25 weeks...and a shocker

First, thank you all, all the people who "derlurked." I've saved the blog addresses of those who were not on already my reading list, and I look forward to reading your stories.

Apparently, there is an ultrasound every month from this point on. I was pretty darned happy to hear this, and I went back to Mediscan, where I've had all ultrasounds done so far. This is a lab chain that specializes in fetal testing, and the doctor here is one that I absolutely have come to like and respect. Her name is Vandana Bhansal, and I highly recommend this place (and her) for antenatal testing.

The ultrasound was going well. Dr. Bhansal then casually asked J what her blood type was. Both my mother and I were shocked out of our wits when she replied "B negative." Negative?!?! That means she does not express the Rh antigen. I do express it, as does my donor.

Rh- moms need specialized attention when they are carrying an Rh+ baby, because if there is is mixing of fetal and maternal blood, the mother will make antibodies against the fetal Rh antigen. Those antibodies can then cross the placenta and can cause fetal anemia and jaundice. Severe anemia can even result in fetal demise. If the mother is sensitized to the Rh antigen in one pregnancy, then all the later pregnancies are at risk. To prevent this, the mother should be given the Rhogam shot at 2 points: at 28 weeks of pregnancy when the chance of fetal blood mixing is 1%, and at delivery, when it goes up to 10%. If an Rh- mother has a miscarriage or trauma during pregnancy, the Rhogam shot is administered at that point as well.

Now, Rh negativity is sort of rare. It is high in the native American population, and rare amongst Caucasians. I thought it was rare amongst Indians as as well...I found out that it was more common than I thought, coming in at about 10%.

  

I never dreamed that a Rh- surrogate would be selected, especially given the masses of women available for surrogacy in this country that are Rh+. I never got the surrogates initial  screening tests (I had to literally  badger my RE for the initial thyroid testing results); had I seen this, I would have gone with somebody else. I'm shocked that I had to find out by accident, and I am so grateful that I got Dr. Bhansal; had I not, this may have never come to light, and I'm not sure if my RE told the OB specifically about this, or was aware of it. 

So here I am, having to live with this wrinkle as well. We immediately had her tested...as of now, she does not have antibodies against the Rh antigen; she has received one of the two mandated injections (the one given at the time of birth) following all her pregnancies. Not being the sort to take chances, we will have to administer the Rhogam shot during pregnancy as well. Now, Rhogam used to contain thimerosol (ethyl mercury) as a preservative. It was recently removed in the version administered in the US, but I don't know whether the older version is still in use in India. I'm stuck with the headache of ensuring that a thimerosal-free version is given. 

All was well in the ultrasound too: the thing that made me slightly worried is that the head circumference growth is lagging--it went from above the 50th percentile at 19 weeks to the 12th percentile at 25 weeks. The one thing that is absolutely ahead is femur length, coming in at the 84th percentile.

 I'm trying not to think about microcephaly, and I'm trying to remind myself that I have an absolutely tiny skull as well, and was apparently incredibly low birth weight (under 4 pounds at 41 weeks!!), and I turned out to be perfectly healthy. This baby is sort of like how I've been all my life---small head, long legs, so worrying is stupid,right?

No choices, no milk

I had an interesting consult with the OB today. Incidentally, she is the doctor who handles most of the surrogacy cases in Mumbai (apparently), so she is also the person with the most experience in dealing with surrogacy, and that should not be taken lightly.

But what I heard was distinctly disheartening. Remember that choice to waive the steroid shot that I mentioned? She clearly had told me that the first time I talked to her, but today she told me that it is her protocol, and she is going to do it. I could try some things to prevent that, but that would be both counterproductive and foolhardy, so I will just have to go with the flow.

I then asked her whether J could express colostrum and feed the baby (followed by pumping after the first couple of feeds) for as long as she is in the hospital with the baby? She was like...nope. No surrogate can feed the baby. They actually give them shots + pills to dry up their milk as soon as birth occurs, so even if both parties (the birth parents and the surrogates) want to do this, they cannot. She basically told me, this is my protocol, take it or leave it. Unfortunately, I do have to take it, and the sooner I make my peace with all this, the better.

Just FYI for people doing surrogacy in India: Dr Pai in Anand, Gujarat allows/encourages breast feeding.

In the defense of the people in Mumbai, there is a logical reason they shut off the milk supply: if the milk flow is established, and there is no baby to drink it afterwards, there can be breast engorgement that can lead to an abscess. I had already factored it in, and had naively thought that J could go donate at a milk bank (she lives really close to one) and maybe make some money (I hope to god they pay them) and everybody could win, if she was open to this. But nope, her milk supply will be shut off immediately after birth.

AAh....the stuff I wish somebody had told me about, before I signed up for all this.

I also heard a hair raising story about a surrogate, which is an excellent illustration of why one needs to thoroughly investigate the situation before initiating surrogacy in India: A surrogate shows up with insanely, dangerously high blood pressure at a mere 10 weeks of pregnancy. She claimed she was 27 years old. The OB refused to believe her, and on further grilling of the handler, it was revealed that she was 42 (!!!) years old. Her daughter had been kicked out of her home by her own husband (I think) who had told her she had to produce Rs 200,000,  to get back in.

This woman,  in desperation, lied about her age and her medical history and entered a dangerous pregnancy to get that money for her daughter. The surrogate handler propagated the lie, and I have no clue what the RE was doing.

 Everybody was shortchanged here....the poor woman who was the biological parent, the poor baby, and the surrogate, who risked her life for money. Such a situation can only be prevented by investigating the heck of out the surrogate, investigating her previous medical history as thoroughly as possible to ensure that this is not for 5th of 6th or 7th pregnancy...they can lie about this as well.

 Bottom line: based on everything I've heard and my own experience, I''ll say this to anybody who is thinking about surrogacy in India: Ask a LOT of questions before you start. Make sure your doctor has investigated her past pregnancies as well, and has gotten her previous medical records from whereever her last pregnancy was, all of that. I'll come up with a comprehensive list of things to investigate before you start.

A new year, and an interesting quandary (blanket steroid shots!)

Today marks the completion of the 23rd week of pregnancy. I have such hopes for this new year. As I hugged my parents at midnight, each of them whispered to me that they hoped that this turns out to be the year where I finally get what I've been striving so hard to get. I hope so too.

2013 was a lot of things for me, but I hope I can get to remember as the year in which the most important thing in my life came to be.

As for this new year...I hope it brings good things to as many of you as possible.

We did the glucose tolerance testing. In an odd turn of events, I have the 2-hour glucose levels and the glycosylated hemoglobin values, but not the fasting levels yet. The 2-hour glucose level was 94, and the glycosylated hemoglobin came back at 4.8%. Both tell me unequivocally that J does not have to worry about diabetes. YAY!

I have to go talk to the OB tomorrow to discuss one important point, and it is something that will probably make a lot of jaws drop: In India, apparently, every surrogate pregnancy is considered a high risk pregnancy, and what they do is give every surrogate the steroid shot at 28 weeks to induce fetal lung maturation, no matter what the individual situation may be. The first time I heard this, I nearly bit the head off the poor hapless doctor's assistant who informed me about this, because this seemed insane. Even my very restrained mother freaked out when she heard this: a blanket steroid shot?!

The benefit of a steroid shot far outweighs the downsides (it can negatively affect the developing  immune system of the baby; it can aggravate gestational diabetes in the mom, and so on)  in a situation when pretrem delivery is imminent, and this shot has helped improve the health of innumerable babies worldwide.

But to give it in a perfectly normal pregnancy? Obviously, they make the decision to give this based on the statistics. Apparently, most of the surrogates are preterm (At or before 36 weeks), for any number of reasons: a higher incidence of multiples pregnancies, poor nutrition, low vitamin D levels, the strain of having borne many children, etc. Additionally, when they are not under the supervision of a doctor, if things move very quickly say, around 32 weeks, then there may not be time to give the shot: the situation IS different from that of a regular pregnancy.

But a blanket shot when things look fine? This is such a difficult call to make, and I have the choice of refusing this shot. I just don't know what to do. If any of you have any input to offer one way or the other, it would be most welcome.

Also, I have majorly revamped the "Science of Infertility" page, summarizing a lot of what I have discovered/realized in the past year. It is worth a read especially if you are still in the trenches.

A glimpse of the realities of surrogacy in India

The 19w1d scan went off wonderfully. My baby is a cheeky monkey...he/she kept alternately yawning and sticking its tongue out at me. No issues were spotted, the bloodflow to the placenta (as measured by the doppler) was great, and the cervix was closed at 3.4 cm. All good news.

Now, J and I have had a rather closer relationship than what is recommended between a surrogate and the mother. Everybody (lawyers, doctors) encourage you to keep a contact to a minimum. The reason behind this is that India's surrogates are women from lower socio-economic strata, and the mothers appear vastly wealthy to them. Hence, the theory is that if they can extract money out of you, they will. This is an extremely ugly equation, and I've tried my best to sidestep it entirely. I don't care if the surrogate takes money from me. I had always planned to give her far more than the amount she had been promised, and indeed, I have been giving money to her every  time I see her. My gynecologist called me a bleeding heart...to her, these are greedy grasping women who see this as a business. 

I don't see it in this way...the way I see it it is these are women who are trying to make a better life for their families, and they have never had the luxury of being honorable and principled. It is hard to be that way when you have so little. So if my surrogate tells me small lies to increase my sympathy for her and get some money out of me, I honestly don't give a damn.

But on the day of the ultrasound, J may have upped her game. She told me that she was being evicted from her home, and was forced to go live with her sister in a place on the outskirts of Mumbai. Bleeding heart me was immediately horrified and I started thinking...how can I fix this? How can I get her housing?

She claimed she needed a hefty deposit for a new place. At this point, even my sort of unworldly mom was like well, she is playing you. The only person who can corroborate whether this is indeed real  is the handler, and she is a woman from the same community...she will lie for her if necessary, and yes, she did claim that J had to move in with her sister the very next day. 

I want to find out if this is true or not, but I have no way of doing so: the handler is not taking my calls, and I have no way of corroborating anything.

I also realized what an uphill struggle everything is when I want something out of the ordinary. J's delivery the last time was at the same hospital, with the same doctor. When I first asked her, she told me she had given birth at full term. Recently I asked her what week it was, and she said 32 weeks.  The way she tells it, she was induced: I was horrified: why would you induce at 32 weeks? She claims the baby was a very high weight (like nearly 8 pounds), which does not add up for a 32-week delivery. Hearing all this, I just wanted to get the medical summary. Easy right? Nope. I ran into one unexpected wall, when the doctor who had managed the last pregnancy told me she could not get this information, because it was medically unethical for me to see it. I then asked, well, can you just get the information and sum up the scenario? She said "nope, ask the surrogate." The surrogate claims she has no paperwork. Trying to get her to access her own medical records from the hospital will be, well, Sisyphean.

Right now, there is no point in pushing. I just have to pray that everything goes well, because the simple things that you can influence in other places cannot be managed here.  If  J turns out to have gestational diabetes (which may explain the induction and the large baby), she is not going to do anything to control it. I have to beg her to take her vitamins, and for the last two ultrasounds, I literally had to bribe her to show up. And despite what it sounds like, she is sort of a decent person...just unmotivated and wants to hang out at home while she gestates the baby, and not be bothered by pesky blood tests because she truly does not get what any of this is all about.

I should add...a lot of what I am going through here may be avoided if you go via an agency like Surrogacy India. They provide housing (for the surrogate and her children apparently), transport, and all in all may do much more. I'll be profiling them, and one other agency.

Writing all this out was cathartic. Everybody around me is telling me to just stop thinking about all this, and that is what I'm going to try to do for a while and see how the cards play out.

A commentary on the practice of medicine and what lies ahead.

One of the worst things that I realize I do during the TTC process is become too immersed in it. When I was trying to get pregnant, I would google and run pubmed searches till I could practically recite the study results; I chased down every possibility I could think of, and I thought of a lot.Some of that paid off though. I just wish I had done less of it.

The same issues are starting to rear their heads back again now. I've examined practically every study that compares IVF protocols and have obsessively examined those that look at  blastocyst aneuploidy and quality.But anyway, I think I've learned a lot, and I'll be updating both the science of infertility page, and creating a new section on IVF. 

I was talking with my RE's wife (also an RE; a really sweet lady who did my retrieval) about how well this cycle worked out and I commented that a lot of it might have been due to the protocol I tailored for myself (I also tweaked it on the fly) and she joked that I should consult for the more difficult cases, and I quipped back that I would, if I got paid for it. But there is an important take home message here: even among a group of patients labeled "infertile," there are subsets with unique issues. Recognizing those issues, tailoring each protocol individually, being invested in the tiny details, and making changes based on those details as the treatment proceeds may be what is required to optimize your treatment.

As an example, I decided to check LH levels during my treatment (my RE only checks E2). Everybody responds different to both the agonist or the antagonist. I realized that with the antagonist, my LH was getting too suppressed, my E2 was not rising as it should have been (E2 production DOES require LH), and the follicles on the right were lagging (13 mm, as opposed to 19 mm on my left).  I decided to add back LH (in the form of menagon) on the last day of stims. We did not check E2 or follicle growth after that, but the results on egg retrieval day were fabulous; my right ovary had caught up and made even more mature eggs than my left. Was the situation helped by the low-dose LH add back? Impossible to say, but plausible.

Unfortunately, few take such a detail-oriented approach, or have the sort of attitude necessary for such an approach. While patients of a particular disease type fall into into subsets, medical treatments today use a broad strokes approach; the same freaking approach is used to treat everybody who comes your way. I have rarely ever met a doctor who is maverick and intuitive and adjusts the protocol (ANY treatment protocol) on the fly. It takes a rare sort of personality to do that. What REs do when you do not respond (which is the club-on-the-head approach of pushing the stim dose up higher and higher) does not count.

The only doctor I've come in contact with who is truly intuitive and maverick and can to an extent accurately delineate between the shades of grey of human biology is my mother, and the sort of intuitiveness about what is the issue and what may work that she has is extremely uncommon. Her results speak for themselves; she is in a field where the doctors end up doing very little to help their patients, while her methods produce a near to full recovery in a pretty high percentage of her patients. 

Btw, when she was giving me sub-cutaneous injections, we discovered something nifty: Instead of squeezing a wad of skin for sub-cut injections, try stretching the skin out with your fingers; I did not even feel the needle go in. The few times I got the traditional grab-fatty-skin-and-plunge-needle-into-the-pinched-up-wad-of-skin approach (from the nurses at the clinic), it hurt way more.  

Anyway, I digress. Coming back to medical approach and its effect on the success rate, there are some IVF clinics in the world that may show a level of success that surpasses that of their peers, and one of them is CCRM. I visited their webpage for the first time the other day, and I was impressed. Forget about protocol optimization (but please, blog visitors, feel free to talk about your experience with respect to this, it would be very useful), they use an embryoscope that minutely tracks the growth of each embryo, they do PGD, and they freeze their embies one per vial (they have to, if they are doing PGD)...I was practically salivating. But god knows, I don't want to go through another IVF or pregnancy again. Anyway, the time of reckoning is coming up quickly. Transfer to the surrogate occurs on Tuesday.

Then begins an interminably long wait: my RE's clinic believes in testing 12 days after a 5-day blastocyst transfer, which does not seem logical. It would make sense if you were doing a 3-day cleavage embryo transfer (because then you would be testing on the 15th day of embryonic life), but it just prolongs the wait (and the torture) if you want to wait until the 17th day of embryonic life. And given that in every pregnancy (even the one with the Trisomy 4 blastocyst), I had a positive HPT by the 10th day of embryonic life, my RE's assertion that "testing 10 days after 5-day transfer may be too early" cannot be taken seriously. Let us see how putting my foot down goes. But here we go again, soon.

A tale of 2 ovaries, surrogacy, and the pitfalls of day 3 transfers

I've become aware, over my TTC journey so far, that my 2 ovaries may behave differently with respect to egg production. I think all 3 of my pregnancies (not sure about the first) came from eggs from my left ovary. The one time I had a BFN was when my right ovary was in play.  This IVF, when it became clear that my right ovary follicles were smaller than my left, I asked the embryologist to keep track of the eggs from the right and left. At egg collection and fertilization, it seemed, surprisingly, that the right did better than the left.But.....as things progressed,things changed.

Right Ovary Day 1 2 PN 2 PN 2 PN 2 PN 2 PN 2 PN 2 PN 2 PN 2PN Day 2 4A 4A 4A 4A  4A 4B 4C 4C no data provided Day 3 8A 8A 8A 8A 8A 6C 6C 4B 2A Day 4 early blast early blast early blast morula morula 8C/B 8C/C fail fail Day 5 4AA 4AA 3AA early blast early blast fail fail fail fail Day 6 frozen  frozen frozen poor  blast poor  blast fail fail fail fail
Left Ovary Day 1 2 PN 2 PN 2 PN 2 PN 2 PN 2 PN 2 PN Day 2 4A 4A 4A 4B 4C 4C 2A Day 3 8A 8A 8A 8A 6C 6C 5A Day 4 Early blast Early blast morula 10 C/A comp 8 C/B 8C/B 5A Day 5 4AA 4AA 4AA 2AA 1AA fail  fail Day 6 frozen frozen frozen frozen frozen fail  fail
If you plot the fate of each embryo to figure out where the blasts came from, its amazing how much better my left is than my right. I still can't understand why the mojo appears to be in the left and not in the right (70 % of my fertilized eggs from the left made it, as opposed to around 37% from my right). I'm sure such a dichotomy may also exist in other people, it may just be difficult to spot. Another point I want to emphasize...sometimes the embryo you think has no chance on day 3 CAN actually make it to blastocyst, like my 6C  Day 3 embryo that became my 1AA blastocyst. I was reading a post from a lab who only does day 5 transfers and  the doctor commented on how often they are surprised by poor quality day 3 embryos actually go on to become Day 5 or Day 6 blasts and produce healthy children.  I think a lot of people look at poor quality day 3 embryos and think that they may be saved if they go into the uterus and are certain that, if they wait till Day 5, they will end up with nothing. But I think a little faith is needed, because from all scientific and anecdotal accounts, that location seems to make no difference. Embryo cell culture is something that HAS been optimized, then tried and tested by many labs around the world. And while the uterus is a great place to be, there is definitely a body of studies that show that in a subset of women, the uterus may itself contain hostile factors. Basically, its a level playing field if you are comparing the petri dish to a uterus. If a day 3 embryo has the developmental potential to go the distance,  it will,  no matter where it is. And if it won't, it won't. And this part is just pure idle speculation but I would think, technically,that a day 5 embryo may be able to hold its own better against the hostile uterus a touch better than a day 3 embryo...I'm saying this because a day 5 embryo would make more HCG, a hormone known to cause immune cell apoptosis, and possibly other factors that aid in implantation. The issue with day 3 transfers (in addition to all the risks associated with multiples) that I see is that it puts you through a so much longer period of uncertainty- if none of the embryos will make it, it is actually easier on you to find that out after a phone call from your doctor, as opposed to going through a transfer, a 2WW, paying (monetarily and physically) for your progesterone, your blood test, all of it. Importantly, if your Day 3 embryo transfer fails, you remain in the dark as to what the issue was: was it embryo quality, or implantation issues? On the other hand, if a blastocyst transfer fails repeatedly, its a little bit more likely that the issue may lie in uterine receptivity or immune-related causes. Anyway, moving away from preaching (I am sorry to be doing so much of it; I just can't bring myself to stop), my new surrogate is going through the preparations for transfer. I don't have a transfer date yet, but I HAVE decided to  be brave and only transfer 1 blast.  The last time I picked a surrogate, I was hoping it would be somebody I was comfortable with. Now, I'm finding myself desensitized and starting to treat this the way surrogacy in India is meant to be treated: emotions should be left at the door. Obviously, this is a deeply different process compared to say, the one in the States. As a point I am thankful for, this is not her first rodeo, so to speak; this is the second time she is attempting surrogacy. The first time, she got pregnant on the first shot and had a natural delivery. With so much possibility (in terms of embryo availability), I'm still not tempted to try to carry the baby myself. When I first got pregnant, and heck, even the second time, pregnancy was joyous. Now, the thought of getting pregnant, finding myself at the mercy of hormonal upheaval, of getting 50,000 blood tests and waking up 4 times a night--- I just don't want any of it. I know how much good stuff I am going to miss out on and I still don't want to do it. If my eggs don't work and adoption does not seem easy either, then I may have to go through donor embryo IVF (with PGS) in the States, and that thought makes my blood run cold---just because I'll have to go through pregnancy myself. I am aware that I am missing out on an incredible and important life experience  by choosing to avoid pregnancy---but I remain comfortably numb about it all.

Grand plans

I met with this RE in India who came up with an interesting potential cause for my losses: PCOS that was affecting egg quality.  My regular RE had thought my ovaries looked slightly polycystic (~17 antral follicles in each ovary), and he had checked DHEAS and testosterone. DHEAS was in PCOS range (over 200) but testosterone was low, so the PCOS diagnosis had fallen by the wayside. This new guy now wants to recheck antral follicles and also LH and AMH (both of which are elevated in PCOS, and have never been examined in my case).  This offers a possible answer and the fix would be metformin both before and during pregnancy.

I know that there is still a higher than normal risk for miscarriage with the next pregnancy. This is, after all, only an emperical treatment. On suggesting gestational surrogacy, he flatly refused. He told me by all accounts, that I had a healthy uterus, and using surrogates just because I could would be premature and wrong at this point. In all fairness, I have to agree with him. But, I'm not ready to face the prospect of another short lived pregnancy and loss, while back in the States and alone.  I need a good support system and I can get this only if I  a) magically find Mr. Right and get hitched or b) come back to India and try here while being with family. All in all, I've reached the end of my tether as far as going-it-alone is concerned.

Setting the stage for short term return to India will take one year.  I'm willing to put off babymaking for that long. I''ll be only 32 at that point, and by all indicators, would have plenty of eggs left. The only real hurry has always been in my own head. To stay sane, I need plans with contingencies upon contingencies, so here goes.

The Plan 

1)Check genetics (mine and babies) and run every RPL test under the sun. If all is normal, then do nothing for 1 year. Enjoy life and return to the the person I used to be before pregnancy loss.

2) Return to India, start TTCing with unmedicated IUIs after 3 months on metformin.

3) If a loss occurs, then do IVF using 2 different donors ( including my original, who I just don't want to give up on yet) and THEN (with  this RE's blessing),  go to gestational surrogates. This is the part which can be repeated again and again, if need be. 3 losses would be when I'd stop using myself a s a guinea pig, its just too much. With surrogates and a shitload of dough though, its a different thing. I'm really lucky to have these options,.

4) If multiple tries here fail too, then that implies the issue is genetic and with my eggs.  At this point, go to donor embryos and use my body to carry them (hoping that all parts are still functional at the end of this and the issue was never with my uterus in the first place)

5) if this fails too-adoption in India. 

I can deal with the prospect of short-lived pregnancies and more losses, but I need to choose my battleground wisely. Having lived through the last few days mostly easily, I know being at home will do it.  But importantly, finding real peace requires preparing myself  for the final 2 options which involve letting go of a biological child. Once I become ok with this concept (its going to take work) then who cares how long it takes to get there? Life is making me work for a child, I have faith that it has something good (even if its not what I originally envisaged) waiting for me.

What needs to be done.

I'll be flying out to India tomorrow, I'll have the D&C there and they can do a karyotype of the embryo. After that, the healing process begins.

I keep thinking, why does this tear us up so much? There is the love you have for that 7-20 mm mass you have growing inside you which was going to be your baby, but honestly, that bereavement is much easier to handle than losing your baby after having known him or her, or even at birth- that pain has to be unimaginable. You cannot really bond with you baby this early on, never having felt him or her, but yet you love the idea of them so much that letting go of that is not easy.  But you have to. Its easier if you believe in destiny. Bighead was not meant to be, neither apparently, was Turbulence. So I have to let them go, their souls were meant for other places, other bodies and I pray that wherever they end up, they are happy.  You still mourn though, I've broken down over my first baby so many times, and I'm sure there will be many moments in the future when I'll be doing the same for the second. But this is not the hardest part.

Neither is physical pain/ discomfort involved. When involved, in itself  pain is a trigger for depression. But, in my case, physical discomfort is pretty minimal. Right now, physically, I'm fine. I've never been through the pain of a real miscarriage, I'm in the pink of health both before and after the D&C.

The real torture of one early loss, or repeat early losses, is fear. Fear that your dreams will ultimately be ashes, that you will never have a baby. Fear that you have to go through this again. Fear of walking into an ultrasound and having the doc coldly inform you that he does not see a heartbeat (both  my losses, I've had non-empathetic jackasses for docs). Fear of walking around with a dead baby inside of you. Fear of getting your hopes up and seeing them dashed into the ground. And that is the true torture

As I told my mom, this is like a boxing match, and you are up against nature. You can keep getting back up to fight, but it has all the power. If it knocks you down, you keep getting up until a) you either give up and change course or b) it lets you win. To this, my mom said, so go into the fight unemotionally. You know what needs to be done, just do it without engaging your hopes and dreams and fears and letting this trio jerk you around like a puppet.

A good idea in theory, impossible to do, or maybe somewhat possible after being knocked out repeatedly numbs you to everything.  I'm not there yet. The prospect of an other loss, of walking into an ultrasound and finding out the worst, has me literally whimpering.

But are what are my advantages? Lots of easily fertilzable eggs. Financial freedom (I've got a good amount saved up and my family is well off as well). Lets also throw in that I'm pretty darned pragmatic, resourceful and don't really care how I get to my current end goal  (a healthy child with my genetics in my arms). I also get pregnant very easily, but don't count this as an advantage any more because I do not know if  this is about genetics or my body is killing off my babies.


Because I can, I  am seriously considering taking my body out of the equation.  These losses are hell on me, and its much harder to face because I don't have that supportive partner who is suffering as much as I am at the moment.  I'll get through this one much more easily because I am flying 24 hours (not fun) to be with my family, but I cannot do that every time I have a loss.

I looked into gestational surrogacy in India, I contacted a clinic yesterday, and this is what I got back.

Program Fees  
The charges (in USD $) for Single Gestational Surrogacy program are as given below.
Stage I $ 8,900 (three free attempts for surrogate, SI charges and lawyer charges)
(Surrogate booking; Agreement; IVF / ICSI procedure; Pregnancy test)  

• Surrogate investigations, preparation, endometrial priming & booking  
• Legal (agreement) charges, Surrogacy India fees
• Follicular monitoring, Procedural (IVF / ICSI) charges, Hospital stay, semen freezing, ET, surrogate care, pregnancy test.

Stage II $ 7,900
(Antenatal care; Medications, investigations, special care, special accommodation, child care, diet, lost wages, Insurance, surrogate clothing)  

• First trimester (3 months)  
• Second trimester (3 months)  
• Third trimester (3 months)  

Stage III  $ 5,900
(Delivery; Post natal surrogate care; Visa assistance)  

• Delivery process (normal / caesarean)
• Birth Certificate
• Surrogate care (2 months) (Medications, stay, care, diet, lost wages)

Mulling it over. Its affordable, for sure. And possible for me, because this is the city where my parents live and resources are not an object.

What the future holds is unclear. But I'm trying to get to the end goal with minimal additional damage to myself.