Alternative Reproduction: What Couples Really Face

Same-sex couples starting families are headed to primetime in The New Normal, a fall sitcom from NBC based on two gay men looking to start a family with the use of a surrogate. It's one of the first expansive and relatable looks into the process. But a local affiliate station in Salt Lake City, Utah banned the comedy because it worries that this show about families is "inappropriate" to be watched by families.

Even in the show, Bryan and David must contend with the surrogate's bigoted grandmother. The New Normal might be, as Jonathan Kipp of Oregon Reproductive Medicine, a leading fertility clinic for LBGT couples, "another step in showing Americans that our country's families are diverse." But it's also a hint at what couples who try surrogacy experience when confronted with a culture not yet prepared for a "new normal."

According to U.S. Census data from 2010, an estimated one-quarter of all same-sex households are raising children. The Census didn't ask how many used alternative reproduction. But for those couples, the expensive process comes with a host of frustrations and little support during the search for a donor.

Just how expensive -- costs associated with alternative reproduction run steep and can prove to be challenging for couples.

* Surrogate fees range from $20,000 to $40,000.
* Insurance coverage for the surrogacy cycle ranges from $15,000 to $25,000.
* Program coordination fees for surrogacy range from $15,000 to $22,000.
* Egg donor fees range from $5,000 to $10,000.
* Program coordination fees for egg donation range from $4,000 to $8,000.
* Doctor's office fees, labs, medications, and the like range from $13,000 to $20,000 and more.
* There will also be incidentals such as attorney fees, psychological and genetic consultations, complication insurance policies for donors and travel expenses that could add an additional $1,500 to $5,000 and up.

April Nelson, 38, an attorney, and Margaret Fiore, 49, a corporate trainer, of Mayfield, Md., began discussing whether to have kids several years into their relationship. The couple of seven years opted for IVF and now have twins, a boy and a girl named Addison and Avery, who are now almost 4 years old.

Nelson and Fiore's journey began in the summer of 2007 when first exploring how to get pregnant "the old fashioned way," Nelson jokes, referring to simply using anonymous donor sperm for insemination. The couple encountered their first hurdle, however, when it was determined by doctors that Fiore's likelihood of producing a viable egg was minimal because of her age and hormone levels.

Then the couple spent a few months considering options, and with Nelson still midway through law school and Fiore having always wanted the pregnancy experience, they decided to try in-vitro fertilization (IVF) using eggs from Nelson implanted in Fiore.

"The process was exciting and terrifying and exhausting all at the same time," said Fiore. There were periods when both were on injection hormones and making multiple visits each week to the fertility clinic. The couple underwent mandatory counseling sessions to ensure they "knew what they were doing," and Nelson had to participate in even more assessments required for egg donors. The clinic was open affirming, but neither its policies nor the law were truly prepared for how to "categorize" them.

From left: April Nelson and Margaret Fiore, with Avery and Addison

Fiore couldn't be categorized as Nelson's surrogate because there was no medical reason Nelson couldn't get pregnant. So Nelson was classified as an egg "donor" to Fiore.

The couple also had to cover their bases legally. According to Nelson, "Our experience truly illustrated how the law continues to lag behind the science in this area. I had to terminate all rights to the eggs, but once they were 'embryos,' Margi and I shared 'joint custody,' in the sense that neither she nor I could make decisions about the use of the embryos without the other's consent. But, once the embryos were implanted, the fetuses were once again no relation to me legally."

Michele Zavos, with the Zavos Juncker Law Group of Bethesda, said the couple already had the adoption paperwork ready when the twins were born. Once their attorney filed it, they had a formal adoption in less than two months.

The birth certificates were then re-issued reflecting parent no. 1 and parent no. 2. According to Nelson, there were mixed feelings on the day of the adoption.

"We were happy to know that our family was now as protected as it possibly could be in terms of the parentage of the children," Nelson said, "but there was still something a bit degrading about having to stand before a judge in order to be granted the status of parent to two children who are already genetically mine."
For couples considering alternative reproduction, the first thing to do is get educated. "The changes in advanced reproductive technology alone in the last 20 to 30 years have made the possibilities for gay couples to have children much greater," said Abigail Glass, a Sherman Oaks, Calif. based therapist specializing in fertility treatment, adoption, and surrogacy. "We have come a far distance in supporting gay couples to start families, and I believe we have much further to go."

Each decade provides new advances in reproductive medicine, and alternative reproduction has drastically changed. During the last five years alone, modifications in the methods of egg freezing have resulted in greatly improved egg survival, fertilization rates and pregnancy rates. Commercial egg donor banks that provide pre-screened frozen eggs are still relatively new in the industry as a whole. Those banks were always available for any kind of families, but they are still not considered to have as high a success rate as fresh cycle transfers. "The hope in our industry is that science gets to a place where pre-frozen eggs are the 'norm' in order to make the entire process much more cost efficient to the intended parents," says Wendie Wilson-Miller, president of Gifted Journeys, an egg donor agency located in Toluca Lake, Calif. and author of Insider's Guide to Egg Donation: A Compassionate and Comprehensive Guide for All-Parents-to-Be.

But the culture hasn't kept pace with fast-moving advances in medicine. The overall lack of resources and support groups for same-sex couples seeking alternative reproduction is frustrating. "I do believe that there could be significantly better resources out there for gay families seeking egg donors," says Wilson-Miller. Resources should include which agencies and IVF clinics consider themselves "gay-friendly" and openly ask all of their egg donors if they are willing to donate to same-sex couples or single gay parents. "It is important to know (at least for us) if a donor is open to working with all types of families since that is our clientele," said Wilson-Miller.

Nelson and Fiore are grateful for the support they received from friends and family in northern Virginia and Alabama. "Our neighbors truly are our family," Nelson said. "What makes me know I am home is that most days I don't even think about being gay or that we are in a same-sex relationship. We are simply the Fiore-Nelsons who have the two wild 3 1/2 year olds who fly up and down the block on their hot wheel tricycles about 25 times any given day. We are just Addison and Avery's parents now."

Rich Palermo and Steve Mazza

Not every couple experiences extreme setbacks. Rich Palermo, 39, and Steve Mazza, 40, of New York City, consider themselves lucky. "Our egg donor was the first woman we looked at on Circle Surrogacy's site, and we loved her from the first minute we Skyped with her," said Palermo. The egg donor passed all her tests and produced a ton of eggs. Same thing happened with the surrogate -- "she's the first woman presented to us by Circle, and there have been absolutely no problems, medical or otherwise," said Palermo.

The couple had both considered alternative reproduction (possibly doing it as single parents) before they had even met. Six months into their relationship, they got really serious about alternative reproduction. The couple, married a year now, said initially they were nervous about choosing their egg donor and surrogate.

"At first it was a bit scary and overwhelming, mostly because so many pieces had to come together and we didn't know where to begin," said Mazza.

One big challenge the couple faced was being so far away from their surrogate, who lives in Missouri. "It's weird knowing that our baby is so many states away from us, but our surrogate helps us out by sending weekly pictures of her baby bump," says Palermo. The couple was warned that their surrogate might not get pregnant on the first implantation, so they shouldn't get their hopes up. But she did. And they recently flew to Missouri for the 20-week ultrasound and found out they're having a healthy baby girl.

Palermo and Mazza had a great support system of friends and acquaintances who had already gone through the process. "They were so open with us about everything they encountered to start their families, and it really helped us get a sense of what we were in for," says Palermo. Partnering with Circle Surrogacy and CT Fertility, the couple also attended a seminar about surrogacy for same-sex couples at the New York City LGBT Community Center. The love, support and advice the couple received from their family and friends really made their experience that much better. "We involved our family and friends from day one - giving them frequent updates," said Palermo. "It's not that we couldn't have done it without them, though it would have been much harder, we just didn't want to."

For couples considering alternative reproduction, Palermo and Mazza suggest talking to as many people as possible who have gone through the process. "It really helps to hear what others experienced - so that you can have realistic expectations about the process and so that you can try to avoid some of the pitfalls that others encountered," said Mazza.

The couple both grew up in large, close Italian-American families on Long Island. They learned early on that a big part of family is showing up for each other - for birthdays, holidays, Sunday dinners, soccer games, and school plays.

"We grew up with that kind of support and love, and it is exactly how we want to raise our family," says Palermo. "We have friends who warn us that our lives will now completely be about our daughter. We say to them: 'great!'"


Helpful Online Resources
The American Fertility Association, Theafa.org
American Society for Reproductive Medicine, ASRM.org
RESOLVE: The National Infertility Association, RESOLVE.org
Parents Via Egg Donation, Pved.org