lost wages if the surrogate becomes ill and/or if they go on bed rest and/or during the delivery and recovery, house keepers to assist with house work if tired/ill, healthy food, gym memberships, massage, chiropractor, and pretty much anything else you could possibly imagine that could somehow be tied to pregnancy.

As you can imagine, this portion can get extremely expensive. Interestingly enough, the average for expenses for surrogates that are close with their intended parents versus those who are strangers are drastically different. And I imagine so… I don’t think my best friend is going to go on a crazy shopping spree with my credit card for thousands of dollars of maternity clothes. She will go and get what she needs, plus I’ll push her to get a little more. Same with a house keeper etc. This is the part of the legal contract that is actually helpful as it stipulates the maximums allowed that the surrogate can charge.

All receipts and payments to the surrogate needs to be kept and tracked. Our lawyer and others have noted that we will most certainly be audited when it comes to tax time, so keep track of everything. To date, no one has yet been charged under this specific law so the boundaries around what are considered ‘expenses’ has yet to be decided in court. We don’t really want to be the first case… so we are following the rules precisely.

Step 12: Legal… again. ($$$- Around $5,000 – $10,000)

At around 24 weeks gestation, you get in contact with your lawyer again. When it comes time to give birth, it is important that the Hospital know the information surrounding this agreement as well as who the biological parents are. The lawyer starts correspondence with the Hospital to ensure they are aware and on board with our arrangement. Additionally, we need to ensure that all medical decision making for the baby, once born, is at our discretion. Legally, the baby is still considered to be the surrogate’s- so we need to ensure that the Hospital is ok with the surrogate having the authority to make decisions about herself and the baby while it is inside of her, but once born, all medical directives for the child would come from us.  Complicated.  But important.

heroStep 13: Have the baby. (OHIP covers the costs of the birth the same as any other in Ontario)

Suddenly the birth process sounds so easy, doesn’t it?

Here is the part where you surrogate actually endures labour and gives birth to your child. Yep, as I mentioned before. She’s an angel or a super hero.  Or both.

Step 14: Who’s baby is it? ($$- Legal fess cover off some of the above but you also need to pay for DNA testing etc)

Legally, until proven otherwise, it is the surrogate’s baby. We would initiate DNA testing of the child, the intended parents, and the surrogate to get confirmation of the biological origin of the child. This takes a little bit of time to send off and then receive the results. In the meantime, you cannot register the child’s birth as registering him/her in the intended parents names isn’t allowed, and registering him/her in the surrogates name would be false. And so you wait…

Step 15: DNA Results are in! Now off to court…!? (Covered in the legal expenses referenced above)

Once the DNA results come in, the lawyer now has to prepare what is called a Declaration of Parentage. This is a formal procedure in which the lawyer presents our situation to the judge along with the surrogacy contract and DNA results and petitions the court to put the intended parents (us!) names on the birth certificate. This normally happens in a closed door session in front of a judge.

The second step to this is a Declaration of Non-Parentage. This is sort of the opposite procedure. In Ontario, believe it or not, it is legal to have more than two persons names on the birth certificate. So adding our names would mean that it would now be listed as the surrogate plus us. We then have to provide the court with the above declaration to get the surrogates name off the birth certificate so there is no further legal link to the child.

Congratulations! You now have a baby AND the law recognizes that s/he is yours!

Now time to register the birth and celebrate.

Oh… and explain to the world that even though you didn’t have a baby bump, the baby is actually yours biologically.

Step 16: Have the Gov’t Screw you Again ($$$$- Cost of my top-up benefit and EI for ‘maternity’ portion of your leave from work.

Because I didn’t actually give birth to the child, I am only entitled to receive gov’t assistance (read: Employment Insurance) for the parental leave portion of the year (37 weeks). I can choose to take a full year off work, however, I do not receive anything for the ‘maternity’ (15 weeks) leave portion.

This has actually gone to the uppers courts previously as it was challenged that this is discriminating against those who are unable to bare children (cause it sure is… Haven’t we been through enough?  Since I can’t bare children, and you already won’t pay for me to try to have them, you then won’t give me the same benefits as a birth mother.  Nice). The court rules that the maternity portion is specifically for recovering from childbirth, it is the parental section is for raising the child.

To add insult to injury, my job allows for maternity/parental leave ‘top-up” to top up my salary to a percentage during my leave. However, the language reads that it will top-up the difference between my EI and my wages (to a percentage)  … So if I don’t get EI, I don’t get top-up.

But hey, I’ve got the child of our dreams- so I guess I’ll focus on the bigger picture.