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by Robin von Halle

A recent New York Times article highlighted the difficulties faced by tennis star Gigi Fernandez after she discovered a long and rigorous tennis career had left her infertile. Her athletic accomplishments are impressive, but she admits that she was selfish as a young athlete, ignoring signs that her body was being affected by her intense training. Excessive exercise can lead to ovulation dysfunction, something most women ignore but a sign that their fertility could be affected.

Compounding the issue was Fernandez’s age. Pro athlete’s most fertile years are often spent focusing solely on their careers, and thoughts of future spouses and families are pushed to the wayside. After retiring at 33 Fernandez finally met the perfect partner, golf star Jane Geddes, but waited five years before deciding to have a child. Now in her late thirties, the odds were against her.

Seven unsuccessful fertility treatments and two failed adoptions later, Fernandez and her partner Geddes felt defeated. Luckily for them, hope came in the form of a friend who offered to donate her eggs. In early 2009, Fernandez and Geddes welcomed twins into their family, but it wasn’t without a struggle.

Fernandez is far from the first women to struggle with infertility after a successful athletic career. Olympic ice skater Nancy Kerrigan was able to give birth to a son after six miscarriages. Olympic swimmer Dara Torres went through IVF and artificial insemination but was unable to conceive and became a spokeswoman for American Infertility Association.

Where many women go wrong is neglecting to realize the effects of age on fertility. After age 35, a woman’s ability to conceive begins to decrease. After 40 it drops severely. More and more women are focusing on their careers, athletic or not, and putting off starting a family. Unfortunately, nature doesn’t wait for a successful career. I hope hearing stories like these will alert more women to the risks of waiting too long to start a family.

Fernandez’s advice to young women is to start planning for motherhood in their 20s, when fertility problems are much more rare. I couldn’t agree more.

We love to see positive stories about the joys of surrogacy because far too often the media focuses on the less common negative ones. In this heartwarming video, Gina Scanlan shares her experiences as a gestational surrogate for two couples.

Part 2: fertility drugs, synchronizing the cycles and pregnancy.

By Mary Ellen McLaughlin

Once a candidate passes the psychological screenings and physical exam and has chosen her intended parents, she is ready to get started on actually becoming a surrogate. Medically, there is a lot to learn, and that can be scary if you don’t know what’s coming next.

The first step in this stage is the hysteroscopy (HCG), which is a visualization of the uterine cavity through a thin scope inserted through the cervix. This determines the shape and size of the uterus and whether the fallopian tubes are clear. She also goes through a series of infectious disease testing. This is done to ensure that all parties are clear of transmittable disease such as AIDS, herpes, hepatitis, etc.

Once the tests come back, the surrogate is ready to go through a mock cycle, which puts her on the same drugs that she’ll be on for the real transfer (except Lupron), so her physician can check her uterine lining’s response to estrogen replacement. The doctor also performs a trial transfer, where the angle of the cervix and the length of the uterine cavity are measured. This determines how far to insert the catheter loaded with the embryos for exact placement.

If all goes well, the surrogate and intended parent/egg donor synchronize their cycles using birth control pills. About 14 days into this stage, both the surrogate and intended parent/egg donor usually start taking Lupron, a hormone that dramatically lowers estrogen levels. (Check out our March post on terms it’s helpful to know.)

The surrogate is typically about a week or so ahead of the intended parent/egg donor to ensure her uterus will be ready when the eggs are retrieved and fertilized.

When the surrogate’s menstrual cycle starts while on Lupron, her Lupron dose is normally decreased by half and she starts adding estrogen replacement to the mix (in the form of pills, patches, or shots, depending on the doctor). Some doctors prescribe other medications as well (Dexamethasone to suppress male hormones to increase implantation, antibiotics to guard against any infection that might have gone undiagnosed, etc.).

The retrieved eggs are fertilized with sperm from the intended father/sperm donor and incubated for two to five days. The surrogate’s Lupron injections stop the day before egg retrieval. Progesterone replacement starts the day of the retrieval and continues until the 12th week of pregnancy or a negative pregnancy test. Estrogen replacement also continues until the 12th week of pregnancy (when the placenta takes over hormone production). Because the surrogate was on Lupron, her natural hormones were suppressed. She will need external sources of these very important hormones in order to maintain any pregnancy that occurs.

When the fertilized embryos are at the proper stage, they are loaded into a special syringe with a thin flexible catheter at the end. The catheter is inserted through the cervix into the uterine cavity where the embryos are “injected.” Most doctors will only transfer three to four two-day-old embryos or two five-day-old embryos. Any unused embryos are frozen for future use if a pregnancy doesn’t result from the fresh cycle. The surrogate is then put on bed rest. Some surrogates are on bed rest a couple of hours following embryo transfer. Others have been on bed rest for up to three days.

A quantitative HCG, in which the amount of pregnancy hormone is measured, is usually done 14 days after the egg retrieval. At that time they are looking for the HCG level to be 50 or higher. Anything over 200 is indicative of a multiple pregnancy. The surrogate will have a second quantitative HCG test two days later to verify that the pregnancy hormone numbers are going up (they should double about every two days). If the quantitative HCG is negative, all external hormones are discontinued and a menstrual cycle starts within five days.

If a pregnancy has occurred, an ultrasound is usually done at six weeks to check for a heartbeat, and again at 12 weeks before the surrogate is released to a regular OB/GYN. During this time, hormone levels are checked several times to ensure that the proper levels are being maintained for pregnancy. Once the placenta starts taking over the hormone production, the surrogate is weaned off the hormone replacements.

The rest of the pregnancy would be the same as any other pregnancy.

This is a long process and can take up to two years to complete from start to finish. But once you see that the new parents hold their child for the first time, everything you have done instantly has a greater meaning.

Mary Ellen is the Surrogacy Spotlight’s featured expert of the month! If you have questions or are looking for more information about surrogacy, visit http://www.facebook.com/surrogacyspotlight.

By Jodi

I was recently the proud surrogate of two wonderful intended parents who happen to be gay. For me it wasn’t a decision of whether I should carry for a gay couple or not. They are both marvelously Caring and compassionate people, and I know they will be great fathers to their twins.

I feel very strongly about equal rights, and I hate that it’s so hard for gay parents to adopt. When I decided to become a surrogate, both my husband and I had stated that we were open to carrying for a gay couple. When we were almost immediately matched with one, I was excited but also nervous. I wanted to like them, but I wanted them to like me too.

The moment my intended parents walked into the room at Alternative Reproductive Resources, one of them cracked a joke and I knew we were going to get along. They were both very respectful of me and told me that because it was my body, they would let me make any decisions regarding my health and pregnancy. We knew right away that this was the right couple for us. The fact that they were two men

instead of a traditional couple wasn’t even a factor.

A son, a daughter and a year later, I have to say that my surrogacy was perfect. Every step was easy and I couldn’t have asked for better intended parents or friends. The hardest part about leaving the hospital after giving birth was leaving the guys. I can’t say that I will ever be a surrogate again, but thanks to these men, I would do it for them all over again.

Jodi is The Surrogacy Spotlight’s featured surrogate of the month! Visit http://www.facebook.com/surrogacyspotlight to ask her questions or find out more about her journey.

Last week, two surrogates won their battle with their insurance companies when the Wisconsin Supreme Court unanimously ruled that insurers cannot deny benefits to pregnant women based on their reasons or methods of becoming pregnant.

It’s an important step forward for surrogates in Wisconsin, but women in other states aren’t so lucky. Most surrogates are still denied benefits during their pregnancies.

Most insurance policies have an exclusionary clause regarding reproduction or maternity, which denies any benefits related to a surrogate pregnancy. Most policies also include a one-year waiting period from the time coverage begins before a woman can get pregnant and receive benefits.

It’s an issue. More than 90 percent of the surrogates we at Alternative Reproductive Resources work with are not covered by their own policies. And we’re seeing more and more exclusionary language in insurance policies, regardless of the state.

Ideally, we’d like for gestational surrogates to be able to use their own insurance policies during their pregnancies. More often, the policy excludes any treatments related to surrogacy. The intended parents become responsible for medical costs when a surrogate isn’t covered and usually have to purchase an individual policy for her. Several companies offer policies specifically for surrogates, including New Life Insurance, but the policies are extremely expensive and can cost anywhere between $35,900 and $47,900.

It seems insurers still have a long way to go when it comes to covering surrogates. Our attorney, Nidhi Desai, who specializes in fertility law, understands that insurers feel they can exclude surrogates because they receive financial compensation. From a legal standpoint, however, she thinks it’s unfair. “I think it is very important to focus on the principle of the matter, that pregnancy is a health condition, period,” she said.

The ruling in Wisconsin leaves us with some questions. What does this mean for other states? Will others follow suit, and when? There’s no way to know for sure but it’s certainly encouraging to see changes taking place. Federal healthcare reform has also been heading in the right direction with the Affordable Care Act that guarantees coverage to those who have been denied because of pre-existing conditions. The act hasn’t had an effect on surrogates yet, but nationwide changes could be on the way as well.

by Mary Ellen McLaughlin

Fox’s wildly popular “Glee” tackles many controversial topics, most recently, surrogacy. One of the main characters, Rachel Berry, is an aspiring Broadway star and the daughter of two gay men. Her birth was made possible via a surrogate named Shelby Corcoran. The storyline is that Shelby was not just the surrogate but also the egg donor for Rachel’s gay parents, making Rachel her biological daughter. Sixteen years after giving birth to Rachel, Shelby regrets the contractual agreement that prevents her from meeting or speaking to her daughter. Meanwhile, Rachel has been longing to find and meet her biological mother as well.

While this complicated tale makes for great TV, it is far from the reality of a typical gestational surrogacy journey. Gestational surrogates are not biologically related to the child they carry.

Shelby’s surrogacy would be considered a traditional surrogacy, where the surrogate uses her own egg and artificial insemination to become pregnant. However, with as in vitro fertilization has become a standard in fertility treatment, so has gestational surrogacy.

Gestational surrogacy ensures that the surrogate is not related to the child through the use of unrelated egg and sperm, either from the intended parents or other donors. If a traditional surrogacy is used and the surrogate is biologically related to the child, she has legal parental rights if she changes her mind about surrogacy.

Stephanie Eckard was a traditional surrogate in Florida, where her verbal surrogacy agreement with the Lamitina family was viewed as an adoption, where Stephanie could decide to keep the baby until 48 hours after the birth. She changed her mind about the surrogacy a few months into her pregnancy, and the Lamitinas had no claim to the child they’d asked Stephanie to carry for them.

ASRM guidelines for surrogacy also state that surrogates should have already given birth to a child. Shelby doesn’t seem to have any other children on the show, making her a highly unlikely candidate for surrogacy in real life.

Another discrepancy between the “Glee” take on surrogacy and real surrogacies is Shelby’s motivation for becoming a surrogate. A desperate young Shelby, who needed money to fund her dream of becoming a Broadway star, decided the pay for nine months of pregnancy was too good to pass up. In reality, most women who become surrogates don’t do it for the money. They are already mothers of their own children, have stable family support systems, and often know someone who had problems with infertility. They are typically motivated by the idea of helping someone realize their dream of becoming a parent, or simply enjoy pregnancy and don’t mind carrying an unrelated child for another parent.

The moral of the story is, of course, that you can’t always believe what you see on TV. Surrogates are far more often mothers who want to help others create a family than aspiring Broadway singers looking for cash.

By Robin von Halle

Surrogates are unusual women who selflessly carry a child to term for someone who cannot otherwise do so. They endure psychological counseling, fertility treatments, pregnancy cravings, swollen feet and more, all with a smile on their face. The end prize: happy families that they help create.

What these surrogates don’t have much of is a network just for them.  A place to go when the hormones are raging, to question other surrogates about the legal process or just to express how they’re feeling after the baby is born.

Alternative Reproductive Resources has created and is sponsoring an option for this community. “The Surrogacy Spotlight” is a Facebook community for current surrogates, women thinking of becoming surrogates, and surrogacy experts. To join, go to: http://www.facebook.com/pages/The-Surrogacy-Spotlight/133621049988224.

We know there are plenty of great surrogacy forums online already, but many of them seem to be a location where intended parents go to solicit them. The Surrogacy Spotlight is just the opposite.

It’s a place to meet other surrogates going through the same experience. It also gives women thinking about becoming a surrogate a chance to ask questions to see if it’s right for them. It’s a place to express their, joys, fears, frustrations, pregnancies, births and more.

If you are, have been or are thinking about becoming a surrogate, please join The Surrogacy Spotlight as a fan, and we hope you’ll recommend it to others in your network who might be interested. (http://www.facebook.com/pages/The-Surrogacy-Spotlight/133621049988224).

In addition to welcoming your comments and observations, we’ll have two special features. Each month, we’ll have a Surrogate of the Month and a different surrogacy expert.

Starting Tuesday, July 6, our Surrogate of the Month will be Jodi, who recently gave birth to twins for two wonderful intended fathers. She will share her surrogacy journey and take questions from you throughout the month.

Our expert will be Mary Ellen McLaughlin, an ARR partner and former nurse who works with surrogates. She’ll discuss the psychological and medical aspects of the experience. Future experts will include attorneys, psychologists, physicians and more.

We have been working in the fertility field for more than 15 years, and understand that having an outlet to help get you though the process is therapeutic. We trust The Surrogacy Spotlight will do just that, and welcome your involvement to ensure it happens.

This is a Feed Post from Conception Connection, the blog for Alternative Reproductive Resources.

by Carin

I was devastated but decided that it was time to be practical. We sat down with the doctor to discuss options. Option 1: try another cycle with my body. Option 2: find a surrogate to implant the donor eggs into. Option 3: adopt. I decided option 1 was out. I was terrified of another miscarriage. I didn’t know if I could handle it emotionally. Adoption was an option but there was the matter of the six remaining embryos. We decided to try the surrogacy route.

We contacted the same agency that had found us the egg donor and they went to work looking for a surrogate. We were told that it was sometimes difficult to find a surrogate in our home state of Illinois, so they also looked at all the bordering states. Meanwhile, yet another cyst had been slowly growing on what remained of my right ovary. By mid-summer 2008, it had reached eight centimeters and needed to come out. The agency called us in August telling us they had found a surrogate for us in Nashville. We hemmed and hawed and finally decided that it was too far. I wouldn’t be able to make it to all the appointments; if she delivered in Nashville there was the chance of having to go through the adoption process to take the baby out of state. And if she delivered in Illinois then we would need to put her up in a four-star hotel for up to a week before the delivery. We grudgingly let her go hoping that something else would come up.

Then there was the matter of this growing cyst. I had decided after the last surgery that if they needed to go in again, they might as well just take the rest of the ovary out. It wasn’t like it was helping me at all. Whatever eggs may have been left were worthless and I didn’t want to have to deal with a fifth surgery. My husband joked that we should get a punch card saying that if you have four surgeries you get the fifth one free. After speaking with my gynecologist, RE and GYN/Oncologist, it was decided they would do a sub-cervical hysterectomy. They would remove the right ovary and tube, as well as the uterus but would leave in the cervix. The surgery would put me in surgical menopause at age 36. My doctor told me that I would not need hormone replacement treatment unless the menopause symptoms were unbearable. Ironically, the replacement hormone they would put me on – birth control pills!  Someone out there has a warped sense of humor.

On September 15, 2008, four years and seven months after deciding it was time to have children, my doctors removed my last chance of ever getting pregnant. The dream was over. It’s funny, because I didn’t feel sad.  I didn’t feel empty.  The only thought on my mind was finding a surrogate who could help us start a family. Was she out there? If she was, then where the heck was she? I needed to find a surrogate…NOW.

This is a Feed Post from Conception Connection, the blog for Alternative Reproductive Resources.

By Carin

In January 2007, I started the process for IVF. For those of you who have not yet gone through it, prepare yourself for the emotional roller coaster of all time. I learned how to do the injections and my husband enjoyed getting his revenge for my hormone-induced craziness by jabbing me in the butt with the gigantic progesterone needle. I think that was the highlight of his day! I did everything right but only was able to generate a few follicles. They converted my IVF attempt to an IUI. Again, no luck. Undaunted, we tried again with a higher dose of stimulation drugs. This time I had four nice-sized follicles so they went ahead with the retrieval. When I came to from the anesthesia, I was told that of the four follicles, only one produced an egg and that egg failed to fertilize. My body had failed again.

After discussing with my doctor, it was finally decided that we would switch to an anonymous egg donor. Keep in mind that my husband and I discussed and argued this thought over and over and over again. He wanted to do adoption so we would be guaranteed a child. I wasn’t ready to give up on pregnancy. So he gave in and we agreed to try egg donation first. We signed up with a wonderful agency that found us a donor right away. The agency described her as an “über-donor” because in previous donations she had produced two sets of twins. Look no further, this was the one for me!

We got a lawyer and signed all the paperwork for the donor contract and then she started her stimulation. Since she was young and had healthy eggs, she responded great to stimulation. They retrieved a whopping 20 eggs. Of those, 19 fertilized. That’s 95 percent for you math people out there! Of those 19, 10 were viable embryos. We were set. In October 2007 I went in for a transfer. They put in two embryos and told me to go home and rest to allow them to settle in to their new home. After an agonizing two weeks I went in for the pregnancy test. Negative. They transferred another two in February 2008.  Success! However, the nurse cautioned that the numbers were really high which could mean twins or a possible ectopic pregnancy. I waited as the numbers went up, then leveled off. The pregnancy was not viable. The numbers started dropping. My body had failed again. Not even with perfect embryos could my body handle a pregnancy. How many more times do I have to go through this?

This is a Feed Post from Conception Connection, the blog for Alternative Reproductive Resources.

by Carin

Now, I am a firm believer that everything happens for a reason. When people look sadly at me because I can’t have kids of my own, I still tell them how lucky I am. I have a wonderful husband, an incredibly supportive family, wonderful friends and, despite the surgeries, I am in excellent health. Even with the infertility stuff, I was grateful to have insurance to cover most of what was needed. I also truly believe that fate waited until I was ready to give us the greatest gift. One week after my surgery I got a call from the agency. They had found us another surrogate. This one was in Illinois and lived in the south suburbs of Chicago. She was promised to another family who had backed out due to financial reasons. The agency had already set up a meeting for Friday (we got the call on Wednesday) and didn’t want to have to change it. Of course I still couldn’t drive and my husband had already taken a lot of time off work. I frantically called my husband and told him that he needed to take another day off because this could be the one. Luckily, he had a very understanding boss who let him go for the afternoon.

Meeting this woman and her husband were like a dream come true. There I was, shuffling along, one week after another “C-section,” clutching my little pillow to my abdomen, sitting in a conference room listening to a woman tell me that she may be willing to carry my child. After the meeting, we were each told to go home, talk it over and to let the agency know within 48 hours if we accepted each other. We didn’t even make it home before we called the agency and told them an exuberant YES! The other couple waited until the next day but they were as impressed with us as we were with them.

After a bunch of legal mumbo jumbo that is very important but not necessary to rehash here, we were ready to start her on the stimulation drugs. In February 2009, two embryos were transferred into our surrogate. Two weeks later, almost exactly five years from the date of my first pregnancy test, we got the news that it had worked. She was pregnant. Of course she was ecstatic (as we were five years ago) but we knew better now. So much can go wrong. We refused to get excited until after the first ultrasound. We saw the heartbeat but I still couldn’t bring myself to breathe. Days turned into weeks and weeks into months. At the end of the first trimester I was able to breathe a little bit. We told our families and kept waiting anxiously for each new appointment. I don’t think I truly felt comfortable telling people until halfway through the second trimester. I refused to allow myself to hope and believe that this could actually be happening. To her credit, she put up with my craziness, my skepticism and was a constant source of comfort and support. A deep and lifelong friendship had been forged. We were truly blessed to have found each other, as fate had intended.

Even now, with our four-month-old blessing, it is hard for me to believe that I am actually a mom. I had been told that as soon as I hold the baby in my arms, I would forget all the troubles that came before him. On the one hand, that was true. On the other hand, I never want to forget. That struggle has made me who I am today. I don’t mean a crazy hormone-deprived person who suffers hot flashes (but never when I am actually cold enough to need them). My infertility journey has taught me that I could handle much more than I thought I could. I was stronger than I thought I was. It made my relationships better and more open. Like I said, everything happens for a reason. This little boy will be loved and cherished always, as will the woman who gave up her eggs to allow him to exist, and the woman who selflessly carried him and delivered him safely and securely into his mother’s arms.