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Message of Hope from S.J.

No matter where you are in your journey – whether you are in your late 40’s trying to start a family, are on your first or tenth miscarriage, were told by a doctor that your chances ever to get pregnant were slim, Do not give up hope! This is not the end of your story. With hope, the odds do not matter. With hope, anything is possible!” 

”Its hard to wait around for something you know might happen, but its even harder to give up when you know its everything you want.”

author unknown

Terminology

These are just some, not all, of the infertility terms; the ones listed are ones that pertain to my journey. Please consult with your medical professional about these terms. Unless noted, all are from RESOLVE – The National Infertility Association.

Advanced Maternal Age (AMA)

Advanced Maternal Age (AMA) is often defined as maternal age of 35 or greater at the time of delivery. However, however it also greatly affects fertility.

Anti-mullerian hormone level test (AMH)

Anti-mullerian hormone level test (AMH) blood levels of the hormone AMH are often used by fertility specialists and gynecologists as part of the evaluation of ovarian reserve. In other words, this test indicates the quantity of eggs in a woman’s ovaries.

Cesarean section (C Section)

Cesarean section (C Section) is the delivery of a baby through a surgical incision in the mother’s abdomen and uterus. In certain circumstances, a c-section is scheduled in advance. In others, it’s done in response to an unforeseen complication.

Chemical pregnancy

Chemical pregnancy is actually a very early miscarriage, which takes place before anything can be seen on an ultrasound scan – usually around the fifth week that you are pregnant. It means that a sperm has fertilized your egg, but later on, the egg fails to survive.

Ectopic pregnancy

Ectopic pregnancy occurs when a fertilized egg implants somewhere other than the main cavity of the uterus. An ectopic pregnancy most often occurs in one of the tubes that carry eggs from the ovaries to the uterus (fallopian tubes), which is also known as a tubal pregnancy.  (MAYO website)

Embryo transfer

Embryo transfer refers to a step in the process of assisted reproduction in which embryos are placed into the uterus of a female with the intent to establish a pregnancy.

Gestational carrier (GC)

Gestational carrier (GC) is where the woman carrying the pregnancy (the gestational carrier), is not genetically related to the child she is carrying. The eggs and sperm are derived from the “intended parents” (or, if necessary, egg donor, or sperm donor, but not in our case). Through the process of IVF, the eggs are fertilized in the lab, and then the embryo is placed into the uterus of the gestational carrier.

Hysterosalpingogram (HSG)

Hysterosalpingogram (HSG) is an X-ray test that looks at the inside of the uterus and fallopian tubes and the area around them. It often is done for women who are having a hard time getting pregnant. During the test, a dye (contrast material) is put through a thin tube. That tube is put through the vagina and into the uterus, which flows into the fallopian tubes. Pictures are taken using a steady beam of X-ray (fluoroscopy) as the dye passes through the uterus and fallopian tubes, which can show problems such as an injury, blockage or abnormal structure of the uterus or fallopian tubes.

In vitro fertilization (IVF)

In vitro fertilization (IVF) is a highly sophisticated, meticulously timed procedure, which involves removing an egg or eggs from the female’s ovary, fertilizing it with semen, incubating the dividing cells in a laboratory dish and then replacing the developing embryo in the uterus at the appropriate time.

Infertility

Infertility is defined as the inability to conceive after one year of unprotected intercourse (six months if the woman is over age 35) or the inability to carry a pregnancy to live birth.

Intracytoplasmic sperm injection (ICSI)

Intracytoplasmic sperm injection (ICSI) is an in vitro fertilization (IVF) procedure in which a single sperm is injected directly into an egg.

Partial molar pregnancy

Partial molar pregnancy is a pregnancy where there is an abnormal embryo and possibly some normal placental tissue. The embryo begins to develop but is malformed and can’t survive. A molar pregnancy is a noncancerous (benign) tumor that develops in the uterus. A molar pregnancy starts when an egg is fertilized, but instead of a normal, viable pregnancy resulting, the placenta develops into an abnormal mass of cysts. (MAYO website)

Ovarian reserve

Ovarian reserve is a term that is used to determine the capacity of the ovary to provide egg cells that are capable of fertilization resulting in a healthy and successful pregnancy.

Protocol

Protocol In IVF, it refers to stimulation regimes that you follow in preparation for your treatment.

Recurrent pregnancy loss

Recurrent pregnancy loss is defined by the loss of two or more clinical pregnancies. It is distinct from sporadic losses before 10 weeks.

Salpingostomy.

Salpingostomy. The ectopic pregnancy/growth is removed through a small, lengthwise cut in the fallopian tube (linear salpingostomy). The cut is left to close by itself or is stitched closed. It can be done either through a small incision using laparoscopy, which is what I had or through a larger open abdominal incision (laparotomy).

Secondary infertility

Secondary infertility is defined as the inability to become pregnant, or to carry a pregnancy to term, following the birth of one or more biological children. The birth of the first child does not involve any assisted reproductive technologies or fertility medications.

Stimulation (STIM) medications

Stimulation (STIM) medications in order to get sufficient follicles and eggs for the in vitro fertilization process, the woman is stimulated with injected medications to develop multiple follicles (egg-containing structures). The injections are usually given by the woman, or by her partner.

Transvaginal oocyte retrieval (TVOR)

Transvaginal oocyte retrieval (TVOR), also referred to as oocyte retrieval (OCR), is a technique used in in vitro fertilization (IVF) in order to remove oocytes from the ovary of a woman, enabling fertilization outside the body. It is commonly known as the egg retrieval surgery.

Unexplained infertility

Unexplained infertility   refers to the absence of a definable cause for a couple’s failure to achieve pregnancy after 12 months of attempting conception despite a thorough evaluation, or after six months in women 35 and older. It is common in 10% of couples who are infertile.

Statistics

INFERTILITY STATISTICS 

  • 1 in 8 couples (or 12% of married women) have trouble getting pregnant or sustaining a pregnancy. (2006-2010 National Survey of Family Growth, CDC)
  • Approximately one-third of infertility is attributed to the female partner, one-third attributed to the male partner and one-third is caused by a combination of problems in both partners or, is unexplained. (www.asrm.org)
  • A couple ages 29-33 with a normal functioning reproductive system has only a 20-25% chance of conceiving in any given month (National Women’s Health Resource Center).
  • Most first-time miscarriages are random and do not reoccur. With one past miscarriage, the odds of miscarrying in your next pregnancy are about 2%.
  • With two previous miscarriages, the risk of another miscarriage is 28%, and with three previous miscarriages the risk increases to 43%.
  • Once the pregnancy and heartbeat is confirmed by ultrasound, estimates for miscarriage rates range from 2 to 5 percent. (above three stats from Miscarriage Beyond the Basics: UpToDate July 2015)

IVF STATISTICS 

Fertility clinics in the U.S. report and verify data on the assisted reproductive technology (ART) cycles started and carried out in their clinics, and the outcomes of these cycles, during each calendar year.  ART includes all fertility treatments in which either eggs or embryos are handled.

  • Based on CDC’s 2015 Fertility Clinic Success Rates Report, there were 231,936* ART cycles performed at 464 reporting clinics in the United States during 2015, resulting in 60,778 live births (deliveries of one or more living infants) and 72,913 total live born infants.
  • 7.4 million women, or 11.9% of women, have ever received any infertility services in their lifetime. (2006-2010 National Survey of Family Growth, CDC)
  • Approximately 44% of women with infertility have sought medical assistance. Of those who seek medical intervention, approximately 65% give birth. (Infertility As A Covered Benefit, William M. Mercer, 1997)

Average IVF Success Rate In The United States For Fresh Embryos

Age < 35Age 35-37Age 38-40Age 41-42Egg Donation
Number of Cycles39,57319,37617,6179,1148,507
Transfers / Live Birth47.50%39.60%28%15.70%56.80%
Average Embryos Transferred1.71.92.22.61.7

Average IVF Success Rate In The United States For Thawed Embryos

Age < 35Age 35-37Age 38-40Age 41-42Egg Donation
Number of Cycles26,18213,53910,0783,79211,974
Transfers / Live Birth46.6%44%38.3%32.1%41.5%
Average Embryos Transferred1.61.51.61.71.6

In concordance with research at the fertility clinic that I used, CCRM studies from around the world have shown that in vitro fertilization pregnancies following a frozen embryo transfer are more similar to natural conception pregnancies than fresh embryo transfer cycles resulting in:

  • Increased implantation rates

  • Increased ongoing pregnancy rates

  • Increased live birth rates

  • Decreased miscarriage rates

  • Lowered risk of pre-term labor

  • Healthier babies

“Since frozen embryo transfers occur a significant amount of time after a woman’s ovaries were stimulated with medications, the hormone levels in the body have had time to return to normal, which mimics a more natural conception process,” says William Schoolcraft, M.D., medical director of CCRM (who was my doctor). “This process appears to have a positive impact on the health of the baby.”

We elected to do a frozen/thawed embryo transfer for me (I later miscarried). The remaining embryos were frozen. Upon hiring a gestational carrier, those embryos were thawed and transferred, resulting in our miracle twins!

Currently only 15 states have laws requiring insurance coverage for infertility treatment:

ArkansasLouisianaNew York
CaliforniaMarylandOhio
ConnecticutMassachusettsRhode Island
HawaiiMontanaTexas
IllinoisNew JerseyWest Virginia

GESTATIONAL CARRIER STATS

Because of limited information on the use of gestational carriers in the United States, there is not much data available from CDC’s National ART Surveillance System.

  • Between 1999 and 2013, about 2% (30,927) of all assisted reproductive technology cycles used a gestational carrier.
  • The number of gestational carrier cycles increased from 727 (1.0%) in 1999 to 3,432 (2.5%) in 2013.
  • Between 1999 and 2013, gestational carrier cycles resulted in 13,380 deliveries and the birth of 18,400 infants. The data shows 9,819 (53.4%) of these infants were twins, triplets, or higher order multiples.
  • Intended parents using a gestational carrier tended to be older than parents who did not. Most gestational carriers were less than 35 years of age.
  • Approximately 16% of intended parents using a gestational carrier were not US residents.
  • Gestational carrier cycles had higher rates of implantation, pregnancy, and live births when compared to non-gestational carrier cycles. However, multiple birth and preterm delivery rates were higher among gestational carrier cycles—largely due to the frequent transfer of two or more embryos per cycle.

There is no federal law regarding surrogacy. States where surrogacy is permitted, pre-birth orders are granted throughout the state, and both parents will be named on the birth certificate:

There is no federal law regarding surrogacy. States where surrogacy is permitted, pre-birth orders are granted throughout the state, and both parents will be named on the birth certificate:

CaliforniaNew Hampshire
ConnecticutNevada
Washington D.C.Oregon
DelawareRhode Island
Maine

States where is practiced, but there are potential legal issues:

AlaskaMississippiWyoming
ArizonaMontana
IowaNebraska
IdahoTennessee
IndianaVirginia

States where surrogacy requires a post-birth parentage order is available or results can vary depending on venue, also – additional post-birth legal procedure may be required:

AlabamaHawaiiMarylandNew MexicoSouth DakotaWest Virginia
ArkansasIllinoisMinnesotaOhioTexas
ColoradoKansasMissouriOklahomaUtah
FloridaKentuckyNorth CarolinaPennsylvaniaVermont
GeorgiaMassachusettsNorth DakotaSouth CarolinaWisconsin

States where law or statutes prohibit compensated surrogacy contracts or a certificate of birth naming both parents cannot be obtained:

Louisiana
Michigan
New Jersey
New York
Washington

Our Process for Hiring a Gestational Carrier

 

Searching for Your Gestational Carrier

The process of finding an agency and filling out forms is overwhelming and daunting. We took it one step at a time. Here is the breakdown:

  • From contacting an agency until the embryo transfer, the process took 9 months.
  • My husband and I created a list of criteria that was important to us in a GC. Things like:
    • Needed to have prior experience as a GC
    • Should be a person of faith
    • Healthy (non smoker, active, eating habits, etc.)
    • Excellent references, both professional and personal
    • Someone that was organized, level headed
  • I began searching the Internet for agencies and found two that were more qualified and had a proven track record. I contacted them and within an hour, they both had returned my call. They both asked me some initial questions and by that evening, I started receiving profiles of women that were available to carry our baby.
  • It reminded me of “Match.com” for infertile couples. I quickly learned that this was their way to “hook” a potential client – by sending photos, bios and health history of surrogacy candidates. I had not signed any sort of disclosure or contract with any agency at this time.
  • There were so many questions and facts to read through on the profiles and the questionnaires they sent us. Would we take a carrier that…had vaginal herpes? Was married to someone of another race? Had not been pregnant before? Lived more than 500 miles from us? Had done recreational drugs in the past? Had a BMI over 30? Was under the age of 23? Had a husband who smoked “outside of the house”? My head swirled. It was very overwhelming. None of the fifteen bios that we received that night were a candidate for us.

Meeting Possible Matches

  • Some intended parents (IP’s) take a business approach to selecting their GC and interview around health questions or other potential pregnancy issues. It was important to us to “click” with the personality of our potential GC and family before anything else.
  • Several days later, we received the profile of a woman named Tiffany. She was married, educated, had children of her own and had been a GC for a couple several years ago. She was the wife of a Pastor and also worked at the church. She sounded perfect! She lived 3 hours away from us.
  • We arranged for a conference call between Tiffany, myself and our husbands. We talked for over an hour and really hit it off. We decided to take the “next step” and meet for lunch. The meeting went perfectly. We knew that God had brought the four of us together and that she was “the one” to help us have more children.

 

Moving Forward with Your Gestational Carrier

  • Next, we signed an agreement with the surrogacy/gestational carrier agency. In our contract, if things didn’t work out with our carrier getting pregnant, we were still legally bound and the agency would find a replacement for us.
  • Our agency did an informal review of Tiffany’s insurance and found that there were no surrogacy exclusions, so hopefully her insurance would cover the costs.
  • We hired an attorney who was a member of the American Academy of Reproductive Technology Attorneys who drafted a surrogate agreement. Tiffany also hired an attorney who in turn revised the 62-page agreement.
  • Tiffany sent her medical records to our fertility clinic for review.
  • Our surrogate agency then worked up what is called a “match sheet” which is an estimate of fees (discusses additional costs if we have twins, if she has a c section, etc.). It was reviewed by our respective attorneys and signed by all parties.
  • We hired an independent agency to conduct a formal review of Tiffany’s insurance. They found no exclusions regarding surrogacy but it was not specifically included either. As a safety net we purchased an additional health insurance policy in case her primary insurance declined coverage. This took approximately 2 weeks.
  • Tiffany’s medical records were approved by our fertility clinic and a one-day work up appointment was set. We made travel arrangements for the four of us to go to CCRM in Colorado within the month.

Getting Your Gestation Carrier Approved by Your Fertility Clinic

  • We all traveled to CCRM for a full day of procedures. Tiffany had exams, blood tests, a psych evaluation, consults with the nurse, a counselor and more. The rest of us took blood tests and met with the counselor. We paid for these expenses out-of-pocket, as our insurance does not cover fertility treatments.
  • We found out within a week that Tiffany was approved by CCRM. Our contract stated that if for some reason our fertility clinic did not “pass” Tiffany, the contract would be void. We knew in our hearts that she would be approved.

Health Insurance, Life Insurance & Payment for Your Gestational Carrier

  • As required by our contract, we purchased a life insurance policy for Tiffany.
  • We also enrolled her in the Affordable Care Act as the backup insurance policy.
  • An escrow account was set up to pay Tiffany through a third party agency. She received a monthly draw and was automatically reimbursed for any out-of-pocket expenses she had (co-pays, maternity clothes, etc.)

Beginning the Medical Protocol

  • We ordered Tiffany the drugs for her medical protocol and shipped them to her.
  • Tiffany began her 30-day protocol of hormones, patches & pills. She was monitored by her local OB. One month later, blood tests and ultrasound confirmed that her body was prepared to receive our embryos!

Embryo Transfer

  • The week of the scheduled transfer, we flew out to Colorado. Tiffany was monitored and given the green light for the transfer the very next day.
  • All went well on the day of the transfer. Our embryos were thawed after 2 ½ years of being frozen and transferred into Tiffany. She was placed on bed rest for 2 days before flying home.
  • Two weeks later, Tiffany went in for bloodwork. CCRM called us with the results – positive HCG/pregnancy test! We called Tiffany to let her know.

First Ultrasound

  • Went in for first ultrasound; results showed TWO heartbeats! We were absolutely over the moon. Later that day, CCRM called us with the gender of the babies – Boy & Girl! (Because of genetic testing on the embryos prior to being frozen, receiving the news that heartbeats were detected, and because both embryos “took”, they were able to tell us the genders of the babies. Yes, I went shopping that same day!)
  • Everything was smooth sailing from then on as far as insurance, exams, etc.

Obtaining Legal Rights to Your Child/Children

  • Our lawyer handled the order validating the gestational agreement with the courts. This gave us legal rights to our children once they were born. We did not have to appear; our lawyer did so on our behalf.

Validating Insurance for Your Child/Children

  • We notified our health insurance provider about the upcoming births of our twins and filled out necessary paperwork to validate their coverage (as soon as they were born).

Hospital Tour & Administrative

  • We had a tour of the hospital where Tiffany would give birth. They were familiar with gestational carriers and how insurance worked. There were a few administrative hiccups, but nothing major. We confirmed that the hospital did take our health insurance.

Day of Birth

  • Tiffany was experiencing high blood pressure at 36 weeks, so she had a C-section. We were in the operating room and watched our babies take their first breath. It was absolutely overwhelming and wonderful.
  • Because the twins were legally ours once Tiffany had her C-section, our insurance coverage for them kicked in immediately. In fact, we had our own birthing suite next to Tiffany’s and all of the twins’ medical bills were covered by our insurance.
  • Tiffany was able to go home 3 days after the twins were born. Her employer gave her maternity leave of 6 weeks.

Official Order of Parentage

  • One month after the twins were born, we received the official order of parentage from the courts in the mail. Our names were on the birth certificates.

Although it can vary, our total cost was $100,000 which included:

  • GC Agency fees
  • GC’s fees (and additional fees for having twins, a c section, travel, clothing)
  • All medical bills that were not paid for by insurance
  • Additional health insurance for GC
  • Attorney fees
  • Court costs
  • Life insurance policy for GC
  • Escrow agency fees

 

Gestational carriers can make anywhere from $25,000 up to $45,000 depending on a variety of factors.

Medical steps taken to get our miracle babies:

There are many, many options and paths to fertility. I have had numerous people ask what I did, so I want to share it with you. Please educate yourself, do your own research and consult with your specialist to find out the path that is best for you.

Step One: Find the Right Specialist

  • Once I was experienced three miscarriages, my OB referred me to a fertility specialist. I found the first fertility specialist to be a “salesman”, with a revolving door of patients like me who were desperate to have a baby. After having a miscarriage under his care (and him handling the miscarriage and my questions in a completely unprofessional manner), I decided to find another specialist.
  • That is what I would like to convey to you, the reader. DO NOT let a doctor take away your hope! If you do not like what he or she says, YOU HAVE OPTIONS. Seek a second opinion. I love this quote from Nelson Mandela “Once a person is determined to help themselves, there is nothing that can stop them.”
  • I had a very frank conversation with my second specialist. We had great chemistry – she was my age. I asked her what she would do if she were me. Her response was “I could try to get you pregnant, but my success rates are better with patients under age 35. If I were you, I would go to the best in the world for getting women pregnant at your age.” She recommended me to see Dr. Schoolcraft at CCRM.
  • I called Dr. Schoolcraft and scheduled an initial phone consultation. Although we had to wait three months to talk to him, it confirmed that he was the right choice for us. He told us that he thought he could help us (gave us a 65% chance) and asked us to schedule a one day workup. The earliest appointment available was six weeks away.

Step Two: Begin Testing

Tests, tests, and more tests. Knowledge is power! Dr. Schoolcraft did an entire day of tests on me and my husband.

  • Complete bloodwork panel (18 vials for me, 4 for my husband).
  • A counseling session.
  • A complete physical exam.
  • Procedures including a transvaginal pelvic ultrasound, hysteroscopy, hysterosalpinogram.
  • Semen analysis.
  • A consult with Dr. Schoolcraft.

Step Three: Decide on a Protocol

This is where your specialist will decide what protocol to put the patient on. Some options include:

  • IUI*
  • Hormones (such as progesterone)*
  • Fresh IVF
  • Frozen IVF (Using medication to stimulate follicles and eggs to develop, then retrieving the eggs through surgery, fertilizing the eggs in the laboratory, embryo genetic testing/ICSI,  freezing the embryos and transferring several months later.)

*These are lower cost, less invasive options that are good to start with.

  • Although I had seen more than one specialist and was initially put on hormones, the final step/choice was IVF. Dr. Schoolcraft had recommended doing a “frozen” IVF cycle. A one month protocol of drugs was ordered once the tests returned in order to move forward with IVF. I’ll never forget the day when Fed Ex rang my doorbell and I received my two boxes of meds. It was absolutely overwhelming to see all of the syringes, patches, pills, and vials of medicine. I took a deep breath and decided to take it day by day.
  • The daily regimen wasn’t so bad. I had up to six shots in my abdomen each day. We would alternate clockwise around my belly to help with the bruising and pain. I also had patches and pills.
  • The frozen IVF process takes longer than fresh (3 months vs. 1 month) and is more costly, but according to my doctor yielded better results.
  • “Since frozen embryo transfers occur a significant amount of time after a woman’s ovaries were stimulated with medications, the hormone levels in the body have had time to return to normal, which mimics a more natural conception process,” says William Schoolcraft, M.D., medical director of CCRM. “This process appears to have a positive impact on the health of the baby.”
  • In other words, the advantage of frozen vs. fresh is that my body had time to heal and recover from the stim process and egg retrieval surgery. CCRM grew our embryos to the blastocyst stage (which is day 5 or 6) because there is higher implantation rates compared to day 3 embryos. Additionally, we opted for chromosomal screening to improve our chances of success. Dr. Schoolcraft pioneered a rapid freezing and thawing method for embryos that has a 98% survival rate.
  • I flew to CCRM to prepare for my retrieval. I was monitored for several days and was finally given the “go ahead” for my trigger shot (to trigger my eggs to their final stages). My egg retrieval surgery was very successful and they froze several genetically normal embryos. (Cue music in your head for “Ice Ice Baby”)
  • Two months later I was put on a second protocol of drugs leading up to the embryo transfer for one month. The transfer went well, and we found out two weeks later that I had a positive test!

Step Four: Our Dream of Being Pregnant…Coming to an End

  • Unfortunately, I miscarried at seven weeks. My numbers kept tripling, and I started miscarrying which indicated a possible molar pregnancy. We were heartbroken.
  • After reconvening on the phone with Dr. Schoolcraft, he agreed that the best possibility was to have a gestational carrier/surrogate carry our embryos. I knew in my heart that it was time to hang up the dream of ever being pregnant again. It was the seventh time that I had miscarried. Each time had become more dangerous than the last.  But in my heart, I knew that there were many options, many ways that we could still have a baby.

Step Five: Look at Alternatives

  • My best friend offered to carry our baby for us. We set up an appointment with Dr. Schoolcraft and flew out to CCRM so that she could have the one-day workup like I had done. Shortly thereafter, she was started on a regimen of pills, injections and patches similar to the regimen I was on. Unfortunately, her body wasn’t able to progress on the regimen. We tried three months and decided to stop.
  • It was then that we decided to hire a gestational carrier. We had frozen embryos left over and knew that this was an option for us. It wasn’t our plan a, plan b or even plan c. (See “Hiring a Carrier” in the tab above for more information)
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