Surrogacy: Joyful, Frightening, Always Risky

I first met Dawn Bennett in 2007 at my fertility doctor's office. Her long black hair was pulled back from a face with almond-shaped eyes and a casual smile, as if the idea of carrying my baby in her body was no bigger deal than a night of babysitting. With five failed IVFs, a trio of miscarriages, and my 41st birthday behind me, I didn't know whether to shake the hand of this potential surrogate mother or hug her, so great was my fear that she would disappear if I made one wrong move.

That early spring day, the bees busy pollinating orange blossoms, my FSH level (a monthly test that measures a woman's fertility) had fallen dramatically; lower is better and mine was 14. Since most fertility doctors won't do IVF on a woman with a level higher than that, I felt breathless with hope. In another miracle of timing, Dawn and I discovered that we had both started our menstrual cycles two days earlier—which meant that our bodies were already synchronized. From a biological perspective, we were idling at the starting line, ready to go.

"I have to talk to my husband and kids first," said Dawn, whom I had met through a mutual acquaintance, "but I think we should do it." As a long-time television news journalist who had investigated bank fraud, identity theft and corrupt politicians, I knew that "just do it" might not be the smartest slogan when it comes to outsourcing your reproductive needs, but logic was steamrollered by desire. Applying the usual metrics for deciding to move forward with surrogacy—chiefly, a legal contract, a psychological examination, and a detailed, pre-set fee schedule—would have been the reasonable thing, but if things went well, the takeaway from this meeting would be a baby, something I ached for. And so, after a quick conversation with my skeptical husband, we decided to go ahead on faith.

The number of babies born via surrogate mothers in the United States has almost doubled in the last decade, according to the American Society Of Reproductive Medicine (ASRM), a trade group that tracks gestational surrogate births. In 2004, the number was 738, compared to 1,448 in 2010, but since ASRM tracks only those surrogacy arrangements that are reported by clinics that belong to The Society For Assisted Reproductive Technologies (an ASRM affiliate), some slip through the cracks. Andrew Vorzimer, a reproductive law attorney in Los Angeles who has been practicing since 1994, says his office handled more than 400 U.S. based surrogacy arrangements in 2011 alone, nearly doubling business from 2010.

"People used to only be comfortable with traditional family-building," he says. "That, or adoption, was all there really was. But now, people can get their minds around that it might take the involvement of three or four parties to get their baby. And then, there's the Internet."

Type the words "surrogate mother" into Google and more than seven million hits come up. You can peruse the Wikipedia entry or a website called "What It Costs" (ballpark estimate: $100,000), and then watch a surrogacy spoof by Saturday Night Live writer Christine Nangle ("I hate babies and I love getting fat!" are her qualifications for the job).

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But the bulk of the hits are agencies advertising for surrogates, ads that run the gamut from straightforward—Surrogates Wanted!—to bizarre. One Craigslist ad featured a female Super Hero urging, "Become A Super Surrogate!" The combined explosion of the Internet and reproductive medicine has fueled the commercialization of what used to be a very personal business.

"Instead of sitting across a table from someone, you Skype or see a video on YouTube, and that serves as the consultation," says Vorzimer. "It's not about relationships anymore, it's about business—getting couples in the door and getting their checks."

Plenty of intended parents (IPs in the parlance of surrogacy and adoption) are also taking their search for a surrogate online, trying to avoid the costs of using an agency.

"Looking For Babysitter For 9 intense Months" writes one couple. "We're normal, and boring, and stable: Volvo driving, casserole burning, trips to Lego Land..." The writer goes on to request a surrogate willing to terminate a pregnancy for medical reasons, and closes with a friendly, "If you're our girl, please get in touch!"

This kind of electronic outreach might be quick, convenient, and cheap, but it comes with significant risk. Shirley Zager, a mother via surrogacy herself and director of the support group Organization of Parents Through Surrogacy, says the sheer number of choices now out there coupled with the intricacies of a surrogacy agreement—such as when a surrogate must abstain from sex or how much of a bonus will be paid for twins—can be as frustrating as a 10,000-piece jigsaw puzzle.

"If they're thoughtful and do their homework, they can put the pieces together and navigate it," says Zager. "But not everyone is that sophisticated. They can be exploited and get hurt."

Newlyweds Donna and Yaniv Calif of Las Vegas, Nevada wanted a child of their own. Donna had two girls from her first marriage, but a hysterectomy had ended her ability to carry another. Since they couldn't afford to use a surrogacy agency (the average cost is between $85,000-$115,000) the Califs advertised on Surromomsonline, a popular resource center, hoping to save money on their baby hunt. A woman from New York responded, saying she would carry their child for $15,000.

"We didn't know anything," says Donna. "We were using all our savings and everything was so on the wire. We jumped at the chance."

The Califs flew the woman, whom I'll call Jane, to California, a surrogacy-friendly state. There, Jane passed a psychological screening test and signed a legal contract drawn up by a surrogacy attorney. Via IVF, Donna and Yaniv produced three embryos, which their doctor transferred into Jane's womb. Medically, everything went well, but something didn't feel right.

"Jane was always asking for money in advance," says Donna. "We both had misgivings, but we were already invested, so we just kept believing in her."

Between travel expenses, the surrogate's initial payment, and medical bills, the Califs had spent over $30,000 by the time Jane flew back to New York, so when she called to say she was pregnant, Donna and Yaniv were cautiously optimistic. But when Jane sent her pregnancy test results to the Calif's doctor, he told them he thought they were fakes. Frightened and confused, the Califs called their surrogate, who then dropped any pretense of politeness.

"She said, 'Look, I am pregnant,'" remembers Donna, "and if you don't pay me another $400 by Thursday, I'm going to get an abortion." Held hostage by the remote hope Jane was indeed carrying their baby, the Califs paid up. But when the woman kept changing her story and demanding more money, Donna finally tracked down Jane's mother, who ensured them her daughter was not pregnant. The Califs now believe Jane never took any of the expensive hormone shots and pills necessary to sustain a surrogate pregnancy and had never planned on delivering a child.

"She killed our three healthy embryos for money," Donna says, and Yaniv laughs, gallows humor fueled by the bitterness of being scammed.

"She could have killed our marriage, too," he adds. "I was naïve enough to think that no one would ever do this. I had no idea that corruption would ever reach the field of life."

Because surrogacy is no longer the touchy-feely fringe field of high tech baby-making but a multi-million dollar industry, this third-party reproductive option comes with the caveat "buyer beware." The further I get from my own surrogacy experience, during which I took Dawn to all her doctor's appointments, hovering like an expectant father while the ultrasound wand detected my son's heartbeat or tiny foot, the more I understand how lucky we were to have a problem-free experience. Like the Califs, I had been the ultimate do-it-yourself-er, charging ahead like a greyhound chasing a faraway rabbit that may or may not have been real. The only difference between Donna and me was that I'd felt a strong emotional connection to Dawn from the beginning while she had felt none to Jane.

The inherent risks intended parents face when entering into third-party reproduction are exacerbated by the fact that surrogacy is largely unregulated.

"It's the wild west out there," says attorney Andy Vorzimer. "It's easier to open a surrogacy agency than it is to start up a food truck." And while a manicurist or massage therapist needs certification before they can work on your nails or neck, a surrogate does not.

The federal government has declined to address the issue of third party reproduction at all, leaving little recourse for either intended parent or surrogate should something go wrong. Debora L. Spar, president of Barnard College and an economist and author of the book The Baby Business—How Money, Science And Politics Drive The Commerce Of Conception says this is no accidental oversight; politicians want nothing to do with a hot-potato issue.

"Once you start trying to regulate surrogacy, at some point you have to define the status of the embryo—legal issues like who has control, who gets to inherit the embryos—and that takes you smack into the middle of the abortion debate, where no one wants to go," says Spar. "There's been a little bit of progress but it's been horrifyingly slow. It's certainly not at the top of anyone's agenda."

This vacuum leaves a booming gray market, governed marginally by a confusing patchwork of state laws. Some states, like Arizona, Michigan and New York, don't recognize gestational surrogacy contracts, while others, like Connecticut, do. Still others, like Oklahoma and Idaho, take no stand at all. This means that it is up to intended parents and potential surrogates to protect themselves by doing their own research, trusting their gut reaction, and moving forward with caution.

"Not every agency is created equally and not every surrogate is created equally," cautions Andy Vorzimer. "Sometimes you have to take baby steps to get that baby. Don't look for the easy way out.

To understand why anyone would grasp at an easy way out of the infertility quicksand, you must first delve into the mindset of those of us who cannot have children the natural way. We are not stupid. But we are desperate.

Infertility affects an estimated 10 percent of women in the United States—about one in seven couples—a condition that is categorized as "unexplained" about 15 percent of the time, as mine was. On my 40th birthday, as if Cinderella's other shoe had dropped and turned her into a barren old maid, my odds of having a biological child slid precariously close to zero. I had hit a depressing trifecta: I was old (in a reproductive sense), had a history of repeated miscarriage, and egg quality that stopped just short of rotten.

Fertility dysfunction, whether caused by advanced maternal age, endometriosis, or polycystic ovarian syndrome, ramps up desire as inevitably as the sun ramps up heat. In my late 20s, becoming a mother lagged in importance behind a burgeoning TV news career, cute boys, and cold beer. But ten years later, the painful burn of not being able to perform this most basic female function had come to define my world. My inability to join the oh-so-exclusive club of motherhood slowly made me feel less: less productive, less worthy, less human. My husband watched the woman he married sink deeper below the waterline of grief with each failed IVF cycle and tried to convince me to quit trying, pitching the possibility of living a decadent, child-free life of travel and adventure.

"Why am I not enough for you?" he asked one night, the question shattering the strained silence at our dinner table.

"I don't know," I responded bluntly, the ability to sugar-coat the truth another casualty of repeated loss. "But you're not."

The fierce wanting sparked by infertility can short-circuit objections before they can become annoyingly distracting from the goal. Dr. David Smotrich, a reproductive endocrinologist in La Jolla, California who to date has done more than 1750 surrogate cycles, says the common denominator of desperation often causes irrational behavior.

"Patients are often so emotionally scarred by their infertility that it blocks their ability to think clearly," says Smotrich. "And when they find a woman who says, 'I will carry for you,' they're so excited to see a light at the end of their reproductive tunnel, that sometimes they make bad decisions."

Donna Calif and I are flip sides of the same 21st-century coin. We are women whose bodies somehow didn't work right. We are women who took extreme measures to create a child, injecting our bodies full of fertility drugs, paying tens of thousands of dollars, and betting our happiness on the capability of a stranger's womb and the kindness of her heart. We are women who needed to believe. And in hindsight, only one of us looks foolish—even though if that coin had flipped just half a revolution more, it could have been me who ended up face down on the floor.

My baby was born without complications early in 2008. The night my surrogate went into labor, two days past her due date, I drank red wine and ate pizza in the delivery room as the clock ticked past midnight. I took a nap at 3 a.m. and then kissed Dawn's forehead and whispered "You can do it!" when the pushing started. And at a few minutes past 6 a.m., the gray light of a winter morning streaking through the plastic hospital blinds, I cut my son's umbilical cord with shaking hands and then carried him to the warming table, my husband standing nearby with tears streaming down his face. It was a weird way to have a baby, but Dawn had given us the greatest gift. And so any strangeness was blotted out by joy.

Two years later, the Califs also made it to the delivery room. They had maxed out their credit cards to pay for another IVF and found another surrogate online who agreed to take a deferred payment. But even though Jackie turned out to be perfect, her pregnancy was not. At 26 weeks gestation, her water broke and the baby was born two weeks later, necessitating a long stay in the neo-natal intensive care unit. The Califs, who had spent all their money on high-tech baby-making instead of health insurance, had to declare bankruptcy.

"It was economical suicide," Yaniv tells me one day in a cell-phone conversation. He and Donna are driving back from Los Angeles to their home in Las Vegas—a city where some of the biggest gambles in the world are won and lost. In the background, I can hear their children chattering and laughing, including the daughter born via surrogate.

"So, was it worth it?" I ask, thinking about my own surrogate son and how much I love him. And about Dawn, and how without her, I would not have him. I was thinking about risk and luck and how dangerous it can be to want something so badly. There is a long pause.

"I don't know," Donna finally answers. "I'm 40 years old and now I'm starting my life over again. I don't know what kind of developmental problems my daughter might have. And God forbid the car breaks down because we don't even have a credit card."