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Thoughts from a Repeat Donor – Guest Post by Repeat Donor

donor-teresaPart of my goal with this blog is to show as many sides to this issue as possible. I frequently get asked the motivations for a donor’s donation. I think it is always interesting to hear from our donors, especially those who choose to donate more than once. Here I have the comments from one of our amazing repeat donors who has been with us for a couple of years.

“As far back as I can remember I have always loved helping people. My parents instilled good morals and lived their lives with the golden rule in mind. I first came aware of the egg donation process when a friends aunt was considering egg donation as an option.

They had three unsuccessful IVF attempts due to female infertility factor and egg donation was the last result. Seeing the sadness and how it affected her entire life really sparked an interest in me. I remember thinking what a horrible situation she was going through. I began to do some research on fertility and the egg donation process. I really felt for these couples who desperately needed donor eggs to create their own families. As I deepened my knowledge my heart really went out for all men and women put in this tough predicament. Being introduced to My Donor Cycle I felt very informed and well guided through the entire egg donation process. After completing the preliminary tests of becoming an applicable donor, I had a realization of the commitment and dedication I was willing to do to help someone I had never even met. At the beginning of this journey I would have never of guessed at how much I have grown as a person. I have a greater understanding of the lengths I will go to help someone in need. It also deepened my capacity to empathize with the hardships and suffering of others. It also gave me joy and the elation of an successful donation. Being a egg donor changed my life positively. I hope this process changes all the lives of of intended parents for the best possible outcome. Everyone deserves the chance to have their dreams come true.”

Contributed by: Donor Teresa, Arizona, 2014

Surrogacy Options – A World View – Chapter Nepal

Nepal has recently become an option for international surrogacy. This is mainly due to it’s proximity to India. The push for Nepal came when India closed it’s doors to LGBT coupes and singles and the clinics and doctors in India were looking for a way to replace this income.

Nepal – Surrogacy in Nepal is generally accomplished using Indian surrogates and they are moved to Nepal for delivery. At this stage, the laws allowing commercialized surrogacy are “in process” but not formalized and not guaranteed to be so (though there is high confidence the laws will materialize). Typically, the Indian clinics and their physicians set up shop in neighboring Nepal to complete the embryo transfer and surrogates will spend their gestation in India. It is the end where they are moved back to Nepal or sometimes may stay in Nepal throughout their pregnancy.

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© Jose Fuente | Dreamstime Stock Photos

Positives of Nepal
  • Nepal is using doctors who are pretty experienced in surrogacy and IVF as they are the same clinics and physicians who have been working in India for the last 20 some years (https://gayswithkids.com/changing-surrogacy-options/). 
  • There does seem to be an effort by the Nepalese government toward a legal framework to make surrogacy defined and legal (within bounds). It is hard to find clear information on this online but many advocacy groups seem to feel this is the case. If anyone has further information, please comment an link. 
  • It will be interesting to see the rest of the positives as they form but as Nepal is so new, it is hard to comment too much until they come up with a law. If they create framework similar to India but allowing gay couples, they could make for a decent destination. 
Negatives of Nepal
  •  At this point, there is no legal framework and contracts being created and pregnancies started are putting a great deal of faith in surrogacy becoming legal and safe. This makes me nervous because while couples with babies might be fine even if they find it illegal (typically countries when placing restrictions will allow those children already created a path out with their Intended Parents), couples who have just started or have embryos will likely find themselves in the same place as couples in Thailand (unable to get their embryos out). 
  • Another serious concern with surrogacy in Nepal is the medical infrastructure.   While India has hospitals capable of handling high level NICU issues, this is not the case with Nepal. I would highly recommend anyone considering Nepal for their pregnancy review the following report: Pediatrics App Publications
  • It is difficult to determine the other possible negatives with Nepal as it is so new and as there is no legal framework at this time, evaluating the rights of Intended Parents, surrogates or the children born from these arraignments is challenging. 

I think at this stage, the idea with Nepal is to proceed with caution. I will feel much better about it’s outlook as an emerging surrogacy market after more is learned about the legal structure it takes.

Surrogacy Options – A World View – Chapter Mexico

With my work with Surrogacy Beyond Borders, this is my wheelhouse. I personally prefer surrogacy in Mexico for a variety of reasons but it does not mean it is devoid of issues. There are logistical, legal and experience issues Mexico faces as it gains popularity as a surrogacy destination.

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Mexico – Commercialized surrogacy has been active for about two years in Mexico. There are two areas where surrogacy is legal. At present, the only state where surrogacy is defined and legal is the state of Tabasco (http://mexico.usembassy.gov/eng/citizen_services/passports-birth-report/surrogacy-art-and-dna-testing.html). This does not prohibit embryo transfers in other states but it does require babies born via surrogacy to be born in Tabasco. There is a well defined law which creates a strong legal framework making the Intended Parents the legal guardian and parent of any child born through surrogacy. Mexico City is currently considering a law allowing for commercialized surrogacy as well. This law has been approved by the government but is awaiting the Governor’s signature.

Positives of Mexico
  • There is a well defined legal framework. In Tabasco, the law is very clear in it’s allowing of Intended Parents to be the legal parents of any child born through surrogacy. This has been the case since 1997 when a government official created the law in an effort to have a child himself. Though commercialized surrogacy has not been common until about two years ago, the courts are accustomed to this process as Mexicans have been utilizing theses services since 1997. 
  • There are no restrictions on LGBT Intended Parents. In Tabasco, there is no exclusion on single or LGBT parents. When the baby is born, the name of the genetic link appears on the birth certificate. There is no need to have the surrogates name appear (unless required by the Intended Parent’s government like in the case of the Netherlands or Sweden). In the case of two men, the semen provider’s name will appear on the birth certificate and the mother’s name will be left blank. If the couple lives in an area allowing for gay marriage, they can perform a step-parent or second parent adoption and both appear on the birth certificate. 
  • Medical care is pretty advanced in Mexico. Though Mexico is still considered a third world country (http://www.nationsonline.org/oneworld/third_world_countries.htm), there is great access to wonderful health care. So long as your surrogacy is occurring in a major city, your surrogate and the baby should have access to medical care similar or better than that in the States. This doesn’t mean every hospital in Mexico is as good or better than the states but does mean that a surrogacy in the US could end up a rural or smaller and less equipped hospital in the states while most agencies in Mexico use only big and advanced hospitals. On a personal level, I broke my tibial plateau in two places while visiting our housing in Cancun and ended up in the hospital we use for surrogate care. I was shocked at the advanced level of care I received and though I wasn’t thrilled to have a broken leg, I am happy I went through it so I could feel confident about the care provided in Cancun. 
  • If privacy is what you want, privacy is what you will get. Due to confidentiality and the method of legal agreements, your journey will remain your own. You do not have to face the possibility of seeing your journey broadcast on Facebook or any other social media. 
  • You can select housing for your surrogate. Some agencies (including Surrogacy Beyond Borders) offer surrogate housing. This can be very important as access to healthful food, prenatal vitamins, health care, transportation or a safe environment can be a challenge in Mexico. In the US, housing isn’t practical due to expenses and different culture. Knowing where your surrogate is and that she is living with staff who work for you can help with anxiety throughout the process. 
  • Transparency is possible in Mexico. Where some other international options are less than transparent, Mexico seems to be a location where you can expect similar visibility to the US. Doctors will generally be open with you and share reports quickly. You can visit the surrogates, speak with them openly, share contact details should you wish and some agencies offer escrow management for your money during the process. 
  • Proximity is better for US Intended Parents – For couples in the US, international surrogacy has been a world away. Going out of the US has meant flying 20+ hours each way to visit a clinic, your surrogate or pick up your baby. With Mexico, it is just a short flight with less expense. 
  • Insurance may be offered – Insurance for complications with your surrogate is available in Mexico. Check with your agency if it is offered with their program. This can ensure your costs stay low and that your surrogate will have access to great care throughout her pregnancy without sticking you with the cost. 
  • The cost of Mexico is much lower than the US. Many agencies quote surrogacy only services around $35,000 (not including Intended Parent travel, passport fees, and embassy fees). Surrogacy Beyond Borders offers fees from $42,000 inclusive of surrogate housing for surrogate only or up to $80,000 for the most expensive service including a US donor, embryo creation in the US, egg splitting (if requested), HIV treatment, and gender selection. The standard Surrogacy Beyond Borders couple using a donor and surrogate can expect to pay around $60,000. Compared to the US cost of 120k – 160k for a surrogate and donor cycle, Mexico can be a much cheaper alternative. Also, costs of travel to Mexico for US couples is much less than travel to India or Nepal. 
Negatives of Mexico
  • Mexico has a present reputation issue. Not only do many people see Mexico as unsafe but it has also been hit with recent scandals and stories of couples losing money with one particular agency. I imagine Mexico will get past this at some point but it does cast an ugly shadow.
  • People are rushing in with little or no experience. Due to proximity and relative ease, many new players are coming into Mexico to jump on what looks to be a big influx of business. Unfortunately, new an inexperienced companies run the risk of making mistakes which can make more negative waves. 
  • In Tabasco, only altruistic surrogacy is technically legal. The law in Tabasco relates to altruistic surrogacy which means the companies (including Surrogacy Beyond Borders) offering commercial surrogacy must utilize payment structure to surrogates to ensure the couple themselves are not paying the surrogate for her services. There are a few ways to do this but it does run the risk that loop holes allowing for the commercialization of surrogacy could close. It is important that any agency you choose has a reasonable and sound way of dealing with this. A surrogacy contract with a surrogate CANNOT mention compensation. If it does, the court will not allow it. 
  • As commercialized surrogacy is relatively new in Mexico, things could change. While we don’t expect a change or tightening of laws in Mexico, it could happen. The good news in Mexico is they seem to be heading toward better equality and more progressive views. While gay marriage became legal in Mexico City in 2009, there has been another state recently added to that list (http://www.ibtimes.com/mexican-state-legislature-becomes-first-approve-gay-marriage-1676064). Additionally, Mexican courts in Villahermosa (the city in Tabasco where most births take place) seem to be taking steps to make surrogacy contracts more easily executed. The upcoming addition of Mexico City for legalization of surrogacy also points to Mexico not changing to the more restrictive. None-the-less, there are no guarantees and it is possible for Mexico to go the way of either India or Thailand. 
  • Language barriers can be frustrating. While in India, most medical professionals speak English, this is not necessarily the case with Mexico. While it is unlikely you will have a Spanish only speaking IVF doctor, the doctor managing the care of your surrogate or delivering your baby could be only Spanish speaking. If you do not speak Spanish, the pick up process while you are in Mexico and the medical aspects might be frustrating. 
  • Exit processing times from Mexico are longer than India or the US and can vary. While I have personally seen the exit process take 3-4 weeks, the embassies are quoting about 5 weeks due to DNA processing times. You will not be able to travel from Tabasco to Mexico City (where most embassies are located) for at least 10 days past birth (more if there are medical issues requiring NICU). Your process with the embassy will not start until you arrive in Mexico City and meet with the embassy. This adds to your time and can mean you will end up in Mexico for 5 weeks (three weeks longer than India’s 2 week estimation). Make sure your agency has a relationship with your embassy and you know WELL in advance what documents you will need. It will help to speed up the process as much as possible. 
  • Selective reduction isn’t possible unless there is a medical reason. Abortions are illegal in most states in Mexico. The primary place to terminate a pregnancy should you find a need (God forbid) would be in Mexico City. A medically necessary pregnancy can be affected up to 20 weeks but an elective pregnancy must be completed by 12 weeks (before you can reasonably know of any medical issues). Reducing the number of fetuses is not allowed unless it is a health threat to the carrier. This means, do not transfer more embryos than you are comfortable with and keep in mind embryos can and sometimes do split. 

mexico

Mexico seems to be a great and exciting new frontier for surrogacy options for Intended Parent(s) of all types all over the world. It will be interesting to watch and help shape how it develops. I have personally chosen to provide surrogacy from both here and the US because they feel the most stable to me without restricting LGBT rights. I founded Surrogacy Beyond Borders in January of 2014 after 7 years of offering surrogacy in the US in an effort to offer affordable surrogacy services for my clients. There are some great agencies out there and there are some well intentioned agencies who might just not have the background for the venture. Make sure when you choose an agency to do your research, speak to past and current clients (not just one, ask for two or more) and make sure your money is being handled in a way you feel is safe.

With my work with Surrogacy Beyond Borders, this is my wheelhouse. I personally prefer surrogacy in Mexico for a variety of reasons but it does not mean it is devoid of issues. There are logistical, legal and experience issues Mexico faces as it gains popularity as a surrogacy destination.

A Beginning

Hello World!

Surprised baby boy using a laptop computer

I have thought of writing a blog for awhile but never taken the bull by the horns. I decided to start this particular blog, on this particular day because I realize as a long term surrogacy and donor agency lady, I have a lot of the same conversations on a weekly if not daily basis.

As much information there is about some parts (mainly the bad or sales parts) of surrogacy and egg donation out there, there doesn’t seem to be much in the way of answers to the questions commonly asked and the situations commonly experienced by donors, surrogates and Intended Parents.

My hope is to inform and also create a space for people to ask openly or privately questions relating to a very sensitive and sometimes difficult journey.

A note about moderation – I encourage open and honest discussion and questions about egg donation and surrogacy and the issues surrounding it both in the states and abroad. Comments which add to this goal will be approved. Please respect confidentiality and if you share a story, please make sure it is either yours or you have permission to share it.

Let’s get started!

Surrogacy Options – A World View – Chapter USA

With surrogacy options changing on a seemingly daily basis, I think reviewing the status of the various locales, media, laws, challenges, benefits and costs is a good idea. I personally have experience in just two countries but I have done a fair amount of research on the other available options and I feel I can relay fairly the options here. I do encourage discussion or addition of information in case I miss something, something has changed or I get something wrong. In this posting, I will address the good and the bad of the US.

Stars & Stripes

United States – I think it makes sense to start here because the US has a long history of surrogacy and most see it as the most sound and safe location for their journey. It is also considered the most expensive. US surrogacy has several advantages as the laws are somewhat clearer in many states, there is a long history of case law on the side of Intended Parents, agencies have been doing it for quite awhile in most cases so there is less guess work. I will list some of the positives and negatives below.

Positives of the US
  • Long history with legal security, case law and agencies who know what they are doing. The US has been doing surrogacy since 1985 (http://en.wikipedia.org/wiki/Surrogacy). We in the US have gone through some big issues and successes which have all helped to shape surrogacy in the US today. Our courts have seen many variations of contracts and situations and most issues have an expected solution which makes problems less overwhelming.
  • Tried, true and trusted medical care. Medical care in the US has a great history of being some of the most leading care in the world. Though it is expensive, you can typically assume easy access to great neonatal facilities in major cities. Also, having your medical team speak English can be a huge relief (unless of course you don’t!). 
  • The US is a first world country with presumably first world living conditions and pre-natal care. When you work with a surrogate in the US, you typically assume she and her family is well nourished. This means the money she is receiving isn’t going toward the basics needed to care for her family. Ideally, the money your surrogate receives for her monthly expenses go toward additional nutritional food for the pregnancy and prenatal vitamins. Even if your surrogate lives in a small town (most Surrogates do not come from major cities), she will likely be in reasonable driving distance to a major hospital offering level four NICU care. This is especially important with twins as they are often premie and in need of medical intervention (more on this later). 
  • There are clear Intended Parent rights (in most states). As you can see by the map here (http://www.creativefamilyconnections.com/state-map-surrogacy-law-practices) the laws are very different in different states but there are quite a few where surrogacy is considered very safe and well defined. Surrogacy is also becoming more widely accepted and laws are loosening in some previously unfriendly states. As long as you make sure your surrogate lives in one of the “green” or “orange” states, you shouldn’t experience any issues in your journey with legal blocks. 
  • You will have the ability to have a larger role in your surrogacy if you live nearby (you can possibly attend appointments or at least visit frequently with your surrogate). This can be nice if you want to feel more connected to your process. It can be fun to attend some of the appointments where the major ultrasounds take place. You might think you want to attend all appointments but as someone who has had three pregnancies – the non-ultrasound appointments are pretty boring.  
  • You are protected by HIPPA and other privacy regulations with your agency and medical professional (this doesn’t cover your surrogate’s ability to speak out about your process however).  Your agency is restricted from saying anything publicly about your process even if things turn sour. They are bound by the same HIPPA regulations as are your doctors. Record handling and medical information sharing must be in line with regulations. 
Negatives of the US
  • The cost is much higher in the US than any other location. It is 2-3x higher than it is in most other countries. This is due to agency fees, surrogate fees, legal fees but mainly medical costs. In the US, you should expect to spend between 120k – 180k on average if you are using a donor as well as a surrogate. If you are not in need of a donor, you can expect to spend 70k – 90k on average assuming you don’t need multiple egg retrievals to achieve a pregnancy. 
  • State variance can be an issue if your surrogate ends up needing to relocate during your pregnancy or decides to relocate for any reason. You could start your surrogacy in one state where your rights are well founded and the delivery could happen in a much more restrictive or complicated state. 
  • Due to social media, your journey could be made much more public than you bargained for. There is no real way (even through contracts with the best attorneys) to make your journey 100% private and keep your surrogate for sharing things with family, friends or even the world via Facebook, Twitter, Instagram or any other social media site. 
  • Expenses could sky rocket. I addressed the cost above but that doesn’t assume something going very wrong with your delivery or pregnancy. Due to the cost of medical care in the US, you could end up with hundreds of thousands of dollars over budget and an insurance company denying your claim due to it being a surrogacy. 
  • Your relationship with your surrogate might not go as planned. While most surrogacy cycles are a wondrous experience for both parties, it does happen that either the Intended Parent or the Surrogate begins to behave badly. I have seen both sides and neither is fun for anyone. Though your surrogate signs an agreement saying she will eat Organic, you can’t really legally obligate her to do so. If you wanted to terminate a pregnancy due to medical issues, you can’t force her even if she agreed to at the start. If she was single when she started, this doesn’t mean she won’t become entangled in a relationship that could add complications while she is pregnant. For the Surrogate, though you both decided to give each other space, Intended Parents have been known to overstep and become very controlling. Intended Parents have also been known to not set enough money aside to complete their journey in case of an issue arising making the payment process difficult for all. Also, Intended Parents who committed to being involved can instead end up very distant and not providing the expected support or interaction. 

While there are many other things that are good and bad about surrogacy, the goal with this post is to address those which differ depending on the country where you complete your journey.