Browsing Tag

Family Planning

My Journey to Surrogacy (Part 2) – It Takes A Village to Conceive A Baby

By September 9, 2015 2 Comments
Share:

 

Marisa faced a traumatic pregnancy wrought with complications and kidney damage for the birth of her first child, and doctors warned her that a second pregnancy had the potential to kill her. You can read the details in part one of Marisa’s story here. Below is part two:

After my doctor warned me that I should never, ever, get pregnant again, my husband and I turned to surrogacy as the answer to our prayers for a second child. Once we made the decision to pursue surrogacy, I spent much of my spare time researching procedures, timelines, costs (ohhhh the costs, there are many!), legal contracts, and the emotional aspect of it for everyone involved. I spoke with women who had been gestational surrogates (those impregnated via IVF), and with other intended parents about their journeys, how they got there, and how they found the experience. I also spoke to fertility clinics, lawyers, potential surrogates, and surrogacy agencies.

Perhaps most important of all I had appointments with my own doctors to discuss the how egg retrieval would affect my kidneys and diabetes if we were to have my eggs retrieved instead of relying on a donated egg. Thankfully, I got the green light from my medical team.

Finding a Surrogate

When I spoke with our lawyer, I was surprised to discover that in Canada it is illegal to advertise that you are looking for a surrogate, and it is also illegal for an agency to charge a fee to match you with one. This makes for a tricky scenario for everyone involved. How are you supposed to find a surrogate if you can’t tell the world you want one and there are hurdles for surrogates to being matched to families who want one?

There are websites for surrogacy agencies, but again, they can’t charge you to match you with a surrogate, which poses problems that I won’t address here. What I will say is the agency that we chose ended up being a good choice for us. A lot of intended parents struggle to find a surrogate, but with our agency we were able to get matched quickly. It doesn’t always happen this way, but we happened to find the perfect match on the first try.

Our surrogate’s name is Stephanie. Her and her husband have 3 children of their own. I’m going to talk about them more in my next post but they are truly amazing people. There just aren’t words for how kind and selfless they are.

How the Surrogacy Agency Works – Including Costs

Once we were matched with Stephanie, our surrogacy agency helped to get us in quickly to a fertility clinic that was selected based on my medical history, and in the meantime, the rest of their process began.

Marisa and her family's surrogate, Stephanie

Marisa and her family’s surrogate, Stephanie

The surrogacy agency deals with all financial transactions between our surrogate and us. In Canada, it is illegal to pay someone a set amount to carry your child, but you can reimburse them for expenses incurred directly as a result of being pregnant. These things can include food, gas for getting to appointments, medications, maternity clothing, wages for missed work for the surrogate or their spouse (if their spouse is required at legal or medical appointments), child care, updated wills, life insurance, and their lawyers’ fees to name a few. Stephanie submits her receipts monthly to the agency, and we keep an account with the agency that she is paid from.

In addition to the agency’s fees and reimbursements for our surrogate, we had our own costs, which included legal fees (for an in-depth surrogacy contract prior to fertility treatment), our own missed wages, travel, and childcare. Because there is no fee for matching with a surrogate, you pay fees to the agency after you have made a viable match. The biggest bill of all came from the fertility clinic. That one hurt!

I’d say the cost is the main negative part of choosing surrogacy. The cost is so incredibly high, and no doubt we feel it is worth every one of the tens of thousands of dollars it adds up to. Unfortunately, that also means surrogacy isn’t an option for everyone. Financially you have put an enormous amount into process and even so, there are no guarantees. We had the advantage of having financial help with the whopping grand total, but if we hadn’t, this option never would have happened for us.

Fertility Treatments and In-Vitro Fertilization 

Maria gives a thumbs up at the fertility clinic waiting for her egg retrieval

Maria gives a thumbs up at the fertility clinic waiting for her egg retrieval

The most difficult part of the journey was retrieving my eggs via fertility treatments, and the dreaded two-week waiting period after the embryo was transferred to our surrogate through In-Virto Fertilization (IVF), meaning, that time waiting for the embryo to implant and a positive pregnancy test. There is so much riding on the results. With your egg retrieval you hope for enough eggs to feel comfortable that you will end up with viable embryos for transfer, but not too many eggs that their quality is poor. With the two-week wait you are simply trying to not think about the fact that you just want it to be test day when you can find out if it was successful. Every moment is spent praying for it! Emotionally you can’t help but be hopeful, scared, and frankly a little bit crazy.

After our first egg retrieval, we were able to successfully conceive several embryos but had a failed transfer. This meant that the embryos transferred to our surrogate did not result in a pregnancy. It was such a huge disappointment. I was not prepared for the waves of devastation I felt. I felt defeated, and I was overcome with a wide range of sadness, grief, anger and bitterness. I had a hard time finding the motivation to accomplish anything. I felt like after all we had been through the universe owed us this. We had come so far but it just didn’t seem fair, yet somehow we still had hope. I felt bad for Stephanie because I knew she was also disappointed and going through her own emotions as well, and there was nothing I could do to make her feel any better. We had all done exactly what we were supposed to do, but even though you don’t go into the journey with that mindset, there was always a real possibility that it wouldn’t work.

The soon-to-be newest member of the Fletcher family

The soon-to-be newest member of the Fletcher family

After the failed transfer, we knew right away that we would do a second egg retrieval. In total, I took about 7 weeks off of work for the two retrievals. I ended up needing two egg retrievals, and I took a total of about 7 weeks off work. Everyone I work with was so excited and hopeful for us, including my boss (sincerely, who has a boss like that?!?). My co-workers were all interested and sent me text messages while I was away wishing us well, and reminding me that it would all be worth it when we had our next miracle baby.

As luck would have it, the second round was the one that got us where we are today. Our surrogate is 21 weeks pregnant with our second child as I sit and write this. Just typing those words make me smile and feel like I’m going to burst! There is no less cheesy way to put how I feel.

You can read part three of Marisa’s story by clicking here.

 

Tags: , , , ,
Categories: Pregnancy, Birth + Family Planning

My Journey to Surrogacy (Part 1) – Another Pregnancy Could Kill You

By September 2, 2015 2 Comments
Share:

November 6, 2011 was hands down the best day of my life so far. It was the day I became a mother.

The day itself was anything but the best day of my life. I was only 26 weeks pregnant, I had been dangerously sick throughout my pregnancy and I was scared we wouldn’t be bringing our son home with us from the hospital. I would later find out that my pregnancy had put my life in danger as well.

Despite the complications and the fear, our beautiful son, Elliott Murray Fletcher, entered the world at 4:34p.m. via emergency c-section. He was just over 13 inches long. He still had one eye fused shut and not an ounce of fat on his perfectly developed little body. He had fine, fuzzy hair all over, he looked and was so fragile. My Grammy said she thought he would fit just perfectly in a two-liter berry basket, and she was right.

Elliott couldn’t breathe on his own in the first weeks of his life, so he had a C-PAP machine and oxygen around the clock. He was in an incubator for 46 days until he could maintain his own body temperature without burning too much energy, and had tubes and wires hooked all over his body to deliver nutrients, monitor his heart rate, breathing and oxygen saturation.

And this is how my husband and I turned to gestational surrogacy to complete our family.

When I was 10 years old, I was diagnosed with Type I Diabetes. All in all it wasn’t that hard to maintain decent control of my sugar levels as long as I ate properly, took my insulin, and tested my blood sugar as instructed. I was aware that I would need to try my best every day for the rest of my life to avoid complications, most importantly so I could have babies when I was ready. I even selected my profession as a dental hygienist, not only based on my love of teeth, but because office hours would be kind to managing my diabetes, and it would make it easier to work part time while also being a stay-at-home mom the rest of the time.

When it was time, I got the go ahead from my doctor to “have as many babies as I wanted.”All of my blood work came back with excellent results and there was no reason I couldn’t have a healthy, although high risk pregnancy (all diabetic pregnancies are considered high risk).

Elliott's arm while he was still in the NICU. His father's wedding band fit over his hand.

Elliott’s arm while he was still in the NICU. His father’s wedding band fit over his hand.

As soon as we made the life-altering discovery that I was pregnant, my whole life became about testing my blood (when I was pregnant I tested on average 18-22 times per day), eating and drinking copious amounts of carbohydrates to keep my sugar at a safe level,  all while trying desperately not to vomit because I was so stuffed and also suffering from “morning sickness.” I was at one doctor appointment or another at least once a week. I had ultrasounds every 2 weeks to monitor our baby. I had a high risk OB/GYN that we had to travel 4 hours to see every 2-4 weeks.  I was also very swollen, because my kidneys did not agree with my being pregnant (I had gained a total of 42 pounds when I gave birth at 26 weeks and promptly lost 32 pounds in week, which was almost entirely water weight that my kidneys didn’t have the ability to deal with).

The whole time I was pregnant, I was feeling very overwhelmed, but I didn’t mind too much, because we were going to have a baby, and I was finally going to be a Mom!! It wasn’t a walk in the park, but it was worth every moment, and I would have done it again, if my doctors weren’t so adamant that I don’t ever attempt a pregnancy again, given what was happening to me.

At 25 weeks my water broke and I was admitted to the hospital for another week to try to stave off labor. I was in the hospital for another two weeks after that as it turned out that pregnancy had caused me to suffer from acute nephritis (inflammation of the kidneys), and at that point I had lost about 60% of my kidney function.

One day in the hospital my doctor asked how many children I had. I told him just Elliott so far, and he replied,“well I think he will have to be the only one.”

He said it as gently as possible, and I just said “okay”, because I didn’t want to cry and I was also in shock, despite the circumstances. A few days later, my OB came to talk to me. Her words were “Do not ever let anyone tell you that you can try to have a baby again, another pregnancy could possibly kill you,” and told us we were extremely lucky that Elliott was thriving despite his extreme prematurity.

Elliott had a 90-day NICU stay. Fortunately, he has none of the frequently occurring long-term complications of premature birth. I still count these blessings frequently.

It took me two and a half years to feel like myself again. I was put on 7 different prescription medications to control my blood pressure and help my damaged kidneys. My blood sugar was very hard to control. I was low frequently and postpartum, I couldn’t feel it dropping (this is called hypoglycemic unawareness, and it is extremely dangerous and also life-threatening for a diabetic). On top of it all, I now had a baby to take care of.

I felt defeated. I had always had a positive outlook on being diabetic and now that was gone. I was fed up! I felt like diabetes had taken away so much from me, and it was so painful to know that I wouldn’t be able to give my husband another child, or Elliott a sibling.

But there was hope.

Hope came in the form of gestational surrogacy.

You can read Part Two of Marisa’s Story here. 

Tags: , , , , ,
Categories: Pregnancy, Birth + Family Planning

Child-Free By Choice: How Old Is Too Young for A Vasectomy?

By August 20, 2015 5 Comments
Share:

Since I was a teen I was not interested in having children. I’m not a kid hater or parent hater, but that lifestyle was never something that appealed to me.  I like kids, I also like to hand them back to their parents at the end of the day.  The decision to be child-free is not something I grew out of as I aged, if anything I became more steadfast in my decision to not have children. As a result, I had decided around age 20 to pursue sterilization. I wanted a vasectomy.

That vasectomy took me 15 years.

Not for lack of trying.

Understand that I have always taken my sexual health very seriously and was not after a vasectomy as an easy way to get away from condom use. A vasectomy won’t prevent certain STDs the way a condom will.  My decision to have one was purely for birth control.  While I understand that sterilization has a permanence to it that other forms of birth control don’t, in my 15 year quest to have a vasectomy it seemed strange to me that I didn’t have the right to control my own reproductive health.  As a man, the only form of birth control outside of a vasectomy that I had at my disposal were condoms, and condoms are all well and good, but they aren’t as effective as a vasectomy.

Before I approached my doctor at age 20 to talk about a vasectomy, I did my research.  I had asked him about it previously in passing and I’d also made a purely informational appointment with a urologist to better understand the procedure.  I understood the effectiveness, side effects, consequences and permanence of my decision.

So, at 20 when I sat down with my doctor to talk about actually going through with the procedure, I made sure I was clear.  I explained myself, my wish never to have children, my research and my understanding of the permanence of my request.

Screen Shot 2015-08-19 at 9.29.18 PM

A comparison of the efficacy of birth control methods, c/o CDC.gov

My doctor countered immediately with the argument that I was too young, and “What if you meet someone who wants to start a family,” and something about how this is usually done when you are married and wish to have no more children.

Bottom line: “No. Come back later when you are older”. No defined time frame, just “older”.

At age 20, although I was headstrong, I never thought to argue or advocate for myself. I mean, you just don’t argue with your doctor right?

Life moves along. I was age 25 and had moved to another city. When I was settled in I found a GP and had a physical done, and again asked about a vasectomy.

Same response. “You’re not old enough, you’re not married with kids, come back when you are 30”. I also got a lecture on the use of condoms. I think my new GP thought I was trying to find a way to forgo condom use, which again, I was not.

When I was around 31 I had a new GP and was in a long term relationship. My then girlfriend also didn’t want to have kids so I thought that for sure I would have success this time around!

Denied. At least he was the nicest out of my doctors. He said that this was a permanent procedure and that most men requesting it were married and already had kids. I did argue a little bit, explaining my firm decision to remain child-free and that I’d asked for the procedure several times since age 20.  He asked me to wait a year, he’d put a note in my file and we’d talk. That seemed fair. Mostly, I just wanted to satisfy whatever arbitrary conditions there were.

Life got in the way.  I married my long-term girlfriend and we moved clear across the country.

Again, I had a new GP and I expected the same kind of brush-off from her that I’d received from my previous GPs. My current GP is a no-nonsense, very clinical sort of doctor. Logical and to the point. I like her. When I told her “I am interested in getting a vasectomy” and said I’d already done my homework she simply gave me a referral.

Since she gave me the referral, I’ve occasion to chat with her and asked about the vasectomy referral. I was specifically curious if she would have referred 20 year old me to the urologist. Her answer was simple. “Yes, you are a well informed patient, and have obviously done your due diligence, so if you were that way at age 20, why not?”

The visit with the urologist was great. He was also very matter of fact, straight up. He asked 2 questions. One: Do you have kids? Two: Is your partner is aware of the procedure?

His response to my child-free status was “That’s OK, I’ve met plenty of men not interested in having children”. I also asked him a few questions. He would have performed the procedure on 20 year old me, if I was as confident and well informed as 35 year old me. This was bizarre.  After being told for 15 years that I was too young, that I needed to wait, I was suddenly being told by two health care providers that they would have performed the procedure on me when I was 20.

After 15 years I finally was able to have the procedure and am confident that my wife and I will be child-free.

But I’m left with some nagging doubts about the path it took me to get here.  Is relative youth reason enough to deny someone the right to control their reproductive health?  Only about 5% of men who have had a vasectomy will ever have it reversed.  I can see my previous providers’ concerns about my age, as a study found that the younger a patient is when they decide on sterilization the more likely they are to try to have it reversed, but that’s still a very small percentage.  I also can’t help but wonder how skewed the numbers are right now, as 90% of those who have had vasectomies are married or are in long-term relationships.  I know that my vasectomy now falls into that category, even though I’d been trying to obtain it since I was 20.  While I know I’m not in the majority, I have to wonder how many men like me are skewing the data, thus making it harder for men like me to obtain a vasectomy before marriage and reaching an arbitrary age.

So I’m left wondering, what was it that lead doctor after doctor to deny me a vasectomy over 15 years?  Was it age, gender or were they placing their own morality above my medical wishes?  I’m not sure, but looking back, it sure seems like it was all three.

In retrospect I would have told 20 year old me to go and find another GP and to agitate and advocate more. Lesson learned, I am now my own fiercest health advocate, as I should be. – Edited by Leslie Waghorn

Tags: , , , ,
Categories: Pregnancy, Birth + Family Planning

This Post Isn’t About Bristol Palin: Why Teens Aren’t the Ones With the Unplanned Pregnancy Problem

By July 1, 2015 No Comments
Share:

 At this point, you’ve probably heard about Bristol Palin’s second pregnancy. She announced her news via a blog post last week. She originally suggested that this pregnancy wasn’t planned but followed up that post a few days later with a second one clarifying that her pregnancy was planned…just mistimed.

Planned, unplanned, or mistimed, this post isn’t about judging Bristol Palin or her choices about sex and motherhood. She’s an adult now and deserves to have both the autonomy to make her own decisions about her own body and the privacy to go through whatever she’s dealing with. But I just cannot wrap my brain around how she found herself in this situation. Again.

Bristol’s situation brings up some interesting points that, as a 10-year veteran of reproductive health, I cannot stop considering; mainly, why in the year 2015 do women often struggle to manage their reproductive health? What I really want to talk about is unplanned pregnancy and how incredibly easy it is to prevent with just a little bit of education.

What would you say if I asked which age group has the highest rates of unplanned pregnancy in the nation? If you’re like 70% of Americans, you’d answer “teens.” And like 70% of Americans, you’d be dead wrong. Rather than skyrocketing as most US adults believe, the teen birth rate is in fact dropping like a rock. In 2014 alone, US teen births declined 9% and rates have dropped a staggering 61% since peaking in 1991.

While we like to blame teens for so many of our nation’s ills (get off my lawn!), they’re actually doing a fantastic job of not getting pregnant. The group with the highest rates of unplanned pregnancy in the US are actually right in Bristol’s demographic; young women age 18-29. Bristol is smack in the middle of the current unplanned pregnancy crisis (think crisis is too strong a word? Consider this: more than half of all unplanned pregnancies* in the US occurred for women in their 20s and, of those unplanned pregnancies, 65% were women in their early 20s). She is part of the club of women who are having sex, not effectively using birth control (or at all), and—shocker—getting pregnant before they’re ready.

So why are teens kicking so much butt and young adults—who are older (and we assume?) wiser—falling so far behind?

Comparison of birth control method efficacy via The National Campaign to Prevent Teen and Unplanned Pregnancy

Comparison of birth control methods used by female family planning providers via The National Campaign to Prevent Teen and Unplanned Pregnancy

There’s no magic bullet answer to explain why the teen birth and pregnancy rates are plummeting while the rates for 20-somethings remain so stubbornly high. Some suggest that the recession forced many families to take stock of their finances and teens, who witnessed the day-to-day financial struggles their parents dealt with, and took notice—babies are pretty expensive, after all. Some suggest that shows like MTV’s 16 and Pregnant and Teen Mom have been instrumental in demonstrating the harsh reality of having a baby as a teen; rather than glamorizing these young moms, these shows provided a window into an incredibly challenging and rough time and, again, teens took notice. Some point to the recent American Academy of Pediatrics recommendation that pediatricians begin recommending long-acting methods like the IUD and implant to their teenage patients (there has been a modest uptick in adoption of these methods among teens but it’s still too early to tell if there is a causal relationship to decreases in the teen birth rate). I like to think the best answer is also the simplest: simply put, teens are having less sex AND using contraception more carefully and consistently when they do have sex. So bravo young people!

They are also, to some extent, being exposed to more education about the most effective methods of contraception available to them and they’re taking notice. In 2009, the Obama Administration signed the Consolidated Appropriations Act of 2010, which included $110 million for the President’s Teen Pregnancy Prevention Initiative (TPPI). TPPI created the first federal funding stream available for more comprehensive (ie—abstinence AND birth control) approaches to sex education. Currently, the federal government has recognized nearly 30 programs that have been rigorously evaluated and shown to help teens delay sex and/or use birth control more effectively. Since the implementation of TPPI, the teen birth rate has seen steady and sharp declines…coincidence? Maybe…but it seems unlikely.…**

So, teens are (for the moment) getting all this great education and learning about better methods and/or how to delay sex more effectively and the rates show that things are humming along nicely, but what about those 20-somethings like Bristol?

Well, as most of us know, once you hit adulthood—i.e. graduate high school—everyone assumes you’re good to go on the human body, how it works, and how it reproduces. Beyond a bowl of freebie condoms at the local clinic, there is rarely sexual health education in college curricula and there certainly isn’t much for those young people who skip college for other things. This forces 20-somethings to be proactive about their sexual health—if they want to find a better method (or ANY method) it’s on them to make it happen. For many women, this is just fine. But for many, many more, the stigma, fear, embarrassment, and other issues attached to simply admitting one is sexually active prevents them from seeking out even the simplest methods of birth control or learning about how their bodies really work. They may have grown up in a culture that forbids sex before marriage and so they wouldn’t dream of getting birth control…even when they know they may become sexually active. Or perhaps they simply rely what they know: the humble condom (that they may hate) or perhaps the pill they’ve been taking since high school (that they may not take consistently). Some think they can’t get pregnant during their periods, trust that the man is pulling out on time, they think they can’t get pregnant at that time (or that this will be the ONLY time they have sex), or they just believe that it won’t happen to them. This myth-believing and misinformation about their bodies affects all kinds of women from all different socio-economic backgrounds. Unplanned pregnancy doesn’t have a type; it can (and does) happen to anyone.

It can even happen to a young woman with a famous name, and famous mother who stands on a platform of pro-abstinence rhetoric. Because you don’t know what you don’t know and it can happen to you. So Bristol—best wishes on your new addition; I hope this next adventure is a fun and rewarding one…as a mom myself, I know just how much fun kids can be. But when you’ve had your child, please think seriously about birth control; there is nothing wrong with taking charge of your sexual health and your future and actively planning when you want to next get pregnant. – Edited by Leslie Waghorn

* In this case, “unplanned” indicates that the women themselves reported that they either did not want to get pregnant at that time or did not want to get pregnant ever.

…**As an aside, despite this remarkable progress and clear evidence that the programs funded by this money actually, you know, work, Congress is currently gunning to defund both TPPI and Title X, the nation’s low-income family planning funding stream. I could spend a whole other post detailing how those funding cuts impact millions of Americans but I’ll let this issue brief do it for me.)

Tags: , , , ,
Categories: Ages + Stages, Policy, Politics, + Pop Health, Pregnancy, Birth + Family Planning, Tweens + Teens