Tuesday, October 27, 2009

Giving Thanks

I would like to take a minute to thank everyone who has posted comments on our blog, offered support and continues to follow our journey. It means a lot to us and we are very thankful! For those of you who have expressed a wish to share private messages or questions and don't have our personal email addresses, please feel free to use the email address we recently posted on the blog.... adistantmiracle@gmail.com. Otherwise, please keep the comments coming!

Friday, October 23, 2009

A Shot in the Dark

I wanted to spend some time discussing what Shannon and I heard, learned and decided about vaccinations. I know this means wading into a potentially controversial subject but, I figure, we're already full steam ahead with the highly divisive subject of overseas surrogacy so what harm can a little immunization discussion do? Anyway, the point here is not to persuade, just to explain. In that vein, let me get this out of the way - Shannon and I are in the 'vaccinations are typically safe and effective' camp. Everything that follows is colored by that context.

Please also keep in mind that I am not a doctor and never even played the game when I was younger. The rest of this post is a mixture of fact, opinion and conjecture - all of which is to say, if you've got international travel in your future, please don't use the following as a primary source of information.

Ok... Like most countries, the US Government recommends a long list of vaccinations prior to international departure. And, like most countries, India recommends a long list of vaccinations prior to arrival. However, with one exception - yellow fever (if traveling to/from specific countries) - no vaccination is required. It's your call. So what to do?

The choice was a lot easier for me. There are few if any contraindications for vaccines in men. My little guys ('sperm' for readers not getting the hint) are seemingly incorruptible. Sure, coming down with a nasty fever could undermine their quality. However, the fact is the illnesses for which I'm being immunized are more likely to cause a major medical catastophe than the innoculations. I'm getting the shots.

The trick is Shannon. As readers know, she will not be pregnant throughout this process. However, she will be producing the eggs and, seemingly, eggs are the more vulnerable partner in the embryo dance. To what extent do we vaccinate her?

Well, Dr. Yash told Shannon, no vaccinations. Period. She didn't leave us with the impression that Shannon should never in her life. It was more about the timing. So sure, Shannon's not immune to Hepatitis A, has a lapsed polio innoculation, was never vaccinated for pertussis, never prepared for H1N1 - all of which can be encountered during our trip. But the recommendation was don't do it. Make the embryo first. Basically, take the gamble with her health.

Now remember, we're a couple who believes in the value and safety of vaccinations. And because we had decided not to travel to India until January or February for retrieval (we could have gone in early December), we thought we had a good cushion of time. On the other hand, we're also pretty busy believing in the powers of IVF and really don't want to muck it up. In such a confusing medical circumstance the recommendation is to get a second opinion. For us, this came in the shape of a referred Travel Clinic.

Turns out that in the US, the identification and application of travel vaccinations (say that three times fast) are the responsibility of Travel Clinics - your local doctor won't do it. Their doctors are typically infectious disease specialists and this is all they do for a living. Our fertility doctor recommended one in particular at a local hospital and, following the handshake, Shannon and I disclosed every detail about our trip. If all goes well, we will be in India twice, the first time about two or three months from now, for one week, with Shannon hopped up on IVF meds and the second time, a much longer trip, approximately nine months later.

We had a very long back and forth about Shannon's options during which the doctor - bombarded by questions - asked, first, if either of us was a doctor and then, second, if either of us was a lawyer. Ultimately, we reached a concensus and acted immediately as we felt the more time that passes between vaccination and departure, the better.
  • We would avoid attenuated vaccines - that is, vaccines containing live but modified forms of viruses and bacteria. The modification reduces the microorganism potency but there is still a slight risk of getting sick. For Shannon, this meant not being innoculated for typhoid.
  • We would be ok with other types of vaccines - that is, vaccines that contain either killed forms of microorganisms, pieces of them, etc. This meant that Shannon would get vaccinations for things like Hepatitis A and polio.
  • We would get flu shots using killed virus. For H1N1, that means the injection and not the nasal spray. (In general, the medical community believes one's immunity benefits more from attenuated vaccines than alternatives but for Shannon, this was the no-go.)
  • For malaria we are going to use Malarone (proguanil & atavaquone) for prevention. It's meant to be taken daily so it's a bit of a hassle but supposedly quite reliable and with minimal side effects. For the moment, however, we're considering not starting Shannon on this pill until after retrieval. It's a to-be-determined. [I should add that our Clinic also suggested Lariam, instead of Malarone. Lariam is taken just once a week but its potential side effects are positively awful. In fact, this drug's losing it's popularity.)
I'm not comfortable being overly carefree with Shannon's health as our baby/babies would prefer to grow up with both parents, if you know what I mean. This will likely disappoint the SI doctors but ultimately, as there is no definitive guidance, the decision comes down to the two of us. We're comfortable with our decision and think it's optimal.

Plus we got to walk away with cool band-aids. Shannon's are all sparkly, mine are the Batman logo. That's right, the Batman logo. Jealous?

The One

I am very happy and quite humbled to report that after carefully reviewing and analyzing surrogate profiles, we have selected and formally reserved a lovely surrogate to carry for us! I can't believe I just wrote that - OMG, I am beyond excited!!!!!

For blog purposes, we will call her "R".  We know we shouldn't read too much into her profile and photos, but we can't help ourselves. R has a beautiful, genuine smile and sincere eyes. She describes herself as calm, quiet and understanding - hopefully, she can teach us the secret! Oh, and she is all of 5'2" and a whopping 112lbs, which will make me look like a horse next to her. Ugh!

Anyway, we have dreamed of this day, the day when we could say we've secured a surrogate who will be carrying our child. Not only are we thrilled, we are forever grateful. Thank you R!

Tuesday, October 20, 2009

Busy Bees

Well it's been a busy couple of weeks for us. Not only has our day-to-day taken its toll but the surrogacy process itself has gone full tilt. There's lots to talk about but let's start with a run down of the latest and greatest in chronological order:
  • All application paperwork had been completed, including all of the health screening tests required for enrollment. It took us a couple weeks to schedule, perform and then receive the results of those tests, but we got them done and earned a clean bill of health.
  • Completion of the application also meant our first wire transfer of funds - the application fee - into the great beyond. No, friendly banker, this will not be going to an Ethiopian king in exile.
  • Our US-based fertility doctor let us know, based on other blood work Shannon had to put herself through (it's been a pin cushion month for her), her specific ovulation and cycle start dates. This means we know exactly when she should start taking "the pill" to lock in her cycle. Neither she nor I have taken "the pill" before so this was pretty momentous.
  • We Skyped with Drs. Sudhir and Yash, the first live conversation with our SI lifelines. During this conversation we learned that Shannon should start taking pre-natal vitamins and should seriously think about NOT getting travel vaccinations. (We'll definitely cover this later.)
  • Our application to SI was formally accepted (!) and we were granted access to secured documentation for use throughout the rest of this process. Of particular note was a list of available carriers.
  • We are now reviewing a list of sixteen wonderful women, trying to decide who is going to carry our baby. Can you imagine?!?
Impressive couple of weeks, no? We'll have more to say about some of the above in later posts but wanted to catch everyone up. Next steps for us are choosing a surrogate (!!) and visiting a Travel Medicine clinic to further discuss vaccination. With H1N1 making the rounds, this should be an interesting conversation.

Clinic Follow Up

I wanted to write a follow up to Geoff's posting about clinics to briefly mention our experience with U.S. based clinics....

Surrogacy in the United States ranges from approximately $100,000 - $180,000 and, unfortunately, the cost goes up each year. In no way do I think having a baby is not worth that much money, but I do think it's a significant amount of money the average couple most likely cannot afford. The last thing our child needs is bankrupt parents! The India option offers us an alternative as surrogacy in India begins at approximately $20,000. In addition to travel expenses, in most surrogacy cases, there are often additional charges to also consider, such as cesarean sections, twins, amniocentesis...

As many are aware, approximately eight months ago we began our hard core research of clinics for surrogacy. We knew India was an option but thought of it more as a backup and focused our search on U.S. based clinics. We met with two well known, reputable agencies based in Boston that work with IPs worldwide.

Circle Surrogacy is the bigger of the two clinics and is very impressive due to the virtually unlimited resources they have to offer IPs. These resources and impressive success rates demand a higher premium than other clinics - $75,000.00+. It was easy for us to get enamored by their grandeur but we were not able to move beyond seemingly justifiable prices we couldn't imagine being able to afford.

When we met with Jan Lee, the Director of the National Exchange for Egg Donation & Surrogacy (NEEDS), we were immediately attracted to her tremendous heart and professionalism. Although NEEDS doesn't have the sizable forces behind Circle Surrogacy, their staff is a small army of miracle workers that deliver the unconditional support and experience needed to navigate the stresses and emotional roller coaster of surrogacy. Each of the references we spoke with couldn't speak of Jan and NEEDS highly enough. Regrettably, though NEEDS' fees were less than Circle's, it was still a bit too much for us at this time in our lives. Had cost not been an issue for us, we would very likely be working with Jan at NEEDS.

Surrogacy in India is a much more cost effective option for us. There are also other countries developing surrogacy programs that cater to Western couples, such as Thailand, Russia, Ukraine.... It is obviously not for everyone as it requires a very big leap of faith and patience. I openly admit that it took me a long time to warm up to the idea, but now that we are committed to the process, I am very excited!

Wednesday, October 7, 2009

What is a clinic anyway?

The clinic we've selected, Surrogacy India (SI), doesn't actually perform medical procedures like IVF. Rather, SI is more of a middle man (middle woman?) with a couple bonus services thrown in. If you're familiar with agencies like NEEDS and Circle Surrogacy here in Massachusetts then you have the idea. Here's a list of SI's core services:
  • screening intended parent applicants for general health and medical necessity (they're not going to work with a couple simply too lazy to get pregnant on their own)
  • identifying gestational carrier candidates (unlike with other India-based clinics, SI gives intended parents the option to review profiles and select a carrier)
  • coordinating care of the gestational carrier
  • initiating and managing the relationship between intended parents and the IVF clinic of their choice (SI's preferred IVF center is Babies and Us)
  • arranging all financial transactions
  • providing legal services, including drafting and signing of various surrogacy contracts
  • smoothing out the passport and visa application process in preparation for taking the newborn(s) home
  • supporting logistical needs such as hotel selection, airport pickups and even site-seeing
  • reducing instances of panic, doubt and concern
[Ok, I added the last one but frankly, that's what Shannon and I felt about surrogacy in India in the first place.]

In comparison to many of the other Indian clinics we considered, SI appears to be taking what I'll carelessly label a more Western approach - meaning there's a greater level of formality and a greater level of involvement on the part of the clinic to manage the entire process. A common warning shared by other couples working with India clinics was to be prepared for long delays in response time and to be self-sufficient and aggressive. Now there's a few uplifting tips! To date, Dr. Sudhir - SI's Founder and Director - has not given us any reason to doubt his clinic's ability to fulfill the promise I just laid out. Of course, as we've only just started the process, our optimistic expectations may be shattered after just two steps in the Mumbia airport. But we won't think such thoughts, will we?

Side note: Our fertility doctor asked an India-based colleague (another reproductive endocrinologist) to investigate Babies and Us
. Turns out, despite a disconcertingly corny name, they're considered the leading IVF center in India. I'm sure opinions vary - there's a host of great IVF centers in India - but you can imagine the relief. So Babies and Us? Thrilled are We!