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Thursday, October 15, 2015

Surrogacy gives hope to childless couples

On July 28, 2014, Andrea Muehlhaus underwent a C-section and gave birth to Dylan, a dark-haired baby boy, at Saddleback Memorial-Laguna Hills. The newborn took his first breath at 8:20 a.m. and weighed 7 pounds, 6 ounces. He was perfectly healthy, with 10 fingers and 10 toes.

After the delivery and recovery, the baby went home with his fathers – Robbie Cronrod and Allen Artcliff-Cronrod, a married couple from Los Angeles. Since their first date, they had talked about wanting children, and Muehlhaus had given them that chance.

Muehlhaus lives in Westminster and has two children of her own, ages 10 and 6. She gave birth to a little boy for another gay couple three years ago. “I wanted to give back in some way, and for me personally, I wanted to help gay couples because they can’t have a child on their own,” Muehlhaus said. “They need someone else and I felt like I could be that person who could help them create their family.”

Muehlhaus is not genetically related to either of the surrogate children she carried. As a gestational surrogate, she was implanted with an embryo through in vitro fertilization. The egg was harvested from an egg donor and fertilized through one of the fathers’ sperm.

A traditional surrogate is a woman who is artificially inseminated with a father’s sperm, then carries the child to term. She uses her own egg and is the child’s genetic mother. The couple seeking and using a surrogate are known as the “intended parents.”

Now a surrogate program coordinator at West Coast Surrogacy in Irvine, Muehlhaus matches surrogates to intended parents and guides them through the process. Her most recent surrogacy was handled independently before she started working there. Surrogacy agencies usually process commercial surrogacy cases in which a woman is paid to carry a child. West Coast Surrogacy coordinated 46 births last year and works solely with gestational surrogacy.

“It’s safer for everyone involved,” said Tyler Zion, the intended-parent coordinator at West Coast Surrogacy. “It can get real complicated if the surrogate is genetically the mother. It can put everyone in a position they don’t want to be in. Traditional surrogacy is not commonly practiced. It’s real challenging to give up a genetic child.”

The surrogacy process can take 15 to 18 months from wait time until birth, Zion said. After the surrogate is matched with intended parents, both parties meet in person. It’s kind of like dating, Zion said. If they hit it off, a surrogate agreement is signed. The surrogate undergoes an extensive health screening, ultrasound, background check and psychological testing for both her and her husband or partner.

After the screening process, the surrogate starts taking IVF medication until the embryo transfer. At West Coast Surrogacy, the intended parents are usually involved during every phase along with a case manager.

“Parents who come to us, they have been through everything from A to Z to find out that surrogacy is the last resort to have their own biological child,” Zion said.

He adds that many couples who come to West Coast Surrogacy have suffered multiple miscarriages, serious illnesses and years of infertility.

Surrogate requirements
The American Society for Reproductive Medicine, which provides guidelines to intended parents, surrogates and surrogacy agencies, recommends that gestational carriers be at least 21 and have delivered a child previously. The carrier should have no more than five previous vaginal deliveries and two previous cesarean deliveries.

Most of the surrogates at West Coast Surrogacy are in their early to mid-30s. Older surrogate pregnancies can have an increased chance of complications and risk. Zion said it is important for a surrogate to have given birth and raised a child of her own so that the feeling of loss is minimal and she has a family to return to after giving birth.

Expenses and compensation
Not only can surrogacy be emotionally taxing, the financial cost is significant. Juli Dean, director of Coastal Surrogacy in Newport Beach, said she prepares her clients to spend about $100,000 to $150,000, which covers agency fees, medical costs, health insurance, legal fees and surrogacy compensation.

At Coastal Surrogacy, surrogate base compensation starts at $28,000 plus an allowance for housekeeping, maternity clothing, psychological support and other expenses. Compensation is given for embryo transfer, positive pregnancy, confirmation of heartbeat and other medical milestones. The total compensation adds up to $40,000 to $52,000.

The base pay for first-time surrogates at West Coast Surrogacy starts at $35,000 plus additional compensation similar to that at Coastal Surrogacy. Overall, West Coast Surrogacy benefits’ package rounds out at about $45,000.

Matching and legal issues
Under California law, the intended parents and the surrogate must have their own independent legal counsel before signing the surrogate agreement. A law that went into effect in California in January mandates that a surrogacy contract must spell out how the surrogate’s health care is being paid for (e.g., what insurance policy will cover the pregnancy and delivery, and who is paying the premiums).

The American Society for Reproductive Medicine’s guidelines for patients state that “legal contracts, in addition to delineating financial obligations, may include details regarding the expected behavior of the (surrogate) to ensure a healthy pregnancy, prenatal diagnostic tests, and agreements regarding fetal reduction or abortion in the event of multiple pregnancies or the presence of fetal anomalies.”

During the matching process at West Coast Surrogacy, the surrogate’s and intended parents’ personal beliefs are taken into account.

A surrogate may need to decide whether she would work with parents who might choose to terminate a pregnancy if the embryo has genetic or medical defects.

“Ninety-nine percent of the time, the parents want that option (to terminate the pregnancy),” said Zion.

“The couples have likely endured many miscarriages, and that has brought them here. It is a very expensive process and a lot of them want that option to start again.”

Zion adds that the number of intended parents looking for surrogates outweighs the number of surrogates available. At any given time around 20-30 parents are waiting for a surrogate match at West Coast Surrogacy. The average waiting time is two to six months.

Before the third trimester, Dean advises her Coastal Surrogacy clients to complete the legal confirmation of parental rights.

In the case of an early pregnancy or complications, legal preparations are made in advance so there is no confusion after the birth about the identity of the parents.

“The court system in California used to treat surrogacy like adoption,” said Dean. “Now everything is done pre-birth. The intended parents are legally the parents. Everything plays out the same way in the hospital as it would if the intended parents were giving birth.”

A lifelong bond
At Saddleback Memorial, the Women’s Hospital includes a surrogate bonding room where intended parents can stay and care for their newborn during labor and recovery. Terri Deeds, director of Women’s and Children’s Services at Saddleback Memorial, said the private room is outfitted with two sleeping chairs and a private shower and bath. She adds that families travel from all around the world to deliver via surrogate at Saddleback Memorial.

Still illegal in some countries, such as Australia, commercial surrogacy is becoming less stigmatized in California, Dean said. As celebrities such as Sarah Jessica Parker and Neil Patrick Harris create families through surrogacy, the practice has become more widely understood.

“A few years ago, our surrogates would get the weirdest responses when they told people they were carrying a child for someone else,” said Dean. “I don’t think that happens so much anymore. There is a lot of positivity for it. People are amazed and in awe of our surrogates and their willingness to (carry a child) for someone.”

Today, Muehlhaus remains close to the families she has helped form through surrogacy. She attends birthday parties and regularly receives updates on their lives.

She said surrogacy changed her life. “During my second time around, the parents attended all of the obstetrician appointments, and I got to see the excitement in their eyes and hear it in their voices when they talked,” said Muehlhaus. “You are helping them achieve something and bring this baby into the world. It’s really special.”


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