Surrogacy – a step by step guide

I still remember the moment our IVF specialist recommended gestational surrogacy. We had seen him for a second opinion, after several failed and cancelled IVF cycles and two miscarriages. He diagnosed me with having a thin endometrium lining and explained that surrogacy was our best shot of having a baby, “a plant needs thick and healthy soil to grow”.

But we weren’t ready just yet. It seemed overwhelming. We didn’t know anyone who had been a surrogate or who had a baby through surrogacy.

Almost a year on, after more failed cycles and another heartbreaking miscarriage, we decided to give surrogacy a go. And once I started to research it and talk to others, I discovered it wasn’t as daunting as I had first thought.

In the end, thanks to surrogacy and our amazing gestational surrogate Leigha, we now have a beautiful two-year-old boy.

But today I wanted to write about what you can expect with the process. So that hopefully someone reading this may not feel as overwhelmed as we did at the start.

I’ll start by saying we did international commercial surrogacy in the United States. Commercial surrogacy in Australia is illegal and while altruistic surrogacy is legal (in some States), it can be a long and arduous process.

Here’s a breakdown of my personal experience with the process.

Step 1 - Choosing a surrogacy agency

We skyped with 6 agencies. All 6 were excellent. We ended up choosing a boutique agency, Rocky Mountain Surrogacy as we had an instant repour with the owner Tess and we loved how hands-on and genuine she was. An agency matches you with a surrogate; recommends IVF clinics and lawyers; provides a cost estimate; and guides you through the process.

Step 2 – The match

At our initial catch up with Tess, she already had two surrogates in mind. She emailed us their profiles, and both looked good. Surrogates go through a rigorous screening process, so you feel confident from the start. Our only requirement was that the surrogate had carried before.

We skyped with our surrogate Leigha two days later and had an instant connection. This is so important! You must be able to trust this person 100%.

Step 3 – The legal process

Once we were matched, we met with a lawyer who specialises in fertility law. Having a lawyer is not essential but I strongly recommend it, especially if you’re doing international surrogacy.

Our lawyer helped us with the contract; managing our funds through an escrow account; the pre-birth order; and citizenship for the US. With the pre-birth order, in the US you can sign it before your baby is born to be legally recognised as the parents.

Step 4 – The counselling session

Surrogacy is such an emotional and intimate experience and it’s a big commitment. Our mandatory counselling session proved invaluable as we talked through what to expect, our hopes, fears…. anything and everything that was on our minds!

Step 5 – The IVF clinic

We already had embryos – which we shipped across – but we needed a clinic for the transfer. Tess from Rocky Mountain recommended Utah Fertility Center and organised an introduction. Within a week, we skyped with Dr Russell Foulk and we were immediately impressed.

Step 6 – The screening process

Blood tests, blood tests, blood tests! It’s basically all the same screening tests you do for an IVF cycle (e.g., infectious diseases etc).

Step 7 – The IVF cycle

Only 3 months after we were matched, we did our first transfer. It sadly failed but for the second cycle, we did an Endometrial Receptivity Analysis (ERA), changed our transfer time (as Leigha was pre-receptive) and fell pregnant. We heartbreakingly lost our baby around 9 weeks due to a Sub-Chronic haematoma. But our next transfer was a success and 9 months later, our rainbow baby was born.

Step 8 – Pregnancy

Once Leigha was pregnant, we skyped in for all the scans and any significant appointments. We were in contact nearly every day and Leigha kept us across every detail, big or small. We built a strong and beautiful relationship that I’m sure we’ll have forever. Everyone is different though so it’s best to openly discuss what kind of relationship you want before your first transfer.

Step 9 – The birth

We talked about the birth once Leigha was in her second trimester. We had adjoining rooms at the hospital and when the time came, we were all in the room. Once our son Spencer was born, my husband cut the cord and then we all had skin on skin contact. As you can imagine, there were floods of tears. Relief, love, gratitude, happiness…we felt everything that day.

Step 10 – Coming home

Three weeks after Spencer was born, we flew home. With the help of our lawyer, we organised a US passport and citizenship. Once home, we worked with our Australian lawyer to get Spencer’s Australian citizenship and passport. For some reason I felt nervous about this part of the process, but everything went very smoothly.

This is a brief overview of my personal experience with the surrogacy process. If anyone has any questions, you can follow me on Instagram at straight.up.infertility and contact me at any time.

What I wish I’d known...

When we started fertility treatment, I thought I would be pregnant within a couple of months. I never expected it to take six years, multiple IVF transfers, miscarriages, and finally gestational surrogacy.

Thanks to IVF and gestational surrogacy, we have a beautiful two year old son. But reflecting back, there’s many things I wish I had known before starting fertility treatment.

For anyone who’s embarking on IVF, here’s what I wish I had known:

• It’s a marathon, not a sprint. I assumed that IVF would guarantee a baby, and the first transfer would work. But sadly, for many people, it takes multiple transfers. I think if you go into IVF with those expectations in mind, it will make it a bit easier if it doesn’t work right away.

• It’s a waiting game. There’s lots of waiting when you’re in the throes of fertility treatment, whether it’s waiting for an appointment, waiting to get started, or the Two Week Wait. The waiting can be incredibly hard. I found it useful to distract myself and do things that made me happy while I waited. Often that meant going for a long walk, catching up with friends, having a massage or binging a reality tv series!

• Self-care is crucial! There’s no sugar coating it, infertility is freaking hard. It’s an emotional roller coaster. It can be emotionally, physically, and mentally draining so be kind to yourself and put yourself first, whether that means saying no to certain things (i.e., baby showers!) or doing something just for you.

The medication side effects can also be awful. Everyone is different so you may not have any side effects, or you may experience a truck load. If you fall in the later, self-care is so important.

• Be your own advocate. It took me a while to advocate for myself but once I did, it was invaluable. Come to your appointments prepared with questions, do your research, talk to others going through treatment and get a second or even third opinion if you feel you need it.

• Some people will get it, others won’t. I was surprised how many people – who weren’t medical specialists – had an opinion. You’ll probably get all kinds of advice from “you just need to relax” or “it will happen when you stop trying”. While it’s made traction in recent years, I think we still have a way to go until infertility is understood and accepted as a reproductive disease. It affects 1 in 6 couples worldwide - “Just relax” is not a medical cure.

• Speak to someone about what you’re going through, especially someone who is going through the same thing. It can make all the difference and help you feel less alone. The online TTC community is also so supportive so lean on them when you need to.

Infertility can be brutal, raw, and often lonely. It’s frequently misunderstood. But for anyone struggling with infertility, you are not alone. There’s many of us out there. Find those people. Talk to them. Lean on them. Surround yourself with love and support. Don’t suffer in silence.

My surrogacy journey

The day we met our beautiful surrogate Leigha, she sent me an illustration of a joey in a kangaroo’s pouch and the words: Ryan and Kirsten. I hope I can take some weight off your shoulders and bring you some joy in the years to come. I would be ‘honoured’ to carry your joey.

It had been a long road to get here so I can’t begin to describe the happiness we felt reading those words.

But why did we pursue international surrogacy rather than domestic? Ninety-two per cent of surrogate babies are born overseas and only eight per cent are born in Australia. Why? Australia has extremely tight surrogacy laws (State laws), with the penalty ranging from fines to imprisonment with commercial surrogacy. This leaves altruistic surrogacy, but the approvals process is usually long and arduous. There are also no surrogacy agencies and it’s illegal to advertise so it can take years to find someone.

When we met with Rocky Mountain Surrogacy (Idaho, USA), within minutes it felt like a chat with an old friend. A boutique agency, I could tell right away the owner Tess was personally invested with all her surrogates and intended parent(s).

Through Tess, we met Leigha.

On Skype, we formed an instant bond with our beautiful surrogate Leigha and her husband Josh.

We then met on Skype with Dr Russell Foulk from The Utah Fertility Center and we were immediately impressed. We found him extremely knowledgeable and you could tell Dr Foulk and our nurse Tonya were determined to give us the baby we so desperately wanted.

Leigha was confident. With two boys of her own and a surrogate baby she had carried previously for a couple from Spain, she was optimistic. I, on the other hand, was petrified of another failure. It felt like the US was our last dance.

Our first transfer with Leigha sadly failed.

Three months after our first attempt, we geared up for transfer number two.

Results day. It was early when Ryan got the call, around 5:30 am. Vigorously shaking my shoulders, he woke me up to tell me we were pregnant. We were ecstatic. We Skyped Leigha and Josh right away and they were just as happy.

As soon as we got off the call though, I had a pit in my stomach. I reminded myself it was early days. A lot could still go wrong.

During week seven, we flew to Hong Kong for a mini break. But it meant our first scan was mid-way through our holiday.

With the time difference, the scan was at 3:00 am. That night, I told Ryan I was too scared to Skype in. I thought back to a previous missed miscarriage we’d had, and I didn’t think I go through it again. So, we decided Ryan would take the call in the hotel lobby.

The first text I received from Ryan at 3:00 am was: “They’re running behind with ultrasounds, she’s still waiting.” Ten minutes later, and riddled with anxiety, a follow up text, “She’s going in now”. And two minutes later: “Strong heartbeat, everything looks perfect”.

I jumped on the call and listened to the magical sound of our baby’s strong heartbeat, happiness consuming me.

Our 10-week scan was again at 3.00 am (our time). Given everything had been tracking along so well and Leigha’s hormone levels were high, we decided not to Skype in. Josh would video the scan and we would call them once we woke up.

I woke up at 6:00 am and checked my phone. No messages. With a ball of anxiety aching in my stomach, I checked Ryan’s phone. There was a message on his home screen from Josh: “I’m so sorry but we’ve lost the baby…”.

Words screamed in my head: No!!!Not again!! Please God, don’t let this happen again. We were so close this time. I beg you, please let this be a mistake. But even though I never read Josh’s full message, I knew it was over.

At the 10-week scan, our baby had already passed. Dr Foulk estimated our baby had died around nine weeks. We were shattered. It was gut wrenching for all of us.

Our obstetrician, Dr Jensen, later told us Leigha is the only person he’s ever known to have been crying so hard while the general anaesthetic was taking effect. He had tightly held her hand at the start of the D&C and right up to the second before she fell asleep, she was sobbing.

The hardest part of international surrogacy is when something like this happens. All we wanted to do was see her and Josh in person and all comfort each other. But we couldn’t.

At this point I resigned myself to think we would never have a child. I wanted to scream and cry and be done with the whole thing. With every set back, I had faith. But this time the fight had vanished. I was struggling to move past the fact that we were here again.

I’ll admit I went into our final transfer half-heartedly. I wanted it to work but my thinking had shifted: It won’t work and if by some miracle it does, then it will be a dream come true. But don’t expect it to work as it probably won’t. I didn’t mean to sound pessimistic, but I had to protect myself. I didn’t know how much more hurt I could withstand.

Leigha felt anxious but she defiantly charged into the final transfer giving it her all. It reminded me of a quote from Attius Finch from one of my favourite books ‘To Kill a Mockingbird’: “Real courage is when you know you’re licked before you begin, but you begin anyway and see it through no matter what”.

On 25 October 2018 we did our final transfer, our last hurrah.

Results day. With our nurse Tonya away that day, we had been told another nurse would contact Leigha. When I woke up, there was no news.

To distract myself, I checked my emails. There it was. An email from one of the nurses had been sitting there for hours with the subject line ‘GC Update’. We had never expected an email, so I hadn’t thought to check. The email simply said: “Hello Kirsten. We received Leigha’s results and they came back positive!!! Her HcG is 297! This is a wonderful start!!!”.

It was indeed a wonderful start.

At eight weeks pregnant, we had our first scan. Similar to our last pregnancy, everything looked perfect and the heartbeat was strong. But there it was, what had caused our last miscarriage, a Subchronic haematoma.

The sonographer noticed our uneasiness and told us unlike last time, it was tiny and nowhere near the placenta. It would most likely resolve itself in time. We had to trust that everything would be ok.

After our miscarriage, we had booked a Christmas holiday to Europe, something to look forward to. But our 12-week scan was the night we flew out. About a 22-hour flight, the scan was 12 hours into our flight.

As soon as we landed, I grabbed the sick bag while Ryan anxiously turned on his phone. Straight away his home screen filled with an ultrasound photo and the words: “Your baby is perfect”. We both burst into tears. Truth be told, we actually jumped up and down, squealed and hugged each other. Our fellow passengers looked at us like we were nuts. But we didn’t care. We were so incredibly happy. I had also never felt so energised after such a long flight.

The next few months flew by and before we knew it, it was time to head to Utah. We left Melbourne on a rainy Winter’s day and arrived in Utah on a beautiful summer’s evening.

We pulled up to Leigha and Josh’s house around midnight. The second I caught a glimpse of Leigha’s warm infectious smile, I turned to mush and was a babbling mess. We hugged each other so tightly, both crying.

Two of the most genuine and decent people you will ever meet, Leigha and Josh made us feel so welcome. For the next few weeks, their home was our home. That night I also got to feel some kicks. Throughout our pregnancy, Leigha sent me boxing emojis. Feeling her belly, I finally understood why. She joked that he had kicked her so hard once, she was scared he may have broken her ribs. Although once I felt him karate kick for myself, I wasn’t sure she was joking.

We were due to be induced at 7:00 pm on 5 July 2019. But nothing goes according to plan. At around 2:30 am on 5 July, half asleep I stumbled out to see Leigha leaning on the wall trying to hold herself up, crouched over and moaning. It was time.

We had been through this scenario a million times but even still, Ryan and I both froze. I remember asking Ryan if I had time to have a quick shower. I’ll never forget the ‘you’ve got to be kidding me?’ look he gave me. No, there wasn’t time.

For the next few hours, Leigha had contractions but suddenly they slowed down. This threw us. We had two choices – stay at the hospital and get her induced or go back home and wait until the evening. Of course, we decided to induce.

Once Leigha was induced, everything happened quickly. Her contractions came on hard and fast. Being a pro, she handled them exceptionally well. Witnessing it firsthand and up close, I’m in awe of anyone who gives birth. The tenacity and strength women have during childbirth is simply incredible. And I must admit, I now get the joke about how if men could give birth, there would be hardly any children born.

It wasn’t long before Dr Jensen was asking Leigha to do some final pushes and saying he could see the head. Ryan, Mum and I couldn’t stop balling. Thank goodness for the person who invented waterproof mascara. And then we heard him cry. His first beautiful cry. Spencer was here.

After six years, our long-awaited darling son was finally here. Our eyes flooded with tears, Ryan and I stumbled over and held Spencer’s tiny hand. In that moment, we knew it had all been worth it.

Shortly later, the midwife ushered us into our adjoining room so that Dr Jensen could check Leigha and we could feed Spencer. A few moments later, it was pandemonium. We saw an Emergency team rush into Leigha’s room. Ryan quickly followed but was told to wait outside as Leigha had started to bleed out.

With Spencer resting quietly in my arms, I prayed she would be okay.

Dr Jensen calmly took charge and stopped the bleeding. Leigha was okay, but she did lose more than 1.5 litres of blood. In the days that followed, she also experienced Postpartum Preeclampsia, a rare condition that causes high blood pressure and if left untreated, cause seizures or other serious complications. For Leigha, it was causing painful headaches, swelling, and dizziness.

It was another reminder of the extraordinary gift Leigha had given us. She had risked her life for us, for Spencer.

It may have taken us six years, but the day Spencer was born, most of the heartbreak and grief melted away. I had heard this from a friend who had battled infertility. That the day you have your baby safely resting in your arms, so much of the pain goes away. While I was sceptical, the mere thought of this was always a warm comfort. And she was right. The bubble did finally burst.

It was a long and often difficult journey but by the end we had our beautiful son Spencer. So I would do it all again.