Sunday, August 30, 2009

Speed Bump

The surrogacy process is so complex that Zach and I have had to take a project-managment approach to the whole thing in order to stay on track (and to keep our brains from spontaneously detonating).

We have files.

We have task lists and timelines.

And today we had an actual meeting, which generated a whole new task list.

One of those tasks is for me to create a full-on matrix of all the information we've collected about the eight agencies we're in the process of researching. (Yes, EIGHT. Yes, MATRIX.)

But I don't need that matrix to report the results of our most recent surrogacy consultation, because I can sum that up in one elegant phrase: HELL, NO!

Having given some of the many considerations further consideration, we've concluded that we want to work with an agency that fully pre-screens its surrogates.

So our first indication that this particular agency was a no-go was finding out that they hold off on the medical and psychological screening, as well as the criminal background check, until after there is a match.

But we continued the conversation, because you never know—we might be persuaded to change our minds on that point. (Not likely, but possible.)

Then we got to the all-important subject of medical insurance. And here's where the red flags started to fly.

First we were told that the agency has had success with surrogates applying for medical coverage through a particular HMO that does not specifically ask about surrogacy on the application.

So the surrogates aren't committing insurance fraud, the agency representative says, unprompted.

Wow. Really? That's your sales pitch?

Because Zach and I are scrupulously honest about EVERYTHING.

We tell waiters and waitresses when they've forgotten to charge us for a soda.

We hand back money when cashiers give us the wrong change.

We report undocumented income on our tax returns.

We're probably the only people in the borough of Brooklyn who got the (required) permit for asbestos abatement, which adds extra hassle and time and expense to the process, rather than exhanging winks with a contractor.

Need I go on?

So the idea that we would work with an agency that takes a very shady shortcut—one they have to defend as "not insurance fraud"—is so far-fetched it couldn't even hope to grow up and become a nonstarter.

The agency rep went on to say that at least one other carrier does cover surrogacy but reserves the right to put a lien on the surrogate's compensation. So we change the contract to say that we're reimbursing for living expenses rather than for surrogacy, she says.

That's two flavors of shady, as far as we're concerned.

So now Zach and I are staring at each other, incredulous, and the rep just keeps talking (she was on speakerphone, so she couldn't see the open mouths and raised eyebrows on our end of the line).

Then she rattles off the surrogate fees, which—as with every agency—vary depending on whether you work with a first-time or "proven" surrogate. (Those are base fees for "singleton" births. Fees are higher if it's a multiple birth or if a C-section is required, or both.)

But then she told us that the fees were negotiable—and that she's the one who decides what's appropriate for each woman. They tell me what they want, and I tell them what they're worth, she says.

And now we can't get off the phone fast enough.

Because it took a long time and a lot of thinking and reflecting and soul-searching for us to get comfortable with the whole notion of surrogacy to begin with.

And one of the things that enabled us to get comfortable was the fact that the fees are set from the get-go. Potential surrogates know the fee structure an agency uses before they sign up. And intended parents like us do, too.

And we all trust that the fees are fair (or we wouldn't be working with the agency that set them).

And that allows us to put them aside and focus on the qualitative aspects of the process—finding the right surrogate (or couple) and building a relationship with each other.

So the thought of an agency haggling with its surrogates is just unseemly, and something we want no part of. Even writing about it is distasteful to me.

As unpleasant as the interaction was, it did serve one very important purpose: to reinforce the fact that we need to continue to do our homework, to be thorough and methodical in our approach, and to stay true to ourselves and our values as we ease on down this long and winding road.

Friday, August 21, 2009

Feeling It

We just got some incredible news from dear friends who, like us, have faced some serious hurdles on the path to parenthood.

My first reaction was overwhelming joy.

These are two of the most wonderful people to grace the planet—kind, wise, gifted, warm, funny, smart, honorable, sensitive, fun people. Amazing friends who are going to be amazing parents.

I started to tear up as I read the ebullient words in the message. I had this overpowering urge to hug them—and Zach—but I couldn't. I was at work, where there is a severe shortage of people whom it would be appropriate to hug.

So I sat there alone for a few minutes, contemplating the enormity of the news and feeling a kind of vicarious gratitude that this longed-for outcome had finally come about.

And then it happened.

I felt this small but certain pang.

Not envy. Not resentment. Not sadness.

But desire.

For the first time in all these years—years when I knew I wanted to be a parent, when I couldn't imagine our lives without children—I had a visceral experience of the desire to have children.

I felt it in my gut.

Maybe because our friends' good news filled me not only with joy for them, but hope for us.

Maybe I hadn't allowed myself to really experience that desire, that hope, until now.

Maybe some kind of innate self-preservation mechanism has been hard at work, protecting me from the very real possibility of disappointment down the line.

I've known for a very long time that I won't ever have that indelible experience of motherhood: feeling our baby kick inside me for the first time.

Maybe this pang is as close as I'll ever come.

Tuesday, August 11, 2009

Consultation Number Two

We had our second surrogacy consultation yesterday, this time with a doctor who runs a fertility clinic that has a surrogacy agency affiliated with it. The doctor has a child through a surrogate and so was able to give us a lot of very practical advice from personal experience.

We both liked him very much and concluded the phone meeting feeling further encouraged about the process and our chances.

Still, it's all very overwhelming.

I'm reminded of a conversation I had recently with a co-worker who is planning her wedding. She and her fiancé visited several possible venues and were having a hard time comparing them and making a decision. One supplied the wedding cake; another didn't. One had a food-and-beverage minimum; another had a minimum number of courses. One had better valet-parking rates; another had better liquor prices. She put together a detailed spreadsheet but still couldn't come up with apples-to-apples comparisons.

Surrogacy-planning is similarly confounding.

Some surrogacy agencies are attached to fertility clinics; others aren't.

Some fully pre-screen all of their surrogates; others do minimal screening until after you're "matched" (which means that you could very easily become unmatched if the surrogate doesn't meet the requisite medical, psychological, and financial standards or pass the background check).

Some agencies charge $10,000 for their services (separate from the surrogate's fee, the legal fees, the insurance premiums, and, of course, all of the medical costs); some charge twice that.

Some insist that you buy separate health insurance for the surrogate; others maintain that the surrogate's own insurance is sufficient.

Some recommend that we have the surrogate travel to New York for the transfer; others say that we should bring our frozen embryos to the surrogate.

And all of them have their own networks of preferred providers, whether it's lawyers or fertility doctors or egg-donation agencies, so we are getting referrals upon referrals.

This has turned out to be a very iterative process, with each step sending us forward and backward at the same time.

As a result, we've concluded that we need to be running two searches in parallel: one for the agency, and one for the fertility clinic.

Because having the perfect surrogate won't do us any good if we don't have the right embryologist(s) and reproductive endocrinologist(s). And vice versa.

Next up: Consultation Number Three. And Four. And Five. . . .

Sunday, August 09, 2009


Zach and I went to a friend's birthday party at a Hollywood club on Friday night.

I had no idea what people wear to clubs, since I'd never been to one, but I did my best and ended up wearing a low-cut top—well, as low-cut a top as I can carry off under the circumstances—and significantly more makeup than I have worn in years.

I felt a bit awkward about going out clubbing for the first time—I'm in my early forties, after all, and it seemed like an age-inappropriate activity.

But then I realized that at least part of me was in the right demographic.

Because while I'm middle-aged by traditional measures, I actually have the breasts of a 25-year-old.

(You know, on average.)

Wednesday, August 05, 2009

The Fog Rolls In, But Not Out

Yesterday's New York Times has a story by health columnist Jane Brody about chemo brain, aptly titled "The Fog That Follows Chemotherapy."

I've written a little bit about the fog (here and here and here and here and here), although in my case it was mostly about the fog that accompanies chemotherapy.

But now that I'm three (and also eight!) years from chemo, I have to say that the fog hasn't entirely lifted. It's nothing like it was during treatment, when I was barely functional on some days.

Instead, it's a more subtle but markedly persistent phenomenon. When I read this sentence:
"The symptoms are remarkably consistent: a mental fogginess that may include problems with memory, word retrieval, concentration, processing numbers, following instructions, multitasking and setting priorities."
I recognized every single symptom.

For me, word retrieval is the biggest frustration. It's like the opposite of a stutter—there's just a long pause before I finally come up with the often-not-quite-right word. As a writer and a previously often-articulate speaker, this is maddening. And saddening.

I'm also nowhere near as dexterous with numbers as I'd been my whole life. I can still do a lot of calculations in my head, but it seems to take forever. This I can live with—working with figures isn't something I have to do all day, every day. But it's a loss nonetheless.

And while my long-term memory seems to be pretty much intact, the short-term side seems to be suffering. I find myself asking Zach the same question two or three times, usually prefaced with, "I know we talked about this, but. . . ."

The other stuff—concentration, following instructions, multitasking, and setting priorities—all manifest themselves at work, where I'm working on a couple of dozen projects at any given time. I know that these are issues because I've had things like "integrate all to-do lists" on one of those to-do lists for months. It's like I suddenly have ADHD, when focus and organization were never a problem before.

The tricky thing with all of this is that these symptoms coincide with two other events—passing the 40-year mark and being thrust into menopause—both of which are associated with memory and other cognitive declines.

So is it the after-effects of chemo, or middle age, or quitting estrogen cold-turkey?

I'll never know. And at this point, the cause of the problems doesn't really matter.

All I can do is try to find solutions.

Sunday, August 02, 2009

How to Help a Friend with Breast Cancer

In the past couple of weeks, I've received two different variations on the following message:
A friend/co-worker/family member of mine was recently diagnosed with breast cancer. What can I do to support her?
I've written before about what a helpless-feeling friend can do in this situation.

I've also written about how grateful I have been for the psychological respites my own friends and family provided during the most intensive parts of my diagnoses and treatment.

For those looking for more concrete, practical suggestions, I offer these:

Immediately Post-op:
  • I was home for nearly three weeks after my mastectomy. The first few days were a blur (pain + pain meds), but after that my memory is that TV, movies, books, and magazines were key.

    Suggestion: a thoughtfully composed care package with snacks and entertainment options.

  • After a mastectomy (and maybe a lumpectomy, too—I just don't know), you can't wear a bra right away. And depending on the kind of reconstruction, you can be quite uneven for a while.

    Suggestion: several soft camisoles. (Gap is a good source.) Camisoles are both comfy and good for layering/camouflage purposes.

  • Flowers are always nice.

    Suggestion: Choose an arrangement that isn't overpoweringly fragrant or super-heavy. (Lifting is out of the question for a while.)

  • Shopping and cooking can be challenging.

    Suggestion: Arrange to have dinner delivered from a nearby restaurant (especially if she has a family and traditionally does the cooking).

For Those Going Through Chemo or Radiation:
  • I found it incredibly helpful to have planned rewards—things I could look forward to doing after each round of chemo or week of radiation.

    Suggestion: gift certificates for things she can enjoy later on—movie or theater tickets; a gift certificate to a spa or restaurant.

  • If it's a dear friend who lives far away, time together is priceless.

    Suggestion: a visit from you (but don't spring this on her—ask first) or a plane ticket for her to come see you as soon as she is able.

  • Just knowing that I was in people's thoughts was a pretty powerful tonic. Hearing that I was in their prayers was always humbling. (I don't pray myself, so I did feel awkward about it at first. Then I realized that it was an expression of love, something I was very comfortable receiving.)

    Suggestion: Just let her know you're supporting her, in whatever way feels comfortable to you. A thoughtful card or note is always a lovely thing to send. If she happens to be writing a blog, you might check in on it once in a while and leave a comment or sign the guest book if you are so moved.
I hope these are helpful. Of course, most would apply just as well to any other kind of illness or crisis.

If you have other suggestions, please leave them in the comments for those who find their way here down the line. . . .