(3) Doctors, Lawyers, and Psychologists – Oh my!

I had to pass certain tests to be considered an acceptable gestational carrier.  Volunteering my womb was only the first step.  You don’t just walk in and say: “Oh hey, here I am.  Put an embryo in me.”  Qualification involves many steps, some physical, some psychological, and some legal.  In our case, most of the rules were set by OHSU in Portland, Oregon.  In the “physical” department, you won’t be accepted unless you’ve had at least one successful pregnancy (preferably two or more), with minimal or no complications.  I’ve had two.  Check!  One of my biggest concerns was my age.  I was worried I’d be denied because I was 45 years old at this time.  Interestingly, age is not really a deciding factor (above a certain legal minimum) for gestational carriers.  Yes, I was older than the average gestational carrier, but nowhere near setting a record in this department.  (By contrast, upper age limits are set for surrogates, since a surrogate is using her own eggs.)  To be a gestational carrier, your physical condition is important, and I’ve always tried to stay physically fit.  I exercise regularly, eat in a (mostly!) healthy manner, rarely drink alcohol, and don’t smoke or use drugs.  Check!  Right after making my offer, and even before knowing if I’d be accepted, I started limiting caffeine, and I completely eliminated alcohol.  To me, this was a small sacrifice for this important project.  I didn’t want some minor vice to jeopardize my success.

Medical insurance verification was next.  We were unsure if our insurance would cover a pregnancy started through IVF.  Not all insurance companies do.  Luckily, our insurance company covered pregnancy, no matter how the pregnancy actually got started.  But like most (maybe all?) insurance companies, ours did not cover any of the IVF costs.  This was OK and expected.  Darren and Holly already had that covered.  Check!

OHSU also required a legal contract between the intended parents and us.  Holly found some examples of surrogacy contracts, so we wrote up our own.  It was interesting to see examples of financial demands placed upon other intended parents in these internet examples.  We saw examples of women asking for large fees for their service, and additional compensation for much or all of their living expenses for the duration of the “project”.  We had no desire to impose such fees.  On top of all the other IVF costs, the high cost (a few thousand dollars) of paying a lawyer to validate/notarize a contract that we wrote pushed Darren and Holly to question whether or not to proceed.  It seemed like such a waste of money for a lawyer to do essentially nothing!  We offered to pay this fee or split it with them, but Darren and Holly refused to even consider this.  Holly found a lawyer who quoted a more reasonable rate, so we continued.  Check!

During the writing of the contract, my husband and I discussed two very key topics: (1) how many embryos to introduce; and (2) influencing a future baby name.  For topic (1), introducing just one embryo didn’t seem like enough.  The odds are a coin flip at best.  This might be the only chance for Darren and Holly to have a family.  Introducing two seemed OK.  Odds were increased, and I thought I could handle twins if it came to that.  Introducing more than two seemed dangerous to me, and maybe a bit irresponsible (remember “octo-mom”?).  After discussing with Holly and Darren, we decided on two.  As for (2) naming; in the contract my husband and I officially relinquished all rights to naming any future child(ren).  However, out of concern for a known fascination Darren had with the name “Elmo” (of Sesame Street fame), we added the following sentence to the contract: “Genetic Father agrees not to name any Child(ren) Elmo”.  Although there were some minor revisions to the initial contract draft, the Elmo restriction remained in the signed/notarized version.  Whew.  Our lawyer was so good, he never even saw it!

But there were more requirements to meet.  Below is the “Gestational Carrier Screening Checklist” from OHSU for me (and my husband).  Oh yes, any “partner” needs testing too!

Gestational Carrier:

Step 1 – Fertility Physician consultation

Step 2 – Initiate legal contract

Step 3 – MFM consultation

Step 4 – Certified Fertility Counsel

Medical tests:

Full blood panel (results within one year of transfer)

Pap Smear

SIS/HSG/Hysteroscopy  (Any ONE procedure is fine)

Trial Transfer (only at OHSU fertility consultants)

Mock Cycle (if needed)

MALE PARTNER:

Partial blood panel (within one year of transfer)

Medical qualification started with blood tests.  The required blood work was extensive, not just checking if readings are in normal ranges, but also checking for various diseases, viruses, and even STD’s.  The pokes and prods resulted in a clean bill of health for me and my husband.  Check!

SIS test:  The doctors doing the transfer also had to see what my uterus looked like.  Who knew my uterus was going to be so popular!  I underwent a Hysteroscopy, where they put a thin tube through the cervix and fill the uterus with a special fluid.  This reveals the shape of your uterus and highlights any potential problems.  Timing is critical.  This test must occur just one day after you’ve finished a period.  Luckily, my timing was just right for us to stay on schedule.  Check!

Maternal Fetal Medicine consultation:  I was required to see a MFM specialist, which was even more important because of my age and the fact that we decided to transfer two embryos.  MFM’s specialize in high risk pregnancies.  If I became pregnant, I would automatically be considered “high risk” because of my age.  I met with Dr. Winkler, a smart and witty guy who I immediately hit it off with.  He said that I could absolutely move forward, and that I was healthier at my age than some of his much younger patients.  Check!

Certified Fertility Counsel:   A shrink?  Really?!  Oh yes!  Don’t think you can just walk in and carry the child of another couple like it’s no big deal.  At first I didn’t really understand why we (oh yes, my husband too) had to get this psychological assessment.  After all, we’re just normal people, right?   But after talking to the evaluator, I realized it was a necessary step.  They can’t have people with medical, financial, mental or marital problems carrying such precious cargo.  We got through the joint interview, the individual interview, and the extensive multiple-choice quiz (250 questions) with passing results.  Check!  Holly and Darren were also required to see a counselor.  They passed too.

Trial Transfer:  This is where they “practice” the procedure of introducing the embryos.  They do this with a sonogram, taking video so they can see the best way to insert the tube into my cervix.  They also see where my bladder is, and any other anatomy that might get in the way of their view.  Surprisingly, it wasn’t uncomfortable.  It was a lot like having a pap smear, except with high tech equipment all around.  There were no issues.  Check!  I was also able to combine this trial with the Fertility consult -- Double check!!

Even though the checklist was extensive, we completed it all by the end of January.  Speed was necessary though, because Darren and Holly had a serious time constraint.  They were down to the last of four previously purchased transfer attempts, and the fourth needed to be concluded before early April, per their contract.  But this was only the first phase.  There was more preparation to complete before the embryo transfer.  I’ll call this the “transfer protocol”, which takes about 7 weeks.  We’re cutting it close…