Two Guys Vs. Ten Days

Wow. I can’t believe we’re here. So the short of it is that we’re now in our ten day wait. I was expecting a two week wait, so ten days really doesn't seem that bad. But you can still imagine how slowly time seems to be moving. So, I've come up with fun ways to help time pass more quickly:

Teach Willow to jump through a hoop of fire.

Obsessively check my email to make sure I have the date of the pregnancy test correct.

Teach Willow to sleep on her head. (Already in progress)

Obsessively recheck my email just in case there was an update that didn't get forwarded to my phone, despite the fact that this has never happened in the past.

Teach Willow to ignore me when I call her name. (She’s all over that one)

Send myself a test email from one email account to another to make sure I’m getting my email in a timely manner.

Work on my wound care skills on the scratches Willow will give me while teaching her to jump through a hoop of fire.

And last but not least, ask my Thai family to send me daily emails from Thailand to ensure that the NSA isn’t blocking Thai emails to my account.

Yeah….it’s going to be a fun ten days.

Now, the long of it is a bit more involved. At the three day mark, Frankie had 7 good embryos, and I had 8. However, the morning of the transfer we were notified that unfortunately only 3 of Frankie’s embryos had made it to day five, and only one of them was of good quality. :-/  I still have 8, which is awesome but somewhat irrelevant given that our plans revolve around having a child genetically related to him. (He gets 6 weeks off at half pay for paternity leave, but it’s unclear if the pay or leave would apply to a child born that’s not genetically related to him.)

I suppose this is where the great 3 day vs 5 day transfer debate comes in to play. Did we save ourselves a lot of time and money by waiting until day 5 to make sure we only transferred strong, viable embryos? Or, did we needlessly loose embryos because they were in media longer than they needed to be? I really don’t know the answer, but I do know we knew that All IVF transferred on day 5, so it’s nothing we didn't sign up for. While it’s not an ideal outcome, with IVF you never know what will happen, so you just have to roll with the punches.

So, the embryo with a “good” rating, and a not so good embryo were transferred to our surrogate yesterday, and Frankie has one more not so good embryo frozen. Whether or not it would be worth trying again with that embryo remains to be seen. So, this might be our only shot with his material this time around. It certainly wouldn't put us out of the game just yet…but it would be a set-back.

However, we've decided not to worry about it just yet. What’s the point?! All it takes is one. And there’s as good a chance as any that one of those little blastocysts will be the one. And if not, well…. we’ll deal with it later.

And here are the little cell clusters we’re hoping will cling on to that lining:

So, for the next ten days we remain cautiously optimistic and hope for the best.  Fingers crossed. 

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?!) 

Clinic vs. agency vs. facilitator vs. going insane because of too many choices

Every surrogacy journey has to start somewhere, and unfortunately most of the time is starts with a very difficult decision: Who will you trust to facilitate and oversee the process of bringing your baby into the world?

For Frankie and I, this whole process actually started in July of 2012 when we first contacted several clinics in India. We asked questions ad nauseam and eventually zeroed in on the clinic that was right for us. I developed a great relationship with the facilitator of the clinic and began to trust her to help us handle this delicate process. As many of you probably know, this all turned out to be in vain as several months later India shut their doors to singles, which was essentially their way of giving the finger to gays. After seeing months of research go down the tubes we resigned ourselves to the fact that Willow would have to remain an only child for a while longer. But there’s always a silver lining; that night while figuring out whether or not I could coerce Willow into playing dress-up, I discovered that they make wigs for cats!

(I think Willow would look dashing in one of these, but Frankie vetoed the idea…)

Down but not out, we regrouped and started looking for alternatives. There was Ukraine, but they don’t allow singles or gays. On a good note, there was an agency claiming they had ways to get around the whole issue of gays not being able to legally enter into a surrogacy contract. Because that’s not at all dodgy…   There was also Mexico, and this was certainly appealing given that the surrogate would be a lot closer to us physically since we are in the US. But upon further investigation, we only found two agencies facilitating surrogacy there at that time, and for various reasons neither were an option as far as we were concerned. And then it happened; I heard Frankie yell from the other room, “Husband! We can go to Thailand!”

My first thought was one of disbelief. How could it be that I had done so much research into India and never once came across a website or blog concerning surrogacy in Thailand? As I mentioned previously, I have a very special connection to Thailand, and I immediately loved the idea of going through surrogacy there, but it seemed to good to be true. I wasn’t sure what exactly Frankie was smoking, but clearly he had to be in some sort of delusional state as things never work out for us that easily in reality. But, I surmised that at least we could try selling his magical elixir to raise money for surrogacy here in the US.  It worked for that lady in “Weeds” right? We started looking over the website for New Life Thailand, and that quickly snowballed into us sending out emails to all of the major clinics and agencies in Thailand. Not all of the clinics responded, but the ones that did seemed to be creditable at first glance…and so it started to become real. We decided to let ourselves become cautiously optimistic and begin researching again.

Fortunately, around that same time, I received an email from my contact at the Indian clinic offering to put me in touch with one of her friends who facilitates surrogacy in other parts of the world. Because I had developed such a good relationship with her while looking into India, I felt confident in her guidance and I was incredibly grateful. I came into contact with my current facilitator in February, and the courtship began again. As it turned out, she contracts with New Life Thailand which was great given that they were already the agency we were most interested in. Even more importantly, our personalities meshed well, I got honest answers, and I began to really trust her.  About 1,000 questions later, we signed the contract with New Life Thailand and we will be transferring embryos next month. It seems like we just started the process yesterday and yet we've actually been working on this for over a year.

For those of you who might be just starting out in this process, I wish I could give you a magical map that would guide you to the perfect solution for your situation, but such a thing doesn’t exist. Instead, I invite you to consider these helpful hints as you begin your journey.

You must first accept that much of this process is going to be beyond your control. If you cannot deal with that, international surrogacy is not for you.

That said, there is one thing that you can always control: your level of education. Research IVF. Research the egg donation process. Research citizenship options. Research Thai culture. Research until you can’t bear to research any more…and then grab some coffee and keep going.  A good facility or facilitator worth their weight in salt will answer any questions you can throw at them, and then invite you to ask more. (If they don’t, I suggest you move on. Good questions deserve good upfront answers.) But if you don’t do your job asking the right questions, you can’t get mad later when things don’t go the way you expect them to.  Because of the current climate regarding surrogacy in Thailand, I wouldn’t take as long as we did to get going…but that doesn’t mean you should rush in to anything without doing your due diligence.

And last but not least: take my advice, take the advice of others who have gone down this road, take it all in, and then throw it out and go with your gut. If your heart tells you that something isn’t right, listen to it. There is no one successful path. Was New Life the right choice for Frankie and me? Definitely. Is it the right choice for you? That’s a question only you can answer. Remember, you’re going to lose a lot of control during this process, so if you don’t trust your choices and have faith, you will go insane faster than Amanda Bynes.

P.S. I want to offer a huge congratulations to Brooklyn Couple on the birth of their twins!! I couldn't be happier for them! :-D