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Piecing Together The Surrogacy Puzzle

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Dr Georges Sylvestre -MD

Richard Westoby interviewed Georges Sylvestre MD, a very well respected High-Risk Pregnancy obstetrician that I know in the US, about his opinions on singleton vs twins.  He has 20+ years of experience in the field, and just happens to be a gay dad via surrogacy.

Dr. Sylvestre specializes in Maternal-Fetal Medicine and practices at Flushing hospital NY City and is Assistant Professor of Clinical Obstetrics and Gynecology, Weill Cornell Medical College.

The first piece of the surrogacy puzzle is whether intended parents (IPs) want a singleton or twins! Emotionally, I have twins and if I could I would have twins again, but we had a relatively stress-free pregnancy and birth. We were lucky as this is not always the case.

Richard: Why do you think most IPs want twins?

Georges: Having kids via surrogacy is SOOO expensive that it sounds logical to have a single journey with twins that costs less than two singleton journeys. We’re also attracted by the somewhat higher pregnancy rates per cycle for two vs. one embryo. You also think: “what’s the big deal? Most twins do well anyway”.

Richard: Historically, didn’t IVF entail implanting more than 1 embryo?

Georges: IVF has been around for decades and up till around 10-15 years ago it was standard to transfer multiple embryos because the success rate was frankly dismal, between 10-20% pregnancies per transfer.

Richard: Can you explain that further?

Georges: Keep in mind most straight couples having IVF were (and are still) couples typically in mid to late 30’s, who have been trying to get pregnant for a while.

Now there is an increase in gay intended parents using egg donors that are young, typically with men who have no sperm issues and surrogates who have been medically screened so that they are super healthy. Three very different factors that increase pregnancy rates.

Also, the IVF process has improved a lot, so when coupled with egg donation, the pregnancy rates per transfer have logically increased. Recognizing that there were too many triplets, and quads, doctors stopped the practice of transferring 3-4+ embryos, unless the embryos are of poor quality. Many of us think that while twins are far less risky than triplets, they are still quite riskier than singletons.

Dr Georges Sylvestre & David Margolis
Richard: OK. Understood. I hear some doctors now prefer single embryo transfers (SET), also there is a surrogacy agency in Canada that has implemented a policy of only doing SET. In your opinion, what are the risks involved with having twins? Maybe start with what are the risks to the fetuses?

Georges: The main risk remains prematurity. Unfortunately, obstetricians have not found a way to prevent preterm delivery in twins. Nothing has conclusively worked to prolong twin pregnancies and in the end approximately 50% of twins are born premature (before 37 weeks), compared to 13% of singletons. This risk is not limited to “mild prematurity”, like birth at 34-37 weeks; we’re talking about twins born between 24-32 weeks. This explains why overall twins are 3-5 times more likely to develop severe disability, cerebral palsy, lower IQ (average lower by 5 points) and even unfortunately, death.

Babies born at 32-35 weeks are more likely to have some cognitive problems that develop later on: learning difficulties, behavioral problems, speech delays, ADHD and even autism. It seems that when it comes to brain development, every week counts.

Richard: Oh wow – so that’s quite a lot of potential complications with the babies; what about for the surrogate?

Georges: A surrogate pregnant with twins is at increased risk for: C-section (over 75% twins in the USA are born via cesarean), high blood pressure, diabetes, haemorrhage and also death (rare but it does happen). She is also at greater risk of being admitted for a pregnancy complication, for days to weeks, this can lead to bed-rest and the need for additional help around the house/childcare which means more money the Intended Parent will have to pay.

Richard: I have twins, and I know how hard it has been physically and logistically for my husband and I, what are your thoughts about the Intended Parents?

Georges: You hit the nail on the head, there is a huge impact for you!! Many of my friends with twins, one parent stopped working, placed his career “on hold”, or went for a part-time position or even a demotion, in order to take care of the kids. Not many of my friends of singletons did this, and in most cases, both continue working full time. Also, the risk of divorce is slightly higher in parents of twins compared to singletons. Not sure why.

Richard: Probably because they’re so tired!! Anyway, thanks for your thoughts on the risks! It’s always good to get a medical view as well as a subjective one too. What about costs, is it a misconception that twins are two-for-one?

Georges: With the cost of two journeys you would think everything is double. Two lawyers, pay a surrogate twice, two sets of IVF and so on. This leads you to think that it would be cheaper to do a single journey rather than two but actually the cost differential is far less impressive than you think:

a) Your surrogate receives more money for a twin journey (an extra $5,000-$10,000)

b) A cesarean is almost guaranteed which incurs a cost (extra $3,500-$5,000)

c) There is an increased likelihood of bed rest and childcare: your surrogate will probably need to be taken off work before term. You will have to pay her lost wages and sometimes for childcare because she can’t take care of her kids.

d) Your time away from work: because of the double arrival, one or the two of you may have to take longer parental leave or consider a long-term change in career. That’s costly.

Tristan & Noah

Richard: That last part definitely happened for us. However, what about the IVF costs for a second journey, surely the costs double?

Georges: Not really, you do a Frozen Embryo Transfer (FET) and typically your embryos have already been created, so no donor fees and fewer medications are required. Also most surrogacy agencies will give you a price reduction for the second journey (especially when using the same carrier) so ask your agency upfront what discount would they offer for a repeat journey?

Sometimes your legal documents can just be renewed. But your surrogate will normally charge a higher base-fee as she is now an “experienced” surrogate.

Richard: Georges, thank you so much for your time. I think it gives IPs a lot of information on why medically it might be better to have a singleton over twins. Although I can definitely say that being a dad to twins is double the work but quadruple the fun!

Georges: Twins can be fun when it all goes smoothly. For us when my oldest was 2+ years old, I no longer had a baby, we had a toddler. I was looking forward to having another baby again and to go through the birth, baby milestones, etc. For the second journey, although I did not enjoy the IVF process again, I was relaxed about it as I already HAD a child. I knew we wanted a second child, but there was none of that urgency associated with the transfer(s) of our first baby.

Richard: Thank you so much for that Georges, very informative on so many different levels.

To summarize, more often than not, having twins works fine, however, when it goes wrong it seems to go very wrong. What Georges is saying is that having a single child reduces the risk of complication but it doesn’t negate it! In this journey of science and making the variables work for you there is a lot we cannot control and getting pregnant is one of those things. We can control the environment, the amount of embryos implanted but then the rest is down to nature or God, Buddha, Allah (in whomever you believe) or just the fact that you did the transfer on a Tuesday – we just don’t know what makes some embryos stick and others not.

Anyone thinking about twins or singleton can get in touch with Richard via guidetosurrogacy.com

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Families Through Surrogacy – The Ukraine Solution

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Families Through Surrogacy

As Families Through Surrogacy’s consumer-led seminar series returns to the UK in October, SAM EVERINGHAM catches up with Stacy Owen, one of a growing number of UK citizens engaging in Ukraine for surrogacy.

Stacy and her Morrocan-born husband Simo live in Sutton, Surrey. Stacy was 41 when she turned to surrogacy after enduring twelve years of infertility grief and loss. Simo, an electrical tester, was ten years younger. None of Stacy’s ten pregnancies had lasted more than nine weeks and her doctors could only say the problem was ‘immune issues’. Surrogacy was the only option left.

Stacy is frank about her needs. “I looked into the UK surrogacy process (but) I didn’t want to have to ….. form a relationship and take the risk (with British law) of not being able to have our baby(s) should the surrogate change her mind.  I wanted it to be a business transaction….. I didn’t want to be forced to be involved with the surrogate, although I remain in contact to this day.”

With US surrogacy being too pricey, Stacy discovered Ukraine – one of the few countries which provide for legal parentage for foreigners using surrogacy.  One clinic offered an all-inclusive package for €30,000 including IVF and birth costs, egg donor if required, medications, legals, surrogate expenses, compensation as well as their own food and accommodation. She Skyped with the clinic a few times and they signed up in April 2017.

Stacy stimulated for one cycle herself and found the hormonal effects a challenge. Their first transfer took but failed at six weeks. Their ‘package’ included an egg donor, who they had to choose online as a backup. The 21-year-old they chose produced enough eggs to create six high quality embryos.

Their clinic substituted a new surrogate. Six weeks post transfer Stacy’s email pinged with the first scan. An ultrasound had arrived clearly showing two healthy embryo sacs. “It was amazing to receive”, Stacy remembers. “We were so excited and over the moon that we had twins”.

Stacey & Owen

Nonetheless, Stacy only told her parents and one friend.  “I didn’t want all the questions and enquiries – the process was a very private one … we had too many past losses to feel comfortable before they were born”

Their clinic had a policy of not introducing intended parents to their surrogate until the end of the first trimester, given pregnancies can often fail prior. So Stacy and Simo had their first face to face contact with their surrogate via Skype at 16 weeks. Until this point letters were exchanged.

Stacy flew to Ukraine to meet her surrogate for the 26-week scan as well as other English couples.

“Legal stuff was the one thing we didn’t know about, we thought the clinic handled all of it’ Stacy confesses. She had assumed the exit process might take three weeks. When they discovered other UK couples have had to stay in Ukraine between 5 and 7 months post-birth, Stacy felt ill. “Oh my god, what have we done”.

But having built a career in educational governance, Stacy was used to project planning and paperwork. So by the time they travelled to Kiev at 37 weeks gestation she had almost two lever arch files in preparation for the application for British Passports and Parental Orders.

The Owens had purchased an economy surrogacy package which gave them a room in a shared villa outside Kiev. It was like a ‘Baby Club’ boarding house, Stacy recalls, full of expectant parents – Chinese, Romanian, Spanish, Belgian. There was no air-conditioning – it was sweltering.

“I cried for two days when I first arrived – it seemed in the middle of nowhere and the thought of living here alone when my husband left was daunting” Stacy admits. However, the experience and meeting parents from around the world was ‘a wonderful one’.

Against all odds, their twins were not premature and Ukraine hospitals do not induce. To their surprise, they had 16 days to kill until the birth at almost 40 weeks.
Their package meant delivery in a cheaper city four hours south of Kiev. They arrived by train. Again their clinic provided transport, interpreters an apartment as well as baby formula, baby clothes, nappies and money for food. When Aleah & Eli were born, strict hospital protocols meant they could visit for an hour daily until discharge on day seven.

Stacy was so organised that she met the UK’s arduous passport paperwork requirements on the first attempt. So ten weeks post birth this family of four was winging it back home to Surrey. The Owens had a family building story they would never forget.

Stacy is just one parent who will share her surrogacy advice amongst those who have engaged in the US, Canada, Ukraine or UK at FTS seminar series next month in Dublin (23 Oct), Edinburgh (25 Oct) and London (27 Oct). These will include advice and short talks from surrogates, surrogacy professionals and legal experts. Details at http://www.familiesthrusurrogacy.com/uk-ireland-oct-seminar-series/

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Surrogacy in the UK

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Surrogacy In The UK

With all the recent Newspaper headlines about celebrity couples using surrogacy as a way of creating or extending their families, it is perhaps unsurprising that the number of couples exploring surrogacy as an option in the UK is on the increase. However, it is important for those considering surrogacy to remember that many of these Newspaper headlines are in respect of couples and arrangements which take place abroad, and, as such, do not comply with the law in the UK. Couples should be very wary of using these celebrity couples as a template for their own surrogacy plans.

No matter what the genetic make-up of a child, UK law regards the woman who carries and gives birth to the child as the legal mother. If she is married at the time of insemination or implantation of an embryo, UK law regards her husband as the legal father – unless it can be shown that he did not consent to the procedure.

This is the case wherever the surrogacy arrangement takes place ie. even if the surrogate mother is a foreign national residing abroad and even if the surrogate mother’s own home country regards the commissioning couple as the parents and provides documentation to this effect.

UK law does provide a procedure by which the commissioning couple can then acquire full parental rights for the child born. This necessitates an application to the UK courts for a Parental Order. If made, the Parental Order extinguishes the parental rights of the surrogate (and her husband if necessary) and vests all legal parentage in the commissioning couple. The surrogate mother and the legal father must give full and free consent for the Parental Order to be made. Such consent cannot be given before the child is six weeks old and the application must be made to the Court before the child is six months old.

Surrogacy contracts in the UK are illegal and are unenforceable. Surrogacy arrangements, however, are legal provided strict criteria are complied with. These criteria are designed to protect the altruistic nature of surrogacy and prevent commercial surrogacy taking place in the UK. It is very easy to unwittingly fall foul of these criteria and find yourself in circumstances where there is then doubt as to whether the Court can make a Parental Order. This leaves the intended parents without legal parentage for their child and facing the prospect of alternative legal structures to protect their family eg. adoption – which was never intended for use by parents in these circumstances and thus brings with it complications and unintended consequences.

Parliament has recently acknowledged that the law relating to surrogacy needs to change in the UK. This has been prompted as a result of UK law having been found incompatible with EU law and to be discriminatory. It is envisaged within the next two years a Law Commission Report will make recommendations as to change which will bring surrogacy law up to date with social change, although there is still a strong sense that the altruistic nature of surrogacy should be retained as opposed to there being commercial contracts introduced. In this area of assisted reproduction, it is really important that intended parents take proper legal advice both before and after their child is born as in every case there is a legal process that must be complied with if legal parentage of the child is as intended.

Bio
Liz Bottrill is a Partner in the Family Law Team at Laytons Solicitors with over 25 years’ experience in the field. She has a particular interest and expertise in the law relating to children and fertility. www.laytons.com

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Surrogates – Extraordinary Generosity Provides Family to Hundreds

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Hannah Bailey

There have been huge changes in surrogacy availability in recent years. UK couples have in the past engaged in Thailand, India, Nepal and Cambodia. But these countries have now closed their doors to foreign surrogacy, pushing renewed interest in surrogacy in the UK.

Deanne Hart has a condition which meant she was born without a uterus. Nonetheless she has working ovaries allowing her to produce eggs. After four years with her partner they were keen to start a family and joined Surrogacy UK.. Ultimately a UK surrogate expressed interest and they spent three months getting to know each other and their respective families. Putting together an ‘agreement’ (surrogacy contracts are not legal in Britain) with their surrogate, they were lucky to achieve a positive result on the first attempt.

Surrogacy for Brits is also increasing in the US and Canada. The key is selecting reliable providers.

Hannah Bailey lives in the Bath district. She has MRKH, a condition which affects one in five thousand woman. It means she was born without a womb. Hannah was diagnosed aged 17, so had some time to plan her options. Hannah considered a number of options to have a family such as adoption, but decided upon surrogacy. She joined Surrogacy UK and meet a potential surrogate. Surrogacy UK enforces a three month getting-to-know-you period, which proved beneficial as the partnership was not right. Hannah admits she and her partner became impatient with the poor Surrogacy UK ratio of surrogates to intended parents at the time (although this has now been rectified).

They felt that for them, the US was unaffordable, so they looked at Ukraine. It was a country which has laws recognising foreigners as the legal parents via surrogacy. However their UK lawyer advised that obtaining UK citizenship for children born via Ukraine was going to require many months abroad and much red tape. Canada also allows foreigners to engage in surrogacy, but unlike Ukraine, awards Canadian citizenship. It meant Hannah could bring a newborn back to the UK on a Canadian passport within three weeks, then apply for UK documents once home.

Their UK lawyer introduced them to Canadian professionals and within three months they had met a network of Canadians ready to support them and matched with a surrogate. Soon they were shipping their precious embryos from the UK to Canada.

It was a relief Hannah recalls, that they never had to have a conversation with their surrogate about expenses and re-imbursements. Like in the US, a third party managed this for them. Their son Zachary was born in August 2017 and already their surrogate has offered to help with a ‘sibling journey’ if she is medically cleared to do so. Hannah is hoping they won’t have to find a new surrogate. Wait times have increased in Canada and all prospective parents are now advised that matching is so competitive, they need to record a ‘video biography’ to sell themselves to prospective surrogates.

Cathy HuntBack in the UK, lesbian mums are also more commonly offering their reproductive potential to both gay and heterosexual intended parents, often using their own eggs in what is known as traditional surrogacy. Tricia Hunt and her wife Cathy have four children of their own – two boys aged 13 & 6 (Trish carried) & twin girls aged 2 1/2 (Cathy carried) with the help of IVF and a sperm donor. In recent years though, Tricia has carried children for several other couples.

Tricia & Hannah are just two of some fifteen UK surrogates and parents who will share the ins and outs of local and cross-border surrogacy, at Families Through Surrogacy’s fifth annual UK consumer conference on Saturday 10 March, at 155 Bishopsgate, London.

Focused on the information needs of intended parents and surrogates, the events’ popularity lies in its honesty – putting parents and surrogates front and centre, sharing their real-life journeys.

This year’s conference has a focus on best practice in UK & US surrogacy, with leading professionals exploring the complexities of surrogacy arrangements and how best to lay the groundwork for successful journeys. Sessions will address some of the tough questions about trust, logistics, sourcing donors, matching with surrogates and legal parentage. New sessions will explore surrogate-intended parent relationships, outcomes for children, and how surrogacy is operating in Canada, Russia & Kenya. Tickets from £55 including lunch, morning & afternoon tea.

FTS-London-Conference-March-2018-design3 (1)

Go to http://www.familiesthrusurrogacy.com/uk2018/

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