Reporter's Notebook: Surrogacy

The controversy surrounding surrogacy, the topic of this week's feature, is hardly new. Besides being regulated in the Code of Hammurabi, dating from 1800 B.C., a disagreement over a surrogate situation is linked to the great division between Christianity and Islam.

The Torah, the Bible and the Koran all recount the story of Avraham Avinu, Father Abraham, or Ibrahim, depending on the translation. As the tale goes, Abraham’s wife Sarah was infertile. Faced with the shame of being barren, she gave her husband her Egyptian handmaid, Hagar, to help him procreate.

Once the baby was born, however, Sarah was plagued by jealousy and forced Hagar and her new son, Ishmael, to flee. The two escaped to the Arabian Peninsula, and Ishmael and his descendants are often credited with the spread of the Muslim faith.

Surrogacy remains controversial in many ways because it redefines society’s most basic idea of motherhood, report Lorraine Ali and Raina Kelley in the March 2008 edition of Newsweek. It questions the celebrated bond between mother and child. It mixes science with one of the most common and natural human customs, childbirth.

The practice is banned throughout most of Europe and a dozen states, including New York, New Jersey and Michigan, refuse to recognize surrogacy contracts.

Usually, the issues of compensation are the most contentious. Providing money to surrogates lures poor women to the practice, says Tom Prichard, president of the Minnesota Family Council. "It’s baby selling and the exploitation of women. It’s wrong."

Others, including most medical professionals, surrogates and intended parents, say that surrogate payment is money well deserved. There are much better jobs then being pregnant all the time. There's morning sickness, bed rest, the risk of complication, the possibility of a forced cesarean section, the time carrying a child takes away from one’s own family, household or career responsibilities and the required nine months of personal restraint.

While riddled with controversy, surrogacy is on the rise in the United States.

"At the high end, industry experts estimate there were about 1,000 surrogate births in the United States last year," Newsweek reports. It's gaining ground in Minnesota too, says local surrogacy lawyer Steve Snyder, who also runs the International Assisted Reproductive Center, a Twin Cities-based surrogacy agency. "People have come here from all over the world to find a carrier." Fertility tourism, as it is often called, has become so lucrative it's even being outsourced.

Advances in Assisted Reproductive Technology starting in 1970 have changed the way infertile couples think about having kids, says University of Minnesota reproductive endocrinologist Dr. Theodore Nagel. The first test tube baby was born in 1978 and now there are over a million babies born that way worldwide. One percent of all American births are the result of ART, he adds.

More than ever before, the medical landscape is such that nearly anyone can have a baby if they desire and are dedicated to the process. "If you think about it, with all this technology, one child could have five different parents: a sperm donor, an egg donor, a surrogate, and the intended," says Nagel excitedly. "It's really quite amazing."

Surrogacy is popular because it allows people to have a genetic link to their children and it is often times cheaper than adoption or multiple rounds of in vitro fertilization, says Snyder. Despite its controversy, traditional surrogacy, when the surrogate uses her own eggs, remains especially attractive to low-income families because it is affordable. Artificial insemination only costs between $500 and $1,000.

Gestational surrogacy, when the surrogate only donates her womb, requires IVF, a procedure not covered by most insurance companies, which averages around $12,000 to $15,000 per cycle. Because of this, traditional surrogacy is often the most viable and affordable option for poor couples or homosexual partners looking to expand their family.

In recent years, many states have legalized surrogacy in order to regulate it. In the last five years Texas, Florida, Utah and Illinois have passed pro-surrogacy legislation. More than a dozen other states including Pennsylvania, Massachusetts and California already have pro-surrogacy case law as guidance.

Former surrogate and Minnesota resident Tracey Sajady thinks legislation is the only way to go, citing the day she and the genetic mother and father were scheduled to go to court to complete the adoption process required after a surrogate birth. For the last nine months she had carried a child for her sister-in-law and was flabbergasted when their lawyer told them they should come back to court another day.

He never specified what was wrong, but it’s hard not to wonder if the judge would have denied the surrogacy because of personal politics, says Sajady. "How weird would that have been, if the judge had told us her baby wasn’t really hers? I mean we could have paid all this money and done genetic testing to prove the child belonged to her, but why should we have to do all that?"

The families returned a few weeks later, went in front of a different judge, and the adoption was approved.

Being a surrogate was one of the proudest moments of Sajady’s life. At 28 she watched helplessly as her sister-in-law struggled to have a child of her own. It was painful to watch. They had gone through IVF seven times and still couldn’t get pregnant, she adds.

"With my own two-year-old at home, I couldn't imagine how they felt. After I experienced what a joy it was to have my son, I didn’t want her to be denied that," she says.

Sitting upright in a nearby coffee shop Sajady, a medical sales representative from Mound, taps her perfectly manicured nails on the table and is quick to point out that surrogacy isn’t something only poor, uneducated people do; she has a master's degree after all.

She isn’t the type of woman to just jump into something without thinking it through first, but recognizes some people might. That’s why she says legislation is so important.

Surrogacy contracts between family members can be some of the messiest. Often times with family people fail to talk out all possible options because they assume they already share the same mentality and morals. That isn't necessarily the case, Snyder says.

Sajady and her sister-in-law spent months researching surrogacy online and decided to approach the unconventional pregnancy delicately. They contacted an agency and were given specific guidelines to follow. They had a lawyer drop a contract with dozens of what if scenarios to make sure every one was on the same page.

People don’t think about it, but there’s a lot of trust going into a surrogacy agreement, says Snyder. The intended parents have to believe that the surrogate will be responsible with the pregnancy, that she will take care of her body, eat the right foods and refrain from drinking and smoking.

The surrogates on the other hand, need to believe that the intended parents will give the child they are carrying a safe home. They need to be assured that regardless of the pregnancies outcome, if the child turns out mentally handicapped, or if she gives birth to triplets, that the intended parents will indeed take the baby. Usually, there is no problem, he adds. Still it is good to sort these types of issues before there is a baby.

After nearly a year of discussing the pros and cons of surrogacy, it was decided Sajady would carry the baby. Her sister-in-law would go through IVF one more time; her eggs extracted and combined with her husband’s sperm, the pre-embryo would then be implanted to Sajady’s womb to grow.

The two couples both went through counseling to mentally prepare for the birth. At times Sajady worried she was going to bond with the baby and not want to detach. But, with the help of a therapist she was able to frame the pregnancy as an act of kindness, something to be proud of, and something altruistic in the best sense. "It wasn’t weird at all in our family," she says. "We thought it was just a wonderful thing."

As her belly swelled Sajady realized her worries about bonding were unfounded. During her first pregnancy when her son moved around, Sajady would get that expectant mother giggle, and sigh as if trying to preserve the child’s every movement in the womb as a miracle. But, during the surrogate pregnancy, Sajady felt a kick and jokingly told the baby in her womb, "'Stop that. I'm trying to get some work done.' I was very detached. It was totally different."

For nine months she knew the baby inside her wasn’t hers and she was OK with that. The last month of the pregnancy had been "totally uncomfortable. Everything hurt and I couldn't even eat because my stomach was so full. …For me it was just such a relief to be done being pregnant and such a joy to see them with this child finally. It was such a miracle how it got there. I never had any regrets. I never once thought oh, this is weird or unnatural. It seemed very natural.”