Last Week Vs. This Week

Most IPs undergoing international surrogacy can tell you about a little ritual that develops as part of this journey. It essentially consists of waking up, reaching over to the nightstand where your cell phone has found a new home, and compulsively checking your email to see if the clinic sent you an update overnight. This process has become an integral part of our lives.

Last week, shortly after my last post, I completed this ritual and woke up to a very alarming email. Apparently Grub Hub, the restaurant delivery service we use, had removed one of my favorite restaurants from their list. As you can imagine, this shot me right out of bed.  After taking time to mourn the loss of my Dragon rolls and Spicy Tuna Maki, I noticed another email that some might argue was equally alarming. It read:

“Your surrogate experienced bleeding after taking medication for a week. The doctor has canceled her from the program to protect the success of your program. I have attached the profile of your newly allocated surrogate, please let me know if you have any questions.”

Uhhhhhh…….

I thought perhaps I had read the email incorrectly, so I read through it again. Sure enough, they had just switched out our surrogate. Granted, we had given them permission to do this if necessary, but it was still unexpected, and certainly a little jarring. I didn’t know how to react at first, but soon found myself looking over the profile of the newly assigned surrogate. On paper, she was great. She was 32, she had been a surrogate before, and she had a total of 3 uncomplicated pregnancies. So, while we were a little taken aback at first, ultimately we were ok with the change.

Fast forward 8 days. We had gotten comfortable with surrogate number two, and were happily going about life when I woke up to the following email:

“I apologize for the continued change, however we are doing everything to ensure the best success of your program. The doctor has replaced your surrogate with another surrogate. Please let me know if you have any questions”

Yes, gentle reader, we are now on surrogate number three, and we haven’t even managed to make it to embryo transfer yet. If we were running in the "going through surrogate Olympics", I’m pretty sure we’d be right up there with Usain Bolt at this point.

We can’t say that all of this change has been entirely welcomed. In fact, it was quite stressful for a time. But then we really started thinking about it; If given a more explicit choice, what would we have done? Would we have wanted to proceed with less than ideal conditions? Definitely not. And when we started thinking about it like that, we were actually comforted by the switches.

Let’s face it. All of this is happening half way around the world. Surrogate number two had a thick enough lining, but it was deficient in other ways that weren't as obvious. It would have been really easy for the doctor to move forward with her and just ignore the less than ideal lining. In fact, that probably would have been the most profitable choice for him. But he didn’t move forward. Instead, he presented us with an alternative that would help achieve better results. Sure, it’s in his best interest to garner the best success rates for his business, but it also makes us feel like he cares about quality practice in his field of medicine.

It was also another reminder of how different international surrogacy is compared to what people expect from domestic surrogacy. In domestic surrogacy, IPs search for the surrogate version of “The One”; their perfect match.  This is the one and only surrogate that will travel with them through their journey. If her lining isn’t ideal one month, then they wait until the next month and hope that conditions improve. It's actually a really lovely process, as a real bond can form between surrogate and the IPs. However, this is generally sacrificed with international surrogacy. It's good in that you don’t have to wait to get your cycle going, but you also don’t form any sort of bond with your surrogate before proceeding into what is a very emotional journey with her. 

Additionally, in domestic surrogacy, IPs are given much more control over the process. This is partly due to the patient centered care structure in place here in the US. But, let’s be honest, it’s also partly due to people like me who are control freaks. In international surrogacy however, much of that control is taken out of your hands. Again, advantages and disadvantages. We like the feeling of being in control, and having that control taken away can be a real challenge and feel like a huge disadvantage. Simply put, If you feel like you’re not up for that challenge, you really need to consider whether or not this is the right process for you. 

So what’s the advantage? Well, let’s put it this way, Frankie is a physician and I’m wrapping up nursing school. We have several friends who are Family Medicine Physicians and OB/GYNs. However, truth be told, even with such a  large body of medical knowledge at our disposal…we’re simply not qualified to make some of these decisions. We can certainly ask good questions, but we’re not there to interpret the ultrasounds, to talk to the surrogate, or to monitor the development of embryos. No amount of information from internet IVF/surrogacy forums or even medical/nursing programs can replace or even come close to the knowledge the physician has. 

Frankie is amazing when it comes to caring for the kidney. It’s what he does, and it’s his passion. But would he ever treat someone just from reading their medical record, without meeting them and without verifying information for himself? No, never. So why should we expect to have enough knowledge to make certain calls pertaining to the treatment of our surrogate without having her as a patient? Really, we shouldn't; and because we know our knowledge is ultimately quite limited, we wouldn't want to make those calls. 

Instead, we decided to trust our agency, our clinic, and the physician in charge. We met him while we were in Thailand, asked him many questions about his experience and his process, and we walked away feeling comfortable with him in charge of the medical side of this process. We knew we would be giving him the authority to make certain decisions for us and lessen our burden; and having that security and comfort has been a huge advantage.

So yes, since the last update, we’ve gone through three different surrogates. However, here is the last email we got…

“Hello!

Regarding your Egg donor, 18 eggs were retrieved today, and we'll have your next update on Monday (embryo report).

I also have your surrogate's last update before transfer. Her endometrial thickness is 10.1mm.

 As always, Please let me know if you have any questions.”

Sure, we had to get a few emails that made us a little uncomfortable, but did we make the right call trusting our agency? For us, the answer is undoubtedly yes. I’ve said it before, and I’ll say it again: There are no guarantees in IVF and surrogacy. There’s a good chance this first attempt won’t be successful, and we’re prepared for that. But just the same, it feels good to have people who put forth effort to stack the deck in our favor.  

The embryo report should be coming in tomorrow and the first embryo transfer is scheduled for the end of the month. Wow…..just wow.

Emotional Restraint vs. Hope

Every nurse faces the same challenge at some point in their career. I faced it last semester during a clinical rotation for my nursing program. I was part of a cardiac code team; pounding on a woman’s chest as the rest of the team provided her with oxygen and various meds in an effort to resuscitate her. But we failed, and just like that she was gone.

When the physician told me to stop compressions, I stepped back, took a few deep breaths as he called the time of death…and I felt numb. This was part of my training. As nurses we are taught to care for our patients like we would want our loved ones to be treated. We are also taught to distance ourselves emotionally. For a good ten or fifteen minutes, I achieved that goal. I had given all I had to give, while still trying to protect my own emotions. It was while we were preparing her body for the family to view that it hit me. I saw one of the techs remove her wedding ring to give to her husband, and with that, the numbness cleared. I promptly excused myself, went to the bathroom, locked myself in a stall and cried until the burning in my eyes forced me to stop.

It remains a mystery to me how we are supposed to care for someone in such a deep way and then not feel broken inside when our best attempts to save them fail. The good news? I cried a little less the next time this happened.

I have tried to approach this surrogacy journey with the same caution. I try to hope for the best…but only in an emotionally restrained way. I can nurture the idea of having a child, but I have to stay emotionally distanced to protect myself. But every once in a while I can feel myself slipping, and today I allowed myself to do something dangerous.

We got a report from our agency telling us that our Egg Donor had a preliminary scan that showed 20 follicles developing. I became really excited. This was the first news that we’ve gotten that makes me feel like it’s all actually coming together and that’s when it happened: I let myself really hope that this will all work out. I threw away my restraint, and let myself really hope.

The problem with that is, the further you get your hopes up, the further they have to fall.

I know when it comes to IVF and surrogacy, there are no guarantees. But despite my best efforts, I’ve already managed to: mentally design a nursery, wander down the baby aisle at Target, start thinking about names I like, start eliminating names I don’t like, and start making up new and inventive names like “Ragdoll Curtain-rod” …you know, in case I take off as a celebrity. This is all very well… but it’s also a game of emotional roulette. What if this doesn’t work out, and all I’m left with is the image of a nursery that my little Justin Case will never exist to use? (Hey, if Kim and Kanye can have a kid named North West, I can have a kid named Justin Case…but really, celebrities need to stop with the cruel names.)

Financially, this process isn’t cheap. We’re extremely fortunate to be able to try this even once, as we fully realize there are others who don’t have that luxury. However, we can only afford a certain number of tries until we would be forced to take a hiatus in order to reestablish our funds. I think some people assume that because Frankie is a physician, we’re rolling in money; when in reality we’ve only done that once and it was after a very odd night in Vegas that we choose not to speak of… (Because you know what they say, “What happens in Vegas, makes you feel like you need a shower and antibiotics”… What’s that? That isn’t Vegas’s motto? Huh.)  In all seriousness, we’re not struggling, but we’re not thriving just yet either. Medical school isn’t cheap, and we have a combined student loan debt that exceeds the cost of the average home here in the US and last month Frankie’s loans came out of deferment, so it's time to pay the piper.  If we ever want to have a mortgage or perhaps a college fund for any children we might be fortunate enough to have, we need to work on paying down our own debts. To sum it up, when it comes to more attempts from scratch: Our spirits are willing, but our pocket books are weak. 

So, I try desperately to keep myself in a state of restraint, but hope is a powerful emotion. I’ve allowed myself to get too close to patients, and that’s left me in tears. I can’t allow myself to become too close to the idea of a child that might never come in to existence because I’m afraid of what that might do to me inside.

 But what I can do is cautiously wish for one of those 20 follicles to develop, be fertilized and become something that will make our lives complete. I can cautiously wish, and leave the rest to fate. 

Thailand vs. India

Thailand Vs. India...

Round One…

Fight!!

Ok, so I suppose this really isn’t a fair fight. After all, Thailand is home to Muay Thai Kickboxing, and India is home to the Kama Sutra. It’s clear which country is a lover, not a fighter. Just the same, when it came to the surrogacy battle, India definitely won out. (Before it was taken out of the competition Tonya Harding style by the Indian Home Ministry and their visa regulations…) With India off the table, Thailand became the best option for us, and after getting over the shock of having to regroup and change locations, we’re actually pretty happy that things have turned out this way.

One of the reasons we’re so pleased is because of my aforementioned family in Thailand who have been so incredibly supportive of us during this process. But I feel like there are not so personal advantages and of course disadvantages as well. So, for anyone who has had to face the same situation, or for those just starting to consider surrogacy, I present to you some of the pros and cons of Thai Surrogacy (according to yours truly).

Let’s get the cons out of the way. I’m always one to pick hearing the “bad news” first. The biggest issue is that surrogacy is neither legal nor illegal in Thailand. So, it’s not just a gray area within a law, it’s an entire gray sky. There is a draft law in place that if enacted would effectively ban commercial surrogacy in Thailand, and while that draft law has been approved, it currently sits in limbo. No one knows if or when the bill will be enacted, which puts pressure on potential IPs to act quickly. However, this is not a process to rush into, so there is quite a conundrum here; and really it's just something we will have to keep an eye on to see how it plays out.

Additionally, there are some big issues with the Birth Certificate as well. In India, IPs are neatly written into the child’s birth certificate as the legal parents. Badda-bing, badda-boom. Done. However, in Thailand, all babies born are seen as a product of a relationship, even babies born through surrogacy. This means that the surrogate mother’s name ends up on the BC with either A) the genetic father’s name (male IP) or B) her husband’s name if she is married (again, the baby is seen as the product of a relationship, and if she is married then the baby is assumed to be her husband’s.) This makes it crucial to ensure that the surrogate is not married. It also makes it exceedingly difficult (if not impossible) for a single woman to pursue surrogacy in Thailand. After the BC is issued, there is then a process in which the surrogate relinquishes her rights and gives sole custody to the genetic father (The IP) so he can get the proper paperwork done for citizenship and a passport. (Please note there is still some debate as to how this process should work, so I will say that I’m writing this as I see it working.) To be so dependent on a stranger doing all of this is really scary…but no scarier than having a stranger carry a child for us. I feel that if we can trust her to ensure our child is born healthy, we can also trust her to do the right thing and happily give us full rights to the child.

On the financial side of things, there will also be a larger impact on your bank account when going to Thailand. While there is always variation from program to program, most clinics in Thailand charge somewhere around $34,000 for surrogacy with an ED, while clinics in India generally charge something around $25,000. Paying more for the same thing is never a good thing. 

For faithful researchers like myself, the other negative aspect of Thailand is that compared to India Thai clinics are relatively new and therefore have little statistical information to offer. Many of the agencies opened in 2011 or 2012 and some haven’t had any babies born to foreigners yet. (In fact, the agency I'm using just had it's first baby born in June of this year.) This leaves some questions up in the air that simply cannot be answered yet. But, there’s only one way to find out. And eventually, if the Thai government continues to allow surrogacy, this won’t be a problem.

Now that we have that unpleasantness out of the way, we can think about the pros.

For one, “Delhi Belly” takes out many a tourist, but fortunately you don’t hear a lot about “upset GI from Thai”. (Sorry, I tried really hard to rhyme Bangkok with some form of gastro-intestinal distress, but really, what rhymes with Bangkok?!)

Secondly, not only does Thailand still allow gays to enter into surrogacy contracts, their culture is also far more accepting of same-sex relationships than most of East and South Asia. For same-sex couples, that’s a huge plus. If you’re travelling with your partner and have some free time, you can always try to head to Pattaya where they are especially accepting of diversity. (It’s also especially full of prostitutes, or “massage parlors”, staffed by ladies, ladyboys, or boys…so some research into which areas to avoid might be in order.)

Thirdly, many of the clinics in India that I researched discourage or flat out forbid you from meeting your ED. They are anonymous, and prefer to stay that way. I know some IPs had a different experience, but I can only speak to what I was told by the clinics. While I can respect their policies and the privacy of the EDs, it would certainly leave me wanting for something. However, all of the Thai agencies/clinics that I inquired with not only allowed, but encouraged me to meet the ED and the surrogate. For me, that’s a huge plus. I was able to sit down with my awesome egg donor, get a sense of her personality and even ask her about future contact. I hope to be able to do the same with the surrogate at a later time.

Fourthly (I looked that one up...it's a real thing), while all cities have their charm, Bangkok is generally accepted to be significantly further developed than both New Delhi and Mumbai. While this does translate to Thai surrogacy being more expensive than Indian surrogacy; it also means that it is generally more comfortable for the average western traveler. The location of Bangkok in proximity to the coast also means a two hour drive to gorgeous beaches.

And last but not least, you don’t have to worry about buying only green and yellow clothes, or buying those awkward, “Congratulations! It’s a.....Baby!” signs. Thailand has no laws forbidding gender determination, so you can break out the “It’s a girl” cigars at the appropriate moment. (If you want, you can even select the gender of your child… personally, I don’t necessarily say I see that as a pro as I like the thought of letting fate decide, but some people might.)

I like to consider myself to be a realistic optimist, so while I see faults in the Thai surrogacy system, I tend to try and focus on the good. In the end, I think Thailand was the best choice for us, but does that mean it’s the right choice for you? Not necessarily. But at least now you know, and knowing is half the battle. (Did anyone love GI Joe as much as I did growing up?!)