I have had the absolute pleasure of spending the weekend (and my birthday) in beautiful Boston. I have significantly increased my knowledge of American history and was fascinated to walk the Boston “Freedom Trail” that took me all the way from Boston Common to the USS Constitution. Today, I braved the rainy weather and made my way to explore the stunning Harvard University Campus – although I suspect this is far more welcoming in good weather, the trip did help me feel a little more inspired to head back to my hotel and put some work into compiling my Fellowship report. This is a beautiful and easy going city, and a weekend of wandering has been an absolute delight.
I also had the absolutely fabulous experience of spending an entire day with the team from Circle Surrogacy. Circle is amongst (if not) the largest surrogacy agency in the USA (in terms of staff with almost 50 employees, and in terms of the number of surrogacy arrangements they undertake), and certainly differs in structure from some of the other agencies I have seen so far. They function as a “full service” agency which has case management, ESCROW management, attorneys, and social work (and psychosocial and psychological assessment) services all provided in house.
A real strength of the model that this agency promotes (like some of the other agencies I have already met with) is their focus on the relationship between the IPs and their surrogate. I am told that the majority of surrogates really value having contact with their IPs, and Circle encourages IPs and surrogates to have weekly contact. In addition, and where it is possible, they also encourage the IPs to attend ultrasound appointments etc (if only by Skype). Circle acknowledges that there are other agencies (and of course private arrangements) which operate much more of a “business transaction” between the IP and the surrogate (i.e., the arrangement is established; there is minimal contact made between parties; monies are expended and the baby is collected at the end. There is no expectation of an ongoing relationship between the parties). Personally, I can’t imagine not having some kind of relationship with the woman you have entrusted to carry your baby for you for 9 months. And I really wonder how the surrogacy is explained to the children, when the relationship is fiscal, rather than personal.
I also had some lovely conversations about egg donor processes (with the Egg Donation Manager, and a previous egg donor). We discussed the relative merits of anonymous versus known donation, and I was delighted to learn that there is an increasing emphasis towards donors being known to the IPs. It seems that Australia’s very strong push towards known donation is a long ahead of where the USA currently stands, but there is certainly change afoot. And the Circle team were really interested in the processes that Australia takes regarding 3rd party reproduction (such as the establishment of donor registers, and recent changes such as retrospective removal of anonymity for donors in some states). The donor I spoke to had donated both anonymously and in the context of a known donation, and she had clearly preferred the experience of having contact with her donors. She even showed me photos of 2 of the beautiful kids that had been born as a result of her last egg donation, and she was clearly really proud of the family she had helped someone create.
Circle shared with me every aspect of what an IP or a surrogate might experience with the agency, and explained everything from the intake/assessment process, to the legal intricacies, and the complex web of medical insurance options and out of pocket fees. This was incredibly helpful to me, as I had really struggled to understand how some of these processes work. I really wonder how a potential IP can make sense of all of this, especially when they are in the midst of the already stressful experience of trying to have a family through fertility treatment.
I can certainly see the attraction for IPs in the “one stop shop” structure that Circle uses, particularly for clients travelling from overseas (international work accounts for over half of their work – with IPs coming from a number of destinations; and most commonly France, UK, China, Sweden and Norway. Australians accounted for around 4% of their clients last year). This model kind of simplifies all of the various tasks that are necessary in co-ordinating a surrogacy arrangement, and really helps to clarify the costs that are likely to be incurred.
I am consistently hearing that fees to undertake surrogacy in the USA are anywhere from USD$120,000- $160,000. When you account for our currently poorly performing dollar, that is around AUD$170,000 -$230,000. These fees include the (approximately) USD$25,000-30,000 plus expenses paid to the gestational surrogate. Of course, these figures make an assumption that treatment is successful reasonably quickly. Each embryo transfer to a surrogate, or each egg stimulation cycle (either to the IP or an egg donor) represents more expense. For an IP travelling from overseas, it is also important to add the costs of travel, accommodation and living expenses. Most IPs would expect to make between 2-4 trips to the US (to create the embryos, to meet the surrogate, maybe to check in/attend a significant scan during the pregnancy) and to collect their baby at the end). At delivery time, IPs need to plan to be in the USA for at least a week or two after the baby has been born, but depending on when parental rights are established (this will vary on a whole range of factors, such as medical insurance considerations, and the state that the surrogate lives (and gives birth) in), it may take more like 4 weeks. For same sex couples, some states are pretty surrogacy friendly, but for others, the establishment of parental rights gets a lot more complex. Like most things, complexity tend to equal extra time and/or expense.
Nobody goes to these lengths lightly. I have asked the agency staff (at each of the agencies I spoke to) if they saw a specific socio-economic group using their services, but I have consistently been told that there is an enormous range of backgrounds in their clients. While obviously there are many who could never, under any circumstances hope to find these sorts of amounts of money, and there are some for whom $200,000 is not overly significant (apparently these people do exist – I have been told!), the majority of clients seen by the agencies are on fairly average incomes, and have simply prioritised surrogacy over…. well… everything. Many have remortgaged their homes, or borrowed the money; some have had money gifted from parents/other family. I think that there is no doubt that for any person who is prepared to go through all of the emotional strain of surrogacy, and expend all of these financial resources, there really is a sense of desperation to be a parent.
This desperation to parent (that I have also seen in so many of my clients), is partly why I was motivated to undertake this Fellowship. There is always a risk that someone who is so incredibly desperate to achieve a goal, might make poorly informed or rushed decisions. I believe it is critical that anyone who is considering this process (either domestic or international surrogacy), has a plethora of supports available to help provide guidance, information, and advocacy while they navigate their options. It is also critical that for anyone becoming a parent (including through surrogacy) that they have a range of supports they can access to help them through the tough times that they will inevitably encounter. In the midst of all of this work just to achiev a pregnancy, it is easy to forget that this is just the beginning – there will be a baby, who turns into a child, who turns into a teenager etc. Through each of these stages, parenthood is tough, and becoming a parent through surrogacy doesn’t guarantee you an easy run. Some who have become parents through fertility treatment (including donor conception and surrogacy) feel that they have no right to complain when the job of being a paren gets difficult (that “if they wanted it so badly, they should just be happy that they got what they wanted”). But these parents are equally susceptible to the normal anxieties and stresses of parenting, and to the bigger issues like perinatal depression. These families need access to support who understand what they have been through already and can help them negotiate the twists and turns.
I am really looking forward to having a few days off from the Fellowship to explore a little more of the USA, before I head on to Russia. I am guessing that this will be an entirely new fertility treatment world for me to explore.
A massive thank you to Circle Surrogacy, and the individual team members who gave up their day to help me understand surrogacy in Massachusetts: Emily, Sarah, Scott, Kelly, Gina-Marie, Frannie, Amanda and Jessica. Thank you also to Dr Alice Domar (for those in the know, one of the “go-to” people in fertility counselling and research) who took time out from her weekend to speak to me.
I didn’t make it to any galleries during my Boston stay, but I kind of thought that the Make Way for Ducklings statue in Boston’s Public Garden still fitted with my artistic theme of parenthood.