Surrogacy: the truth

Grow up, get married, have babies. This is how the fairytale goes, right?

Not for everyone, unfortunately.

But the fairytale need not end here; in fact, it may just take a slight detour down a road on which selfless women help each other by becoming surrogate mothers - giving the ultimate gift to those who cannot have children.

Nicole Kidman is the latest celebrity to use a surrogate mother. But this is not just a Hollywood trend: we speak to two local women on either side of a surrogacy.

Shelley Savage (33) is a five-months-pregnant surrogate mother. She is married and has a child of her own and is quick to dispel the sticky myths surrounding surrogacy: she knows that what she's doing will change someone else's life forever.

How did she, a woman who conceived her child naturally with her husband, decide to become a surrogate to a couple she had never even met? And how did her husband feel about this monumental decision?

"Initially he did not like the idea - not one bit! Understandably he didn't want me putting my body and emotions through so much for people we didn't even know. But after we'd had our son he told me that if it's something I was still interested in pursuing, he would support me 100%," she explains.

"As it turns out it was our son who was responsible for changing my husband's mind. When you are bent over a cot at two in the morning, unable to return to much-needed sleep, because you can't take your eyes off the most precious creation lying cuddled up in his bed, you can’t help thinking of how awesome it would be to help someone else experience that feeling. What beats taking a deep breath of baby smell and stealing a kiss or two… or three?"

However it hasn't all been plain sailing for Savage, and the first IVF attempt ended in a miscarriage. Fortunately the second attempt is working out well and she is pregnant with twins.

The other side of the story
Melinda McGregor is unable to have her own children after an emergency hysterectomy, and is currently using a surrogate mother.

"Apart from adoption, surrogacy is our only option. I had an emergency hysterectomy four years ago due to severe post-partum bleeding. The cause for the post-partum bleeding was a 'placenta accreta', but I still have my ovaries so we are using our own genetic material for the surrogacy," she says.

It has been a bumpy road thus far for the McGregors, and to date they have already been through four failed surrogacy pregnancies, each one an emotional roller-coaster worse than the last.

"We attempted the first three IVFs with a surrogate in Pretoria. She had an immune disorder, called anti-phospholipid syndrome, but had two successful pregnancies with the correct treatment while pregnant. The fertility specialist at that stage thought we must try the IVFs with her, but while she felt pregnant on our first and third attempt, she miscarried both very early in the pregnancies. The fertility specialist couldn't really give us answers on why it didn't work. Our fourth attempt was done in a new city with a new fertility specialist and surrogate, and again a negative outcome with no reason why it didn't work," she says.

McGregor says she and her husband plan to try one more time with the current surrogate. "The only other option we have is adoption, but we are not 100% sure we want to go that route," she says.

How do the miscarriages affect the intended parents (IP's)?

According to McGregor the treatment itself is very emotional "since you are on such high doses of hormones and then when you have a negative outcome – well, I was very sad, depressed, disappointed, but sometimes also very angry."

How it works
In many cases the surrogate is a friend or family member. One of the most famous surrogacy pregnancies in SA was in the 1980s when a woman carried her daughter's babies for her – effectively being pregnant with her own grandchildren.

For most, though, a surrogate must be found elsewhere. Some women advertise in newspapers or online, though most prefer to go through social workers or fertility support groups such as Tertia Albertyn's Nurture programme - South Africa’s premier egg donor and surrogacy programme (www.nurture.co.za).

Albertyn, a mother to twins conceived on her ninth IVF, is well known for her blog (www.tertia.org) which describes her struggle to have children. While she did not use a surrogate mother, she is well placed to argue both sides of the story given not only her background in infertility treatments, but also her new life as a mother.

"I don't think there is a long-time infertile out there that hasn't considered using a surrogate. By the time you've been on this roller-coaster ride for a few years, you'd consider standing on your head naked if they said it could help you have your baby. I did consider it, in fact I had a surrogate lined up (friend of mine), but the doctor was convinced I didn't need it - not because there is anything wrong with surrogacy, but because in my case there is nothing wrong with my womb. The problem was with my egg quality, rather than my womb. So what I really needed was an egg donor, not a surrogate."

What the experts say
Professor Thinus Kruger, head of the infertility clinic at Tygerberg Hospital in Cape Town, is a fertility specialist who has been involved in surrogate pregnancies for more than 20 years. He says the demand for surrogates in SA is actually very high.

In his experience, he said, surrogacy is often perceived as the only option when women have a damaged uterus, or have lost their uterus to diseases such as cancer; or if there is unexplained infertility.

Don't do it for the money
If you're entertaining thoughts of becoming a surrogate mother to boost your bank balance – think again. Under South African law, the only payment you can receive for being a surrogate is compensation for expenses and time away from work. Usually, a legal contract is drawn up, detailing not only this reimbursement, but also any other issues which might crop up.

Savage is appalled at the thought of "charging" for surrogacy. "People have asked why I didn't take money under the table, and my answer is this: the majority of IPs are average people. Surrogacy is never a first option for anyone so chances are they have already been through years of fertility treatment, and may even have had to remortgage their homes."

The fact that many people still believe surrogate mothers "get paid big bucks for womb rental" is a myth Savage detests.

Busting surrogacy myths

Next on the hate list, she said, is the seedy image surrogacy has been given through Hollywood movies. "Some people still have the Hollywood image of ciggie smoking, trailer-living surrogates out to suck their intended parents dry. Legally this is impossible as a surrogate is contractually bound to living a healthy lifestyle as per the IP's wishes. This will always include a no-smoking, no-alcohol, and no-over-the-counter-medication clause, and can even include details such as exercise, diet etc, but this varies from surro to surro.”

Another vexing issue for surrogates is those who flippantly suggest adoption rather than surrogacy as more socially acceptable. "It's all to easy to sit back and tell someone else who has been to hell and back probably several times over what they should do.

"Unless you are facing that choice you have no idea what goes into making that decision. I personally believe that everyone has the right to hold a little baby that is their own flesh and blood."

Albertyn agrees, adding: "There is a group of vocal people who believe that if you can't have children on your own, you should just shut up and be satisfied with your lot in life. To them I say, I don't think so! If you had diabetes, would you just accept your lot in life? Infertility is a medical condition. It is not God's will, not anyone's fault and certainly not something to be a life sentence.

"Everyone deserves the chance to have a child. The Nurture Surrogacy Programme intends taking surrogacy and egg donation from behind the shroud of secrecy unapologetically into the open. We are immensely proud of what we do, and we are very, very proud of the wonderful, generous women who are part of our programme and who offer this selfless gift to others," says Albertyn.

'It's not your baby'
One of the most commonly asked questions surrogates get asked is how they could possible 'give up' the baby after carrying it for nine months. But Savage doesn't see it like this; she points out that 'it's not yours in the first place'.

"These babies are completely theirs (the IP's), nothing of mine went into the making! All I am doing is babysitting on the inside instead of the outside. Of course I am capable of loving them, but in the same way as I love my brother's kids. I tickle my tummy and talk to them in the same way too, but don't bond with them in the same way as I did with my son, because they aren't mine.

"At the end of the day I don't give them up, just return them to their parents. I have told my family not to draw a comparison with giving your own child up for adoption, because it's not the same in any way. I wouldn't want to keep someone else's baby, I am fertile and if I wanted one I'm perfectly capable of making one for myself!" she says.

To tell or not to tell?
When this day comes it's also important to decide what you are going to tell your child when they are old enough to understand – and whether you would like the surrogate, or the surrogate would like to be, a part of that child's life in the future.

Savage says that this is an important issue which needs to be discussed right from the outset so both parties are clear about where they stand. "In my case I have opted for no contact although if the IPs choose to contact me at any point afterwards it would be more than welcomed. I don't want them to feel indebted to me, I have told "mom" that she should think of me as her remote tummy, and my objective is to make this feel as close to natural as possible, " she says.

McGregor says that her surrogate mother has also opted for no contact after the birth, although both parties have agreed to keep in touch. And when it comes time for the child to learn how they were brought into this world, McGregor says she has no problems telling them their parents used a surrogate mother to carry him/her/them.

Counselling a must for all parties
One thing most experts do agree on is that counselling should be available for both parties before, during and after the pregnancy. This is to mentally prepare everyone involved for the following nine months as well as what comes after that.

Yet Savage, while she believes counselling is a good idea, chose to forgo it and instead "opted to keep lines of communication open between the IP's and myself". She knows she has the option of seeking counselling, "but to this point it hasn't been necessary".

McGregor also didn't partake in much counselling and said, "When we started the procedure we were evaluated by a psychologist, and with the second surrogacy we were again evaluated, but I haven't gone for any other form of counselling than the screening process."

Support systems vital for success
Since the stigma of surrogacy still persists in society, McGregor admits that telling people they are using a surrogate mother has not always been simple.

"Most of our friends and family are supportive, but we have lost a'friends' who don't support our decision. We were even asked to leave a small group of our previous church, because some people thought that we were doing the wrong thing. I think the problem is that both my husband and I grew up in conservative Afrikaans-speaking families, as did most of our friends. But we have learned to deal with this situation, and just try to surround ourselves with positive people."

Savage also maintains that this wouldn't have been possible without her family supporting her.

"If my husband hadn't committed to supporting me 100%, I wouldn't have given it another thought. He is the one on the receiving end of my mood swings, who had to inject me throughout the IVF period, who has to drive to the shop for anchovies at 1am, who brings me crackers in bed when the morning sickness is bad, and who has to pick up the slack at home when I physically am not able to. He also has to deal with situations where people unknowingly congratulate him, as well as watching his wife's body go through all the changes of pregnancy and know at the end of this all we won’t be bringing a baby home from the hospital," she says.

'It will be the most rewarding thing you'll ever do'
What advice do these two women have for others in their respective situations?

They both advise anyone considering being a surrogate or using one, to arm themselves with knowledge.

"Discuss it with your loved ones and don't be disheartened if they don't share your enthusiasm; sometimes all it takes is for the seed to be planted. And while it's unchartered territory for both parties - and I won't say that every aspect of it is a breeze - it will be one of the most rewarding things you will ever do," says Savage.

McGregor advises formality. "Be careful - don't try to find a surrogate on your own. Rather work through social workers or clinics that deal with surrogacy. Follow the right procedure and go for the medical and psychological screenings and make sure you have a legal contract in place. Above all, follow your instinct!"

Sources: Shelly Savage, Melinda McGregor, Professor Thinus Kruger (Tygerberg Hospital, Cape Town)

Visit www.nurture.co.za.

Take a look at Parent24

(Amy Froneman, Health24, August 2008, updated January 2011)

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