Alex Kamer, in memoriam

Alex, holding her son, Bear, with Gov. Gretchen Whitmer, her husband Alan, Crosby, and their dear friend and gestational carrier Leah Zeintek on April 1, 2024.  

In October 2024, Alex Kamer, a member of the MFA leadership board, passed away after a short but fierce battle with cancer.

How can we possibly encapsulate the depth of Alex’s commitment to the Michigan Fertility Alliance and the infertility community? Alex’s devotion to championing what she knew was right went beyond words. Selflessly sharing her own surrogacy story, she educated others and was a driving force behind the passing of the Michigan Family Protection Act. She had a vision: Michigan families should not have to endure the same barriers to surrogacy and family-building that she and her husband Alan had faced, all due to an outdated surrogacy law. Her spirit simply would not rest until that law was changed. Through surrogacy, Alex and Alan became parents to their sons, Crosby and Barrett (lovingly called Bear), a journey that fueled her unwavering advocacy.

Alex’s heart knew no bounds when it came to fighting for families who build through assisted reproduction and surrogacy. She believed deeply that love grows exponentially when families and reproductive choices are respected and protected. Beyond her work with the Michigan Fertility Alliance, Alex was a steadfast reproductive rights advocate, a dedicated volunteer with the Children’s Heart Foundation, and a passionate voice in the national congenital heart community. Her own heart condition prevented her from carrying a pregnancy, but it never stopped her from being an incredible mother, daughter, friend, and wife.

Leah and Alex giving statements to the Michigan Senate’s Civil Rights, Judiciary, and Public Safety committee in March 2024

When Alex joined MFA in early 2021, her first email introducing her and Alan's surrogacy story was direct and quintessentially “Alex”: “I think you might be interested in working with us!” With her calm, feisty tenacity, Alex was a perfect fit for the leadership committee. She was one of the first “believers” in MFA’s mission. Even as we navigated the unknowns, she never wavered in her support for our shared goal of changing Michigan’s outdated surrogacy law. Her commitment to change and willingness to share her story are among the key reasons the Michigan Family Protection Act exists today. Alex showed us all that advocacy can be done with grit, grace, and, at times, the perfectly placed cussword.

Alex’s time on this earth — 33 years — was far too short. Her journey was tragically cut short by a brief but fierce battle with lymphoma, which ended with complications.

It would be hard to find a better person than Alex. From the moment she joined the Michigan Fertility Alliance, we knew we had gained an incomparable force. She fought for what she knew was right, and she shared her own family-building story to effect change. It has been our honor to work alongside Alex, who was instrumental in the passage of the Michigan Family Protection Act. We dedicate the MFPA, and the countless lives it will touch, to you, Alex. And to Alan, Crosby, Bear, and all of her family, thank you for sharing her with us.

November 1st, marked one year since Alex shared her testimony at the Michigan House hearing for the Michigan Family Protection Act; here's a link an NBC news piece featuring Alex’s story.

Detroit Moms: Surrogacy in Michigan

MFA’s guest blog piece in Detroit Mom, published April 23, 2023

Unbeknownst to most Michiganders, the Great Lakes state has played a pivotal role in the global history of surrogacy. It all started back in the mid-1970s. Dearborn lawyer Noel Keane wrote what is believed to have been the world’s first compensated surrogacy contract. It was between a couple and a traditional carrier.

In surrogacy there are two kinds of carriers. Traditional, or genetic, carriers donate their own eggs to the intended parents for their surrogate pregnancy. Gestational carriers are implanted with the embryo of the intended parents. There is no biological connection between the baby and the gestational carrier.

Mr. Keane died in 1997. Mr. Keane’s son, Christopher, told us that over the years at least 600 babies were born through contracts that his father created between intended parents and surrogates. One of those children was Jill Brand (nee Rudnitzky), the world’s first gestational surrogacy baby. She was born in Michigan in 1986. (We did a world exclusive interview with Jill on our blog where she spoke about her views on surrogacy). 

A Monumental Ruling on Surrogacy

Michigan was also the first place in the world where a judge, Marianne Battani, ruled in Jill’s case that the intended parents, and not the surrogate, should be listed on her birth certificate. This ruling was monumental, as most other countries to this day adhere to the Roman law principle of mater semper certa est (“the mother is always certain”), meaning that the woman who gives birth to a child is considered to be the mother, regardless of whether there is a genetic link.

Since that ruling the United States, due to advances in assisted reproductive technologies (ART), has made significant progress recognizing that mater semper certa est isn’t always certain. Today in the U.S., about 2% of all assisted reproductive technology cycles involve a gestational carrier. 

All of Michigan’s progressive happenings ended in 1988 when then-governor James Blanchard signed into law the 1988 Surrogate Parenting Act.

This is in large part because of Mr. Keane’s role in the controversial and heart-breaking Baby M case where a New Jersey traditional surrogate decided to keep the baby, despite having signed a contract that was written up by Mr. Keane. That meant that Michigan became the first state in the U.S. to criminalize surrogacy contracts.

This law made participating in a compensated surrogacy contract a misdemeanor punishable by a fine of up to $10,000 and up to one year in prison. Meanwhile, arranging contracts became a felony with penalties of up to five years in prison and a $50,000 fine. 

So, despite all these firsts, Michigan went from being on the cutting edge of surrogacy to the last in line, being the only state in the U.S. that still criminalizes compensated surrogacy with a felony.

Although not impossible, surrogacy in Michigan has unique challenges due to that 1988 law. Surrogacy contracts are not legally recognized in Michigan courts. There is no contractual protection to either party or the child. A loophole in the 1988 law allows for “altruistic” or non-compensated surrogacy, but does not provide legal language for securing the rights of parents or contractual legal protection.

The law assumes that those unable to carry a pregnancy have access to a woman willing to act as their carrier without compensation. And, that the woman will be medically and psychologically approved to do so. However, this is not the case. Most Michiganders pursuing surrogacy must go out of state to be matched with a carrier. The rigors to qualify as a genetic or gestational carrier are lengthy. Most women don’t qualify.

Michigan remains the state that most harshly regulates the practice.

This is unlike most other states. Most have now either rolled back their surrogacy laws or created new ones that allow for contracts. While an overwhelming majority of other states have progressed to allow legal family formation for infertile and non-traditional couples, Michigan lags miles behind.

The right to have a child is a key tenet of reproductive justice in the United States. There is an urgent need to update parentage and surrogacy laws in the Great Lakes state for children born through assisted reproduction and surrogacy. Every family should have equal access to secure parent-child relationships from birth. This stability is so important to children, to families, and to our communities. 

Earlier this month the Michigan Supreme Court heard oral arguments in a case between a former same-sex couple battling over the custody of a child they raised together. This case could have huge implications not only for the LGBTQ+ community, but also for unmarried couples who grow their family using assisted reproduction.

At the moment, Michigan does not provide a clear pathway to parentage rights for those parents who use a Michigan-based friend or family member to carry their baby to birth. Because there’s no transparent guidance from the 1988 law, a number of Michigan judges have denied pre-birth parentage rights, and biological parents are forced to adopt their own child after birth. That can take years and can come with significant legal costs. One of life’s most fundamental joys is shrouded in red tape and hurdles. 

The inability to carry a pregnancy is a common problem.

Updated numbers from the World Health Organization have found that globally, one in six people struggle with infertility. For those looking to find a reputable agency, clinic, or lawyers, we suggest these national organizations as first ports of call:

• Reproductive Alliance: aims to establish national standards for the surrogacy field based on existing guidelines.

• Society For Ethics In Egg Donation and Surrogacy (SEEDS): a nonprofit organization. Their purpose is to define and promote ethical behavior by all parties involved in third party reproduction.

By Ginanne Brownell, MFA communications director and Stephanie Jones, MFA founder

Michigan Supreme Court’s Big Parenting Decision

When it comes to protecting parent-child relationships, Michigan law has some serious problems. Outdated parentage statutes have led to the state Supreme Court considering this week whether another child will be denied a relationship with one of their parents. Our legislators should act now to update state parentage laws to ensure all children and families can have the legal security and stability they need.  

Over the last few years, several court cases in the state have highlighted a number of holes in protections for children. Grand Rapids couple Tammy and Jorden Myers made international headlines in 2021 when they had to adopt their own children born via a gestational carrier, because of the state’s antiquated 1988 Surrogate Parenting Act. Earlier this year, the couple were finally granted full legal parentage of their now-two year old son and daughter.

Children living in the vulnerability of legal limbo for two years -- that is terrifying. 

In another heartbreaking case, Lanesha Matthews and Kyresha LeFever had twins together before same-sex marriage was legal in Michigan. Ms. LeFever was the genetic mother, and Ms. Matthews was the birth mother thanks to advances in fertility healthcare. After co-parenting their children for a number of years, the couple separated, and a protracted battle began over whether Ms. Matthews’ should be stripped of her legal parentage and her name removed from the birth certificate. A lower court ruled that Ms. Matthew’s acted as a surrogate to her own children. Thankfully, in 2021 the Michigan Court of Appeals overturned that ruling and appropriately concluded that Ms. Matthews was an equal legal parent. 

And now, this week, oral arguments are taking place in the Michigan Supreme Court in Pueblo v Haas. In 2008, the lesbian couple had a child together when same- sex marriage was prohibited in our state and there was no way for this family to secure their child under our state statutes. When the couple separated Ms. Haas, the biological parent who had carried the pregnancy, denied Ms. Pueblo all contact with their child. Ms. Pueblo sought shared custody, but both the trial court and the Michigan Court of Appeals ruled that she was not a parent to her child.  We’re hopeful that the Michigan Supreme Court will finally ensure that this child’s relationships to each of their parents is secure.

 The tragedy of these cases, as well as numerous others that don’t make headlines, is that they have all required prolonged, painful litigation.  Children and families in our state shouldn’t face the fear of losing these precious family relationships.  There is an urgent need to update parentage and surrogacy laws in the Great Lakes state for children born through assisted reproduction and surrogacy.  Every family should have equal access to secure parent-child relationships from birth.  This stability is so important to children, to families, and to our communities. 

 We know Michigan can do better.  Recognizing that abruptly severing family relationships has devastating impacts on the well-being of children, many states—from Maine to New Mexico, and Nevada to North Dakota—have updated their assisted reproduction statutes to protect children. 

 At stake in the case being heard on April 4 are several important rights for LGBTQ families in Michigan including the rights to form families, become parents, and raise children. We at Michigan Fertility Alliance firmly believe that the Michigan Supreme Court should protect and uphold those rights. 

But Michigan can and must also join other states in providing a comprehensive legal framework that supports the full diversity of families in our state, protects the interests of all parties involved, and ensures that children born through surrogacy and other forms of assisted reproduction have legally protected parent-child relationships. 

--Stephanie Jones, founder and Ginanne Brownell, media liaison

Does your insurance cover IVF? Probably not…

Of the four million births in the U.S. per year, between 1% to 2% are via IVF, meaning in 2020 that was a total of 73,602 babies. Yet for the vast majority of patients, this means a massive out-of-pocket expense. These lofty bills stem from the fact that in the four decades since the procedure became available, only 20 states have passed laws that mandate infertility treatment be covered by private insurance, leading to a huge gap in care. In 2018, for example, 80% of Americans who underwent IVF received little to no coverage from insurance, and a 2020 Mercer study found only 27% of companies with over 500 employees cover the procedure. In short, as the American Medical association (AMA) Journal of Ethics put it, “For most people, paying for ART out of pocket is impossible, leaving many without a financially feasible way to manage [infertility] or achieve their reproductive goals.” 

This discrepancy, according to the AMA, represents a very consequential failure. The journal wrote in 2018, “Despite the expense associated with infertility treatment, the lack of mandated insurance coverage for this disease implies that infertility is a condition undeserving of financial assistance and minimizes its importance to patients.” But what is the reason for this failure, and what are the consequences? 

As Dr. Richard Paulson, former president of the Society for Reproductive Medicine told CNN in 2018, many insurance companies still view IVF as experimental— despite the fact that over eight million babies have been born via IVF globally since 1978. Additionally, CNN reported: “Because infertility has long been considered a women’s health issue, insurance companies perceived it as a niche issue and denied coverage to those experiencing it.” In fact, Paulson explained, just 30 years ago, most insurance companies did not even cover childbirth, considering it to be a women’s issue. This dated mindset forces most IVF candidates to pay their own way. More than half resort to using their credit cards to pay for treatment, according to a report by StudentLoanHero. CNBC found that others resort to personal loans or dip into 401ks. 

These financial pressures can affect the viability of the procedure, and lead to multiples, such as twins or triplets, or in some cases, even more than three babies at once. Such was the case for Connecticut couple Marisa and Brad Hillman, who spent $40,000 on IVF, taking out a home equity loan and moving in with Marisa’s parents to cut costs. Each cycle of IVF incurs a separate cost, and the odds of successful pregnancy after just one cycle is just 29%, meaning most patients undergo multiple cycles. Patients like Hillman who pay for IVF on their own “end up weighing the price of doing a single-embryo transfer multiple times or a multiple-embryo transfer once,” CNBC reported.

For this reason, by her third cycle, Hillman asked her doctor to implant three embryos. She commented,“We had six frozen embryos. And if we put in one at a time, that’s $2,000 each time. Or we can put in three, and it’s still $2,000. The number of embryos you put in doesn’t change the cost.”

But it does change the risks, for both carrier and infant. As Dr. Dmitry Kissin of the U.S. Centers for Disease Control and Prevention explained, “The chance of dying during pregnancy for mothers… is three times higher if they carry multiples compared to mothers who carry singleton babies. And for children, the chance of death during the first month of life is six times higher for twins and 14 times higher for triplets.” Additional risks include low birth weight, prematurity and sometimes long-term disabilities like autism and cerebral palsy for the child. 

On the flipside, the American Society for Reproductive Medicine found that state insurance mandates positively impact infertility treatment success. Live births per cycle are significantly higher in states with comprehensive IVF mandates, and these states also saw a significantly lower number of multiples. Researchers concluded that “state IVF insurance mandates are an important mechanism for reducing costs for patients and improving utilization of single embryo transfer.”

As Marcelle Cedars, President-elect of the ASRM, commented, “The evidence is growing that state laws requiring insurance coverage for infertility treatments, including IVF, contribute to increased success and greater safety for patients who are trying to grow their family.” Enacting and updating state insurance mandates could lead to a more safe, successful, and accessible future for Americans seeking fertility treatment. In Michigan, this disparity remains an issue, with no state mandate requiring IVF coverage, and little recorded interest from lawmakers in making this change.  

—Sabrina Nash

Along Party Lines: The Political Side of IVF

On July 21, 2022, every single Michigan House Republican running for re-election “voted against a bill that would protect Michiganders’ ability to access contraceptives and contraception, and protect health care providers’ ability to provide them.” 

The vote follows the Supreme Court’s June decision to overturn Roe v. Wade on June 24, 2022. Since then, the Michigan Republican party has acted swiftly; just days before voting on the contraceptives bill, 157 House Republicans voted against a law to protect marriage equality, and nearly the entire party voted against bills to “to protect Americans’ right to make their own health care decisions and to prevent states from punishing women who cross state lines to seek access to health care.” 

Michigan Democratic Party Chair Lavora Barnes commented on the contraception bill, “...today, they’ve laid out their vision for a dystopian future where Michiganders won’t be able to access contraceptives. It’s clear that Democrats are the only Party interested in securing Michiganders’ freedom while Republicans plan to take us back decades.” 

In addition to bringing up countless questions about government involvement in personal healthcare, restricting women’s access to contraception represents a threat to IVF; birth control is often the first step of IVF. According to Medical News Today, “With IVF, timing is essential. Starting IVF medications and procedures at the right time can improve the likelihood of successful treatment. This is why a reproductive endocrinologist may suggest using birth control pills (BCPs) before IVF. These medications can help prevent potential pregnancy complications and allow doctors to control the timing of ovulation to schedule treatment.” 

Restricting access to birth control, then, poses a major threat to fertility treatments that depend on regulating hormones in this way. The procedure has also been called into question as IVF often requires a selective reduction of embryos in order to ensure success or a safe outcome. Some experts do not think that abortion bans would affect IVF in this way. But in some states, they raise the question of whether destroying embryos would be considered homicide under “personhood” laws, laws that extend the legal rights of people to a fetus or embryo before viability. 

Heidi Smith shared her own IVF story with Michigan-based queer media outlet PrideSource. Smith had polycystic ovarian syndrome affecting her fertility and required three rounds of IVF before getting a positive pregnancy test. However, Smith’s doctors feared she may be carrying multiples, and when they were able to look, they saw there were indeed five babies in her womb. 

They advised her the pregnancy was extremely risky, recommending she not carry it to term. Smith made the difficult decision to reduce to twins, both of which she ultimately lost due to complications. 

She commented, “When you see people say that people don’t value life, like, I totally value life. I’ve seen it before my eyes. I’ve seen the different stages and the fragility. And I’ve watched my daughter fight for her life outside my body. But I just don’t think it’s fair, the situation that we’re in, because nobody would choose to go through painful things.” 

One Michigan representative in particular has begun to advocate for IVF in the wake of the changing laws. Rep. Samantha Steckloff was diagnosed with cancer in 2015, and since then, has herself experienced the complexities of Michigan fertility law. She recalled speaking with a Republican representative’s chief of staff about their IVF experience, noting that Right to Life and the Catholic Conference came up, two organizations that lobby against surrogacy in Michigan, largely because of their concern with embryos. Though “personhood” is not currently part of Michigan law, the doctrine still carries implications for IVF care. 

Additionally, Michigan’s 1931 abortion ban, which can currently be enforced on a county level according to an early August appeals court ruling, could have dire consequences for IVF. National Public Radio’s  All Things Considered examined the issue in a July episode, reporting the law “could have those in IVF clinics facing criminal charges if they discard embryos.” 

Because the ban leaves room for interpretation, it could also severely impact accessibility of treatment even if IVF remains viable; Michigan State University ethicist Sean Valles commented, “...both the ability to grow a family or to delay growing a family, those will both become more and more the prerogative of people who have money and connections and racial privilege.” 

The Washington Post elaborated on this idea, explaining, “... new regulations may inadvertently limit such common IVF practices and procedures such as testing embryos for genetic abnormalities before transfer, making assisted reproduction more difficult and expensive.” They added, then, “while total bans are unlikely, hastily prepared legislation and vague language could have unintended consequences for fertility treatments and related technologies.” 

At the same time, the article found that most Americans don’t object to IVF. In fact, they noted, “Using 2013 Pew Research Center data, less than 20 percent of respondents who view abortion as morally wrong also describe IVF in these terms.” Instead, “a substantial majority of Americans agree IVF can “be a big help” to people trying to get pregnant, while nearly half support requirements for insurance plans to cover the high costs of IVF.” 

While IVF remains a largely nonpartisan issue among constituents, then, one cannot overlook the stark partisan divide in the Michigan legislature on votes that directly impact the future of IVF. As the political landscape of reproductive care continues to rapidly evolve post-Roe, Michigan voters should take note of the additional rights at stake come the elections this November.

—Sabrina Nash, 2022 student advocate

In the Weeds with Infertility (n.): Why Definitions Matter

As of May 2022, the median age of women giving birth in the U.S. has reached an all time high of 30 years old. Meanwhile, the American birth rate fell by 4% in 2020, marking the largest single-year decrease in almost 50 years, and it hasn’t improved much since. This decline in birth rate follows a trend that saw its genesis during the Great Recession in 2007; since then, the U.S. birth rate has fallen by a staggering 20%. In simple terms, as the New York Times reported last year, “American women are having fewer children and having them later than ever before…” 

The good news is these changing rates are not necessarily something to be overly worried about when Assisted Reproductive Technology (ART) is taken into account. IVF and gestational surrogacy in particular have made it so that parenthood is, theoretically, more accessible than ever before.  Not only can IVF help heterosexual couples combat infertility, but it also opens the door of biological parenthood to those previously unable to conceive within their partnerships — such as gay, lesbian, and non-binary couples— and to single Americans hoping to have children without a partner. 

So why exactly is ART not part of our mainstream healthcare? Why does it only account for only 1-2% of American births per year, when our birth rate is so quickly declining? 

The answer lies largely in the way the American medical system defines infertility. The current definition fails to include any American who wishes to have children, but is not in a long-term, heterosexual, cisgender relationship in which neither party has a pre-existing health condition that could also prevent a safe pregnancy. 

For example, the Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), and several American insurance companies define medical infertility as the failure to conceive after one year of unprotected sexual intercourse. This definition represents a massive failure of reproductive justice, as it ignores the fact that a fertilized embryo only requires a successful combination of egg and sperm— something which can now be successfully achieved without intercourse.

Then, that embryo can be carried to term by anyone with a healthy womb, which could mean a biological mother, a gestational carrier, or a traditional surrogate, none of whom need to necessarily identify as a woman. In fact, pregnancy has not required sexual intercourse between a man and a woman since the 1970s, but the medical community and insurance companies still define infertility in this dated way, to devastating effects for many.  

Here is an example: a heterosexual couple has regular unprotected sex for a year as do their neighbors, a lesbian couple. Neither couple gets pregnant, yet one couple is able to receive a formal diagnosis of infertility, potentially making them eligible for insurance coverage for fertility treatments. The other is simply out of luck, forced to spend the money out of pocket in order to achieve the same end goal of having a baby.  Though both couples were unable to conceive naturally, the lesbian couple is not currently awarded the same benefit as the heterosexual one, just because they do not fall into the narrow definition of medical infertility. 

Just this year in April, a same-sex married couple in New York was denied IVF services for this very reason. The city’s insurance policy defined infertility as the inability to conceive “after 12 months of unprotected intercourse,” only applying to intercourse between a man and a woman. Even for heterosexual, cisgender couples, this definition leaves many behind. In reality, infertility can be a result of a number of things that affect the egg, sperm, or the bodies of the involved parties. For example, medical infertility can be caused due to dysfunctions in hormones, the uterus, the ovaries, tubes, sperm or reproductive tract. It can also be a result of exposure to toxins or previous medical treatment such as radiation therapy. Additionally, cancer, heart disease, and many autoimmune diseases, in which a womb may work but a body cannot handle a pregnancy, can prevent a safe pregnancy.

However, many people still think infertility only refers to when a woman cannot achieve pregnancy because she does not produce eggs, ignoring the myriad other social or medical conditions that can complicate natural conception. Even clicking through the comments section of stories on infertility can illustrate the prevalence of this misconception; for example, in this Financial Times piece detailing the author’s own journey with surrogacy, one commenter wrote the author was really not infertile as she produced eggs, disregarding how many additional factors truly fall under the umbrella of infertility. In reality, many people, including older couples, non-heterosexual couples, and those with HIV, are unable to achieve a safe and/or natural pregnancy. However, very few of these people would be considered infertile by current definition. 

Social infertility, on the other hand, encompasses the inability to have children without medical assistance due to non-biological factors. For example, this can include the previously mentioned lesbian couple, who is unable to get pregnant without some form of ART. This also includes all sorts of couples that fall under the LGBTQ+ umbrella that don’t have the egg and sperm combination to naturally conceive. Social infertility also includes single people who wish to become parents. This term encompasses the people who are infertile not because of their bodies, but because traditional, natural conception doesn’t apply to their lives. This is a very real form of infertility that affects individuals on a daily basis. 

Operating with a narrow definition of infertility is detrimental to many prospective parents because, for the few states that require insurance companies to cover infertility treatment, most insurance companies require a diagnosis of infertility to cover any sort of fertility treatment. Additionally, like Michigan, many states don’t provide insurance coverage for infertility at all, which can be the deciding factor for if a person is able to have a child or not. Fertility treatments are incredibly expensive in the United States and are unaffordable for many families. One cycle of in-vitro fertilization (IVF) can cost $12,000 to $14,000, and that doesn’t include any additional fees such as genetic testing, a mock embryo transfer, and injectable hormones. All-in, an IVF treatments is upwards of $20,000. Michigan’s two earner median household income is $66,198. And for most patients, one cycle of IVF does not result in pregnancy. 

This is why broadening the definition of infertility is so vital. Once we begin to recognize infertility in a broader context, we can improve upon the coverage options available and begin to provide equal care to all infertile individuals. Doing so would not only benefit the American birth rate, but also simply make the dream of parenthood accessible to the countless Americans who still today find it utterly unattainable.

—Caitlin Fagel and Sabrina Nash 

Abortion and Infertility: Now we must pivot…

As a grassroots organization, Michigan Fertility Alliance has always tread carefully on conversations around the abortion debate in the United States and what should happen to Roe v Wade. 

 That is in large part because fertility is a non-partisan issue, with one in eight people in the United States (and across the globe for that matter) suffering from infertility at some point in their lives. Not one in eight Republicans or one in eight Democrats. Nor even one in eight independents. Infertility does not discriminate based on race, religion, ethnicity or sexual orientation. With that in mind, we have always recognized that our members and advocates have intense and personal feelings about abortion. So, we have always aimed to remain neutral on the subject. 

 But now we must pivot.

The reversal of Roe v Wade in June by the United States Supreme Court could have profound ramifications for fertility treatments. Abortion has never been just about unwanted pregnancies or as an alternative to birth control (as those against choice often present it as such). Abortion has also always been about a woman’s autonomy over her own body. Abortion has also always been about health care.  Abortion laws might have implications for ART.   

Roe v Wade was enshrined into law BEFORE the first traditional surrogacy contract in the world was signed in 1976 in Michigan. Roe v Wade was enshrined into law BEFORE the world’s first baby was born through IVF in 1978 in England. Roe v Wade was enshrined into law BEFORE the world’s first baby born via a gestational carrier was born in Michigan in 1986. It could be argued that if it were not for Roe v Wade, advances in ART –at least in the United States—may not have happened in terms of embryo creation. According to Dr. Nathalie Crawford, a Texas-based OBGYN who focuses her practice on infertility, the technology of IVF could only come to “exist under the protection of Roe.”  

But breaking it down—how are abortion rights and ART connected? Simply put, it takes embryos to have a pregnancy. Some abortion trigger laws— as well as impending draft laws— define the start of life as the moment of fertilization, meaning that it includes not only fetuses but also embryos and even fertilized eggs. The argument around fetal personhood-- a movement advocating that a fetus should have the same legal protections as people— could create havoc when it comes to fertility treatments. Just one of those issues is around genetic testing.

As something standard these days, embryos can be examined for a plethora of health concerns and genetic mutations that could lead to either pregnancies that are not viable--and could potentially put the mother's life at risk-- or babies that might be born with debilitating abnormalities and short life expectancies. There are, of course, also issues around selective reduction that can also come into play in the debates around abortion and fertility treatments. 

Karla Torres, senior human rights counsel for the Center for Reproductive Rights told Rollcall that overturning Roe could, “really open the door to legislative interference, not only with reproductive decision-making but also around decisions to build families through assisted reproduction, specifically IVF.” Ms. Torres went on to say that there was concern that people using IVF—and their physicians—could face criminal liability for miscarriages, freezing or discarding embryos. Therefore, it is not an unfounded concern that people using IVF and their doctors could face criminal liability for miscarriages, or freezing or discarding embryos. 

Dana Sussman, the deputy executive directive at the National Advocates for Pregnant Women, told Time that, “the challenge for many of us is that we will be living in a legal gray area for a long time.” She added that case law, “will have to be developed, or statutes will have to be clarified, because the scope of [Roe’s fall] is just so monumental, I don’t know that anyone truly has an answer to how this will all play out.”

A recent Washington Post article reported that while many state legislatures have passed laws against abortion, they have included “explicit exceptions for the fertility industry” and of the 83 bills that have been introduced or passed since 2010 that mention both abortion and IVF, 45 of those have exempted ART and IVF. And the writers found that, “none of these bills explicitly included IVF — or any reproductive technology — in banning abortion or defining legal personhood” that begins at conception. “It’s going to have to be a process where we see what kind of laws get passed, see what the laws in existence are, and try to make some determination about what can happen with those,” Sean Tipton, the chief advocacy, policy, and development officer at the American Society for Reproductive Medicine (ASRM), said recently. 

Earlier this week ASRM released a report examining 13 state abortion trigger laws and what effect they might have on fertility treatments. The introduction to the report “The Potential Impact of States’ Abortion Trigger Laws on Reproductive Medicine” stated that while the overturning of Roe v Wade doesn’t automatically restrict access to ART procedures, “the details of state law are critical to understand, as overly broad statutory language and definitions could, intentionally or not, implicate and even ban such procedures.” The report went on to find that, “state actions in its wake have the potential to severely limit the ability to provide high-quality, patient-centered maternal health care.” 

The banner for the website Michigan Reproductive Freedom

In Michigan, the potential of what could happen in terms of aborton legislation and infertility is as clear as mud. Republicans who control the state legislature want to update a 1931 abortion ban that, among other things, made abortion a felony for pregnant women and doctors, even in the cases of incest and rape. House Bill 6270, the Protection at Conception Act, which was introduced by Rep. Steve Carra right before the SCOTUS decision, wants to see doctors –not pregnant people—subject to imprisonment for up to 10 years and fines upwards of $100,000. And although abortion would be allowed to save the life of a pregnant person, the bill purposely excludes mental health and does not provide clarity as to what constitutes as a medical emergency.

 Governor Gretchen Whitmer earlier this year used a special executive power to ask the state’s Supreme Court to rule “without a case before them” on the constitutionality of that 90-year-old law, which had been dormant since the ruling in 1973 on Roe v Wade. Meanwhile, a final push was being made last week to collect “wet” signatures to put reproductive rights on the ballot in November with the proposal of a constitutional amendment: “Michigan Right to Reproductive Freedom Initiative.” That potential law would protect the right of families to make decisions about all matters that relate to pregnancy, including abortion and infertility care. Michigan Fertility Alliance will continue to carefully watch—and lobby—to keep infertility care legal and safe. 

Pride (In the Name of Love)

When Louise Brown was born via in vitro fertilization (IVF) in 1978 in England, her birth marked not only a major turning point in assisted reproductive technology (ART), but also opened up an entirely new possibility for gay and transgender Americans who were previously unable to have biological children within their partnerships. Less than a decade later, Jill Rudnitzky, the first baby using gestational surrogacy, (where the carrier is not genetically related to the child), was born in suburban Ann Arbor, Michigan— signifying even more possibilities for non-traditional pregnancies. This advance in technology meant a completely new way of conceiving children for so many who had once thought this prospect nothing more than a pipe dream. The change was huge, but also presented many new questions. Most notably: how accessible is fertility treatment, really? And who can attain it?  

Well, for same sex couples, there are countless added barriers to biological parenthood. Part of this problem stems from the fact that infertility for LGBTQ couples is different from the typical definition of medical infertility, which tends to rely on heterosexual activity as a determining factor in gaining a diagnoses. The World Health Organization, for example, considers infertility “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.” 

Of course, this definition fails to encompass couples that have sexual intercourse that cannot result in a pregnancy, and also fails to account for single heterosexual individuals, or any individual without one long-term sexual partner, for that matter.  Some bioethics researchers have taken to using the term social infertility to describe infertility that falls outside of the previously understood definition. 

Regardless of the term used, several U.S. states have already incorporated this concept of social infertility into their definitions of infertility. In Illinois, for example, infertility legislation more broadly encompasses different types of prospective parents by simply including: “a person's inability to reproduce either as a single individual or with a partner without medical intervention” in the condition’s definition. 

The reason this inclusive definition matters is because fertility treatment is notoriously expensive in the United States, and securing insurance coverage for the process is especially tricky in the case of social infertility, even through federally funded healthcare. Such was the case for Marine Corps Veteran Miguel Aguilera, an Iraq and Afghanistan vet, who believed he qualified for IVF as part of his health benefits after sustaining combat injuries. 

But Mr. Aguilera is gay. When he inquired about fertility treatment, the Department of Veterans Affairs (VA) informed him this benefit applied to same sex, married couples, not gay men, the rest of the LGBTQ community, unmarried heterosexual couples, or any single individuals— regardless of their sexual orientation. 

 Mr. Aguilera was devastated that sexuality and marital status dictated his benefits in this way. This restriction presented an enormous barrier to fatherhood, considering the exceptional out-of-pocket cost fertility treatment would thus incur. The process can easily cost upwards of $100,000 for gay men who need both an egg donor and surrogate to have a biological child, according to the Family Equality Council, an organization advocating for LGBTQ families. “The whole process made me feel like giving up my dream of becoming a parent,” Mr. Aguilera told the New York Times.

He isn’t alone in this struggle. Only 20 states have infertility insurance laws, requiring insurance to cover at leastsome forms of infertility treatment. Michigan is not one of them, despite the fact that less than 40 years ago, the first everbirth via gestational surrogate occurred right here in the Great Lakes State. 

Even when states do have laws requiring infertility insurance, this doesn't necessarily mean there aren’t plenty of loopholes.  For example, businesses that are self-insured and personally provide employees with healthcare are not beholden to these guidelines. And only  eight of those 20 states extend their coverage to IVF in particular; others focus on “fertility preservation” laws, which typically do not take the broader definition of social infertility into account, instead prioritizing heterosexual fertility over same-sex couples. 

 For many gay parents, then, biological parenthood is still more dream than reality. NBC spoke with Los Angeles- based dads Erik and Adam McEwen who became dads to twin girls through IVF in 2018. The process of becoming parents cost the couple $65,000— a bill that included fertility treatments, legal fees and hospital care for their newborn daughters. And, for the McEwens, this cost did not include finding a compensated gestational surrogate, because Erik’s sister in-law volunteered to be their surrogate. Without her support, Erik commented, “I don’t think we could have done it…mainly because it costs so much money…That’s just something that would not have been possible.” 

Still, there are advocates fighting to make family building more affordable for all Americans. One organization at the forefront of the movement is Men Having Babies, a New York-based non-profit dedicated to helping gay men become fathers via surrogacy. The organization’s founder, Ron Poole-Dayan, spoke to this goal. “True equality doesn’t stop at marriage. It recognizes the barriers L.G.B.T.s face in forming families and proposes solutions to overcome these obstacles,” Mr. Poole-Dayan told the New York Times.  

Another non-profit dedicated to this mission is Connecticut-based Affordable Families, which aims to “alleviate the financial barriers facing anyone who would like to become a parent and requires medical assistance.” 

Affordable Families and Men Having Babies both cite legislation reform as a key part of gaining equal access to affordable fertility care. For more information on their missions and legislation-specific reform, check out these resources:  

Fertility Insurance Mandates & Same-Sex Couples

Gay Parenting and Surrogacy News and Updates

Infertility Insurance Coverage by State

--Sabrina Nash, MFA’s summer advocate (research)

Detroit’s Walk of Hope

LeAndrea Fisher and Sue Johnston, the co-founders of Detroit’s Walk of Hope

When two liked-minded people get together, great things can happen. That is the case of LeAndrea Fisher and Sue Johnston, two Michigan women who in 2019 decided to found Detroit’s Walk of Hope. Both women had gone through their own infertility battles and around the same time they reached out to RESOLVE: The National Infertility Association to learn more about creating a Walk of Hope in Michigan. Linked together by RESOLVE, when the two women met, there was an instant connection. They now affectionately have nicknamed themselves the Dynamic Duo.

The Detroit, Michigan Walk of Hope (WOH) is always held on the last Saturday of the month of April during National Infertility Awareness Week. It is a way to bring the infertility community together, provide support and connection with others on a similar family building journey and educate people about the fertility resources available in their areas. In addition, there is a fundraising component to the WOH. People are encouraged to form “fun”draising teams and have fun in a friendly competition to raise money for RESOLVE, which works to provide free programs, free national and local support groups, and advocacy for affordable access to care. 

On “Walk Day” those impacted by infertility and others who support them on their journey meet each other and walk in solidarity for the cause. People show off their creatively designed Detroit, MI Walk of Hope t-shirts and their orange clothing to get in the spirit for the event. Once at the walk location, those in the fertility community will receive a “Why I Walk Bib” and a color-coded journey bead necklace so they can identify others who are on a similar journey (i.e. adoption, undergoing treatment, third party reproduction, childless not by choice, etc.) To steal a line from “Carousel,” you’ll never walk alone. 

Because of the pandemic, for the last two years LeAndrea and Sue have held a virtual program, which was prerecorded and available to watch on the Detroit, MI Walk of Hope Facebook Group. This year’s event will be a hybrid –taking  place on Saturday, April 30th—and will be both a virtual program that will be able available to be viewed from 11:00am that morning as well as an in-person meet-up at midday at the Tolan Playfield (601 Mack Avenue) in downtown Detroit. (They encourage participants to wear masks as well as WOH t-shirts and orange clothing). It being spring in Michigan, the weather could go either way so it’s a rain or shine event. After you register for the event, you can also generate your own WOH teams and/or join a team. If you form a team of at least five people, each team member will be given a 2022 Walk of Hope t-shirt. We look forward to seeing you there virtually, in person or both. 

--Michigan Fertility Alliance

The Kids Are Alright: Surrogate-Born Children Are Speaking Out

Gee Roberts, born through traditional surrogacy, has been speaking out about her lived experience (photo: Gee Roberts)

In June 2019 the American Bar Association’s family law section, along with Cambridge Family Law Centre and the International Academy of Family Lawyers, put together a conference in Cambridge, England focused on international surrogacy. Experts from across the globe came to discuss a variety of topics around the topic and one of the speakers was Maud de Boer-Buquicchio, who at the time was the United Nations’ special rapporteur on the sale and sexual exploitation of children (2014-2020). The Dutch lawyer had spent her career working in human rights, having at one point delved into the subject of illegal adoptions. Partly because of her experience on this subject and wanting to show her interest in the intersectionality of child’s rights and bioethics, she told me, “I decided it was important to address the [complex] issues of surrogacy.”  

And address it she did, releasing in 2018 a statement on the subject that rankled many within the surrogacy world. She warned in that report that commercial surrogacy, as it was practiced in some countries, “usually amounts to the sale of children” and that there was an urgent need for surrogacy to be regulated. It was, as one expert who helped plan the conference later said to me, “a harsh report” and there was concern by many that she was only hearing one side of the surrogacy story: from those who opposed the practice. (Her follow-up 2019 report was more nuanced).  The Cambridge conference organizers asked her to give a presentation on how she developed her initial findings. After she spoke, one father “went after her,” said the conference organizer. “He said, ‘my daughter read in a newspaper that she is chattel and that I bought her. You have diminished the self-worth of these children.’”  

For the many debates that are held around surrogacy, it seems that oftentimes it is the actual children who are either completely left out of the conversation or they are included but portrayed as victims or chattel, as the father in Cambridge poignantly stated. As Barbara Collura, the director of RESOLVE: The National Infertility Association, told me there is a lack of awareness by those who speak out against surrogacy, that the very children they are saying they want to protect are actually being upset by what they are hearing and taking in.  “How are you making people feel by basically delegitimizing their life?” she asked rhetorically.  “These folks are saying that publicly all the time, and that there needs to be some sort of reckoning around that.”

Doing research for my book, I spoke to a handful of surrogate-born kids about this and asked them how they had worked through questions around their conception and birth. Fiorella Mennesson, who wrote a children’s book on surrogacy called Ma famille, la GPA et moi (“My family, surrogacy and me”), finds it “really inappropriate” when people ask her if she ever has doubts as to who her parents are. “I am not really comfortable with the question because it is absurd and it hurts,” she told me. “It is so weird to be questioned about my parents and who my ‘real’ mother is.’” Meanwhile, Gee Roberts, a British medical student who was born through traditional surrogacy in 1998, says that it gives you a different view on family. “For me,” she told me, “family, it’s not really about genetics.” She has always known the background of her birth, and it was something that her parents had made natural from the start. 

Gee Roberts speaking at a UN conference in Geneva, Switzerland in 2019

When she was in her first year of primary school, her teacher gave the class an assignment to draw a picture of their families.  Gee drew a picture of her mom, dad and her “tummy mummy”, Suzanne, who has always remained a part of her life. The school’s head teacher asked Gee’s parents who this mystery extra woman was in the artwork.  When they explained, the teacher got emotional because she had been adopted. She told Gee’s parents how fantastic it was that they had normalized it for Gee from such an early age. “I think we really underestimate how clever children are,” Gee told me in an interview after doing her medical rounds in a clinic. “Children are not innately anything, we teach them everything they know. So for me [my circumstances are] just as normal as having one mom and one dad to other people.”

For years there have been arguments around what would the long-term ramifications be for surrogate born children: Would they be confused? Would they be angry? Would they wonder who their ‘real’ parents were? Would they feel like they were chattel?  And for years, there was not much research so assumptions were that children born through surrogacy would, like research that came out on adoption, possibly struggle with grief, loss or issues of abandonment. The outlier is the research that has been done by Susan Golombok, who runs the Center for Family Research at the University of Cambridge. She has done a 20-year-long longitudinal study –the only one of its kind in the world—examining what impact surrogacy has on children born through those arrangements. She writes in “Modern Families: Parents and Children in New Family Forms” that with surrogacy differing from other types of ART it could “conceivably result in greater problems for surrogacy families” than for those created through more traditional procedures like sperm or egg donation.

However, her research, which has followed 42 British families at different times throughout the children’s lives, found the opposite: that children born through surrogacy were doing well and had good relationships with their parents. “And the answer to the question of who they saw as their ‘real’ mother was crystal clear,” Susan wrote in “We are family: What really matters for parents and children”, published in 2020. “It was the one who raised them.”In their first assessment when the kids were one-year-olds, contrary to numerous concerns that have been voiced about surrogacy, “the differences identified between surrogacy families and the other family types indicated greater psychological well-being and adaptation to parenthood by mothers and fathers of children through surrogacy” than by a comparison group of parents through natural conception. Parents through surrogacy showed greater warmth and attachment toward their children and a greater enjoyment overall than those natural conception parents.  They also reported lower levels of stress associated with parenting with mothers specifically showing lower levels of depression. 

Susan and her team of researchers found that overall, the kids at 14 weren’t troubled by the fact that they had been born through surrogacy. “They would say things like, ‘this doesn’t really mean a lot to me and there are much more interesting things going on in my life than how I was born,’” Susan told me. Others, meanwhile, talked more positively about it, saying it made them special or it was something different about them. “It just turned out to be not at all true, the things that people were predicting about the angst that these children would be suffering in adolescence,” Susan said. “Because they actually, genuinely, weren’t very interested in the whole thing. It just wasn’t a big deal to them.” 

While Susan and her researchers did not specifically ask the 14-year-olds about money or compensation for the surrogate, they were asked about the way they were born and how that made them feel. “They were completely fine about it,” said Susan. “They certainly did not seem obsessed, ruminating over these kinds of issues.” That research runs contrary to the rhetoric put out by those who have issues with surrogacy who claim children born through these arrangements will feel like purchased products. 

 Both Gee and Fiorella articulated their feelings on this to me. Gee told me she finds it very upsetting that people “almost disapprove of me innately” because of how she happened to be born. Most of them, she assumed, had never been through surrogacy so it felt a bit rich for them to be “speaking” on her behalf.  “If people are saying things like that from a place of opinion, where they have experienced something, then I can validate that,” Gee said.  “But if people are saying it from conceptual abstract things that they just decided with no experience, like where have you got that from? You don’t know.” Fiorella, meanwhile, said she’s often found that those against surrogacy aren’t interested in getting the opinion from surrogate-born kids, yet they claim to talk for them. “We have a lot of extremist people in France who fight against surrogacy,” she said. “They claim that it’s in the children’s interest and it’s really ironic because there is nothing towards the children in what they do.” 

When I asked Jill Rudnitzky Brand— born in Michigan in 1986 she was the first baby in the world born via a gestational carrier— how she felt about comments that surrogate-born children were chattel, she scoffed. By and large, she said,  “you are giving a viable option for people who otherwise couldn't have a biological child. And making that blanket statement is just like whenever you make a broad, gross generalization: you miss the nuance, you're going to make a lot of really cataclysmic errors.” 

--This essay is excerpted from Ginanne Brownell’s upcoming book, “How I Became Your Mother: My Global Surrogacy Journey.” 

Parental Leave: An American Disgrace

Kevin O’Neill (left) and his husband Eric Portenga with their identical triplet daughters born via surrogacy

As a Scotsman who has been living in the United States for almost six years, I still enjoy the cultural and linguistic differences between the two countries. I continue to call the sidewalk the pavement, the elevator the lift, the freeway the motorway and ketchup, tomato sauce. I choose American optimism over British pessimism.  I fancy the massive range of cultures and diversity that surrounds me, and I certainly prefer the four distinct Michigan seasons as opposed to four seasons in one day like I grew up with back home.  

Conversely, when you look past the glossy sheen that America typically has in the eyes of Europeans, there are some fundamental differences between the U.K. and the U.S. that I will never understand. The list is actually scarily long but those at the top include gun control/violence; abortion legislation; gerrymandering, actually the whole political landscape; trans rights; imbalances in the Supreme Court; and student debt management. However, after my recent experience of becoming a father through surrogacy, I got to see the inner workings of the American healthcare system and found it securely has its place in my list. 

In something as multifaceted as surrogacy, navigating the vast amount of online resources is intimidating to say the least. When you finally conquer that mountain, and unexpectedly end up with identical triplets, reflecting back on the process is rewarding, but humbling. As we took a breath to get over the massive complexities involved in fertility and surrogacy—coupled with the shock, thrill, excitement and exhaustion of becoming a new parents— we then discovered another mountain to be scaled:  childcare, work commitments and maternity/paternity leave. 

The United States is the only wealthy country in the world that has no guaranteed paid parental leave at the national level. That is zero weeks and zero dollars. The Democrats push to mandate paid leave fails time and time again. Offering paternity leave to fathers seems inconsistent across employers and state lines. Sure your job may be protected under the Family and Medical Leave Act (FMLA) but how does that help low income or even middle class families or those who are single parents? My husband and I are fortunate to have good jobs and employers who, to an extent, have more family friendly maternity and paternity leave than the norm. But six weeks for maternity and six weeks for paternity is still far too short. As any parent will tell you, it goes past in the blink of an eye. 

If we had not moved overseas in 2016, my previous U.K. employer offered six months fully paid paternity leave, partly funded by government. If my husband’s employer offered the same, we could have taken a year off between us. Even more, employers give generous flexibility around scheduling this leave. It is commonplace for new parents to take a year off work and no one bats an eyelid. Sounds a good deal, right? Well compared to Sweden it is not. Sweden offers480 paid days leave for new parents. That is two years. Let that one sink in.  Yet here we are in America scrapping together resources to get six weeks. 

As a gay dad, I wasn’t entitled to maternity leave as my body didn’t go through the enormous journey of pregnancy and labor. That’s fair enough.  But I did become dad to three 35-week-old premature babies. They spent 15 days in intensive care, which was half of my paternity leave. When they came home they were still tiny 4lb bundles of pure love, requiring round the clock feeds every three hours. This lasted until around three months. Now, isn’t the whole point of paternity leave to bond with your baby(ies)? But how was I able to do that in the NICU when they were in incubators or when they came home and they would barely open their eyes during the first month of life as they were still developing? 

I realize I may be hoping for too much here when even basic family leave is not paid nor provided, but if it were to be, it also cannot be a one size fits all approach. Why should a parent who has had multiples not get extra time off? Why should a parent who has suffered a miscarriage not get paid time off covered by maternity pay? Why can America not be the leader it always aspires to be in policies that are universally fair? Government and employers need to do better.

Since the pandemic, businesses have shown they can pivot quickly to make things happen. They can save huge amounts of money by having flexible work options and make considerable cost savings. Why can’t they invest in more family friendly policies around family leave to make employees happier and feel more secure at work when starting a family? Sadly, it is a question that continues to remain unanswered. It’s not a partisan issue—as, of course, people from all walks of life, politics, religions, ethnicities and sexualities have families. You’d think it would be one thing we could all agree on.

--Kevin O’Neill is chief administrator of the University of Michigan’s Women’s and Gender Studies department. 

A former Michigan governor explains the “Why?”: James Blanchard on signing the 1988 Surrogate Parenting Act into law

How and why?

Those two interrogative words are by far the most common ones that come up when we discuss the antiquated 1988 Surrogate Parenting Act with advocates, lawmakers, journalists, intended parents, surrogates, lobbyists, lawyers and academics. First there is disbelief that this law is still in place—”Wait, it’s still a felony in Michigan to participate in a surrogacy contract?” — and then a rat-tat-tat of questions: How did this law come about?  Why was it signed into law? How is this still the law on the books? Why did the legislature take it up in the first place? 

These all seem like very rational and sober questions to ask to our 21st century selves—especially as no one bats an eye much anymore over assisted reproduction like IVF. But back in 1988—34 years ago at this point—IVF, surrogacy and even conversations around infertility were not widely discusssed. That was because it was all new—the first IVF baby, Louise Brown, was only a decade old at the time and surrogacy had taken a recent bashing in the press over the Baby M case. 

And, of course, it’s important to remember that the vast majority of surrogacies at that point were traditional, meaning that the carrier was also the egg donor (as was the case with Mary Beth Whitehead, the New Jersey surrogate in the Baby M case who fled to Florida with the baby). Only two years before in 1986, Jill Rudzinsky had been born in Michigan. She was the first baby in the world born via a gestational carrier, meaning that she was not the genetic child of the surrogate who gave birth to her. But Jill and the handful of other babies born via gestational carriers during those few years were the exceptions not the rule in surrogacy. Meanwhile these days, the Centers for Disease Control estimate that 95% of surrogacy births in the U.S. are via gestational carrier. So those percentages have flipped completely. 

In the mid-to-late 1980s surrogacy was seen as something new, strange and even dystopian. And Noel Keane, the late Dearborn, Michigan-based attorney who not only created the first compensated surrogacy contract in the United States (and maybe the world) in 1976 but also did contracts between Mary Beth Whitehead and the Starks, as well as Jill’s parents with their carrier, was persona non grata with accusations that he essentially was in the business of selling babies. My former Newsweek colleague Barbara Kantrowitz wrote a cover story for the magazine on the Baby M case when the New Jersey Superior Court battle first began in 1987. “A lot of it was a class issue,” she told me, recalling that there was much reluctance by the editors to even do the story. “I remember what concerned me the most, and I hope I got that out in the story, was ‘Are we headed for a future where rich women pay poor women to have their babies?’ It felt like science fiction.” 

In those early days of surrogacy, radical feminists argued that surrogacy commodified the womb and exploited women based on their reproductive capabilities. They warned that women of color and poor women would be taken advantage of by wealthy white heterosexual couples desperate to have a child. “What we learn from experience today is that a lot of surrogates are white and tend to be lower middle class, so empirically this has not held true,” says Cornell University law professor Sital Kalantry, who has written extensively on surrogacy in both the US and India.

It was the late Michigan Republican senator Connie Binsfeld, who went on to become Lieutenant Governor, who first proposed the 1988 law. “She spent most of her time in the legislator dealing with children's issues, she was kind of like the children's advocate,” said Bill Kandler, a long time Lansing lobbyist. At the time there was a lot of talk around the lack of any legislation covering issues related to surrogacy, and how the Baby M case had really opened up a lot of legal and ethical cans of worms around not only surrogacy specifically but the ethics of fertility treatments in general. “Hardly anybody knew what IVF was so [surrogacy] was really out there for people,” said Mr. Kandler, who also for a time served as Governor James Blanchard’s director of legislative affairs. “People were saying, ‘You are kidding me? You can pay people to have a baby?’ There was probably some individual who testified against the bill. But overall people were like ‘Obviously we want to fix this, it's a disaster.’”  

Governor Blanchard, who as Michigan governor from 1983 to 1991 signed the 1988 bill into law, remembered just how controversial surrogacy was at the time. “Noel Keane was making money off of charging [people] to arrange a surrogate,” he told me recently in a phone interview. “It was relatively new and got everybody upset.” He added that the debate in the state at that time was very much one sided.  “I don’t recall anybody lobbying me on it,” he said.  “I don’t recall any letter writing. I don't remember any controversy over passing the bill or signing the bill or whether they should have a bill. I remember the controversy was all over Noel and making money off this.” (Governor Blanchard, who went on to be appointed the Ambassador to Canada by President Clinton, told me that he even had friends who years later worked with a surrogate, though he did not say where they lived or where their surrogate was based. “And they had two kids and so they're quite happy about it,” he said. “So obviously, it's been relatively popular since.”)

In the end the “Why and how?” behind the law was done to stop just one man from profiting off of surrogacy contracts. Interestingly, this seems to have been something of a trend with lawmakers in Michigan in the late 1980s and early 1990s: creating legislation to dissuade individuals from taking advantage of loopholes where there was no law. “This law was aimed at Noel Keane doing surrogate [contracts] in Michigan [just as] the legislature passed the 1993 law that was aimed to stop Dr. Jack Kevorkian from doing doctor-assisted suicide in the state,” said Robert A. Sedler, a retired Wayne University law professor who also was one of three lawyers back in 1992 who took the state to the Michigan Court of Appeals over the surrogate law. The roll call vote was 30 yeas, six nays, two excused and one not voting. (I was pleased to see my state senator at the time—also a family friend—was one of the six nays).

So with our sober and rational 21st century eyes, it seems dystopian and perplexing that participating in a surrogacy contract —either compensated or otherwise— could get you not only a hefty fine but even jail time. A law created to stop one man from pursuing traditional surrogacy contracts is instead stopping thousands of Michigan couples from having their own genetic children through gestational surrogacy, which has been proven to be a widely accepted treatment option from groups including the American Society of Reproductive Medicine. Surrogacy is recognized in 49 other states (to varying degrees) as safe, effective and regulated, all the while not preying on poor or disadvantaged women. Good law puts safeguards in place that require psychological and medical approval for carriers. And that’s best practice for everyone’s sake.

—Written by MFA’s communications consultant Ginanne Brownell, some of this essay comes from her forthcoming book, “How I Became Your Mother: A Global Surrogacy Journey.”

When your birth makes history: Meet the world’s first baby born via gestational surrogacy

Dr. Elliott Rudnitzky, Jill Rudnitzky Brand and Sandra Rudnitzky at Jill’s wedding in 2016

If Louise Brown and Jill Rudnitzky Brand ever meet, the two women will have a lot to talk about. That’s because their births marked significant first leaps in the science of assisted reproduction. Louise’s name may likely ring a bell because she was the world’s first “test tube baby”, born through in vitro fertilization (IVF) back in 1978. Meanwhile, though Jill’s name may not be known –in part because her parents were keen on privacy and anonymity— her birth was just as significant. Born in Ypsilanti, Michigan in 1986, Jill was the first baby in the world who was born not by her biological mother but via a gestational carrier. (To learn more about why all this was happening in Michigan in mid-1980s, please check out our piece on the role the state has played in global surrogacy history).

Before that, any children born through surrogacy were born via a traditional surrogate, meaning the carrier was also the egg donor. But thanks to the gumption not only of her mother Sandra and her father, Elliott, who is a cardiologist in New Jersey, but also Dr. Wulf Utian, Jill—the genetic child of Elliott and Sandra— was born via gestational surrogacy.

Though she was featured on the cover of Life magazine on her first birthday –where she was called by her middle name, Shira, to keep the family’s privacy— Jill has kept a low profile over the years. She is the married mother of two young children and lives in New York City where she is a marketing executive for an on-demand fitness company.  In an exclusive interview for MFA, Jill spoke with Ginanne Brownell about the significance of her birth and how that has in many ways shaped who she is. 

Brownell: Have you always known about the story of your birth or was there a moment when your parents sat you down and said, “You know, you are the first…” ?

Brand: There was never a time I didn't know the story.  So there are two parts of the story-- there's my parents, what they went through, which is, to some extent, not my story to tell. I wasn't there.  And then there’s the part of the story of my own upbringing, which is more my story. But what may surprise you is while I've heard the story a billion times, I don't know all the details. And I think to some extent the story for me is equal parts amazing and beyond a miracle, and then equal parts just me, totally mundane. My parents had a quest to have a biological child and went through a lot of things to try to make that happen. My dad had this idea and sought out clinicians who could help them do it. And Dr. Utian had the guts, the gall and the resolve to partner with them on it.

Jill on the cover of Life magazine on her first birthday in 1987

So you just grew up always knowing that you were the first baby in the world born this way? 

I'd like to say there was some well-conceived moment when they told me, but I just grew up always knowing. I think the first time that it struck me as being really amazing was when I was a freshman in college. There was a fundraiser at the Cleveland Clinic to help fund the procedure for families who couldn't afford it.  And they honored my parents and me, I suppose— even though it's really more my parents— for their bravery and courage. And we spoke at the event, and there was just couple after couple after couple coming up to me saying, “Because of your family, because of you, we have a child of our own, and you don't know what that means." And that was the first time that I felt like I understood, “Wow, like, this is my story.” It changed the world yet I had never felt that before.

Does that at all feel like pressure? 

That's an interesting one. I'm not even sure I've necessarily expressed this before but I've always felt this tremendous feeling that I've got some sort of responsibility.  Not a responsibility to anyone so much as a responsibility to be special. Like, I was born special, I have a responsibility to be special. I've thought this many times in my life. I don't think I've ever said it out loud. I've never said to my parents or  my husband. And I don't necessarily even know fully what it means. 

That’s interesting to hear how you have always processed it over the years.  

The other thing I remember thinking as a kid sometimes being like, “What if I just malfunction one day? Like a robot?” I would guess between the ages of six, seven, eight thinking, “this hasn’t been the done before and it’s so bizarre.”

Susan Golombok at University of Cambridge has done the world’s only longitudinal study of children born through surrogacy and her findings are, pretty much, that the kids are alright. They view how they came into the world as either a quirky story or something they don’t really think much about. 

Yeah, it kills at a dinner party. One thing my parents ask me, not all the time, but they'll ask me “Does that person know? When do you tell people? How does it come up?” My dad is always very curious about that. “Why does it come up? How do you introduce it? What do they say?” And it’s probably pretty bespoke in each scenario of how it comes up. But it’s never like me saying, "Let me tell you a cool story.” There is normally a reason if it comes up. 

Those who are against surrogacy will often say that children born through surrogacy are sold like chattel or commodities that are traded. How do you feel when you hear something like this?  

I live in New York City. I am surrounded by a fairly socially liberal people. So I've never encountered that point of view. The devil’s in the details here, like you have to understand the motivation [of why] people come to surrogacy. But by and large you are giving a viable option for people who otherwise couldn't have a biological child. And making that blanket statement is just like whenever you make a broad, gross generalization: you miss the nuance, you're going to make a lot of really cataclysmic errors.

Jill, her husband and children

Did you struggle to conceive?  

I have two kids. I have one who was born the good old fashioned way. And then my second, it just was taking a long time. And we knew we wanted more. So we did IVF. And I had some interesting conversations throughout that process. Things resonated in real ways when I was doing it. My husband and I talk about it sometimes, the stories that my parents have told about what it was like and what they went through. It’s like folklore. What we went through, they went through many times over the course of many years with so many roadblocks and failures. We experienced 1/1000th of what they did. 

Do you follow the conversations around surrogacy, especially living in New York where the law just changed last year? 

A little bit. Like when Phoebe got pregnant on “Friends” my friends would be like, "That's because of your parents and you!" Now in some ways it is so common, like, everything with fertility. It's mundane to some extent. My fertility doctor, when I told her my story, because you know it  came up pretty quickly, she was so like, "Oh my god.” It’s like I was Beyonce. She told me that there have been mentions of [my story] in courses she's taken. And she told me of this IVF doctor that she follows on Instagram. And the doctor had posted a picture of the Life magazine where I'm on the cover.  She wrote that, “We always hung that magazine on our wall because that was what inspired my mom to go to Cleveland to meet these doctors to try this thing. And because of that family, I have a younger brother.”

Your family have not kept in touch with your carrier but you are still in touch with Dr. Utian. He was the one who kindly passed my email on to you so we could speak.  

Yeah, my parents get teary eyed every time they think about him. They really do. They definitely email, maybe two times a year. They invite him for my things and they'll send him pictures and periodic updates like when I had my kids, that kind of stuff. They have so much love and affection in their hearts for him. I don't think there's a person on this planet other than their immediate family that they love more than him.

2021 Year In Review: Ode to Our Stalwart Supporters

As I sit down to reflect on Michigan Fertility Alliance’s accomplishments this year, I can’t help but dedicate this to the people and to the stories that make up the unique patchwork of our coalition. Our grassroots work on infertility and surrogacy reform in Michigan is fuelled purely by a passionate group of changemakers with an innate desire to educate, advocate, close the gap and expand options for the one in eight Michiganders suffering from the disease that is infertility. 

Infertility is big. It’s messy. It’s hard to get one’s head around it, even for those going through it. Add in a lack of insurance coverage for infertility services coupled with an outdated state law that (mostly) prohibits access to in-state surrogacy as a viable treatment option —while complicating the process for those who can— and it gets even more Kafkaesque.

So, rather than get lost in the weeds of technical jargon and published papers, MFA spent much of 2021 focusing on how to make the reality of the situation more easily understandable. We felt deeply compelled to connect at a personal level. We did this by sharing the honest stories of infertility warriors and supporters who entrusted us with some of their most personal and raw heartaches. We shared stories of triumph, hope, sadness and truth. We deeply thank all those who found a safe haven with MFA; a place where your story was heard and understood.

By sharing deeply personal stories, MFA advocates were able to connect with 50 lawmakers during the first-ever Michigan Infertility Advocacy Day (MIAD) on September 22nd. We focused the discussions on the 1988 Surrogate Parenting Act and why better pro-family surrogacy legislation is essential and prudent. This day was put together by a focused leadership committee, a support team of student advocates from the University of Michigan’s Women’s and Gender Studies program, and over 100 advocates. The support we received from lawmakers was monumental. These meetings allowed us to establish strong working relationships with lawmakers in the Michigan House and Senate who have remained enthusiastic in advancing pro-family surrogacy reform. We are hopeful surrogacy reform legislative action will happen in 2022. 

Other notable accomplishments of the year include:

• Organizing a foundation of advocates to advance infertility awareness

• Executing a letter-writing campaign to accompany MIAD with over 500 letters in support of surrogacy reform were sent to over 60 lawmakers

• Establishing a supportive working relationship with Resolve: The National Infertility Association

• Publishing weekly content-rich blogs that help educate and have garnered the attention of both national and international audiences 

• Assembling a driven and engaged leadership committee

• Creating a student advocate team from the University of Michigan to support our coalition’s efforts

• Working with an oral historian from the University of Michigan to document and record the stories from those impacted by Michigan’s crippling surrogacy laws

• Sending a bi-weekly e-newsletter to keep advocates and followers informed, under the direction of our media consultant, Ginanne Brownell

• Creating a robust social media strategy to expand awareness and education

For a fully volunteer-run coalition made up of working professionals with other life commitments, I am beyond proud of what we have accomplished this year. We are guided by the instinct to do what is right and don’t get discouraged when we have to pivot to accomplish our shared mission. We recognize this is a marathon not a sprint, and our years of suffering through infertility have conditioned us to endure. We are fighting for those who can’t, don’t know how, are too broken, too tired, or don’t yet know that infertility will be part of their journey. 

To be honest, the past 365 days have taught me more than a lifetime of degrees and accolades. I referenced what I learned as a little girl growing up on a dirt road in mid-Michigan more than I did my professional years — be a good listener, be a supportive friend, don’t overcomplicate things, follow your gut, ask for help and do your best despite the sometimes uphill battle. 

This past year I witnessed the potential of the human spirit, the importance of persistence, the power of continued perseverance, the ability to love strangers who share a similar journey and those who are trying to understand. 

I speak for the entire MFA leadership committee when I say “I cherish you” —  the doers, the advocates, the storytellers, the warriors — for making Michigan Fertility Alliance what it is. I can’t wait to see what we can accomplish in 2022.

With deep gratitude,

Stephanie Jones

Michigan Fertility Alliance founder

Have a Holly Jolly Christmas: Meet Adam, Doug and Jeremy Taylor

Despite a bout of Covid, Doug, Jeremy and Adam Taylor are excited for Christmas this year

Adam and Doug Taylor had big plans for Christmas this year. The Holly, Michigan-based couple were hoping to start a new tradition with their 18-month-old son, Jeremy, by taking him to Chicago to the Christkindlmarket. “I grew up in Germany as a military brat,” Adam said. “Mom would take us to the German Christmas markets between Thanksgiving and Christmas. I still have decorations from those trips that I have up all over the house.” They also planned to visit the Lincoln Park Zoo lights at dusk and to see Santa at Macy’s. Unfortunately, Adam got Covid so they had to cancel plans but they hope to still head to the Holly Dickens Festival before Christmas. “We went all out on gifts for Jeremy this year,” said Adam, “even mailing a letter to Santa.” 

It was on their second date that Adam Taylor told his future husband Doug that he wanted kids. “I put my cards on the table,” Adam said with a laugh as their 18-month-old son Jeremy squiggled in his arms. The couple married in 2017 and built their house in Holly in the hopes that one of the bedrooms would someday be converted into a nursery. But how to grow that family was going to be a struggle, no matter which route the couple decided to take. Adoption in Michigan for gay couples can be a tough road and Adam, who before moving into manufacturing had been a civil rights lobbyist, had been in enough committee meetings on adoption to understand those particular struggles. Surrogacy was the only other option. 

But, of course, surrogacy in Michigan is also a tough pathway to parenthood because of the 1988 Surrogate Parenting Act that makes compensated surrogacy illegal. So finding an altruistic surrogate was going to be a tough journey. A jovial outgoing man, Adam shared much of the couple’s journey to parenthood on social media. One of those struggles had been trying for over a year to get viable embryos through an anonymous egg donor at a Michigan fertility clinic. Finding a surrogate was another hurdle and one Father’s Day Adam got depressed with all the posts he kept seeing on Facebook, as it reminded him that they were seemingly getting nowhere. One of Doug’s friends, Becky Fritz, who he had known since elementary school in Fenton, quickly replied to Adam’s post writing, “Let's have breakfast” and writing that she wanted to be their surrogate. “She's always been an amazing and just beautiful person,” said Doug, adding that she already had one child with her husband. “She just wanted to help create another family.”

Adam, Doug and Becky then got down to brass tacks, sorting out everything from the legal steps to insurance coverage and also doctor’s appointments. Once pregnant, even the barrier of Covid did not stop Adam from going to those checkups. “I saw her during all the appointments,” he said, adding that she lived only 20 minutes away. “I was a stormtrooper during Covid. They would say, ‘you guys can’t come in’ and I would say, ‘try and stop me.’” 

While all three were over the moon about the pregnancy they still needed to tackle all the legal hurdles. Adam was the biological father (the couple plan to do surrogacy again using Doug’s embryos) so he would automatically be listed on the birth certificate. But that meant that unless they could get a pre-birth order from a judge—something that Adam and Doug understood had never been granted to gay parents before in the state of Michigan with a surrogate pregnancy—Doug would have to do a second parent adoption once the baby was born. “That could take two years in normal court proceedings but those are delayed even more now because of Covid,” said Adam. “So Doug would not legally be able to drop him off daycare without notes for me or take him to a medical appointment. If something happened to me, if I died, technically, the state would come in and assume custody of Jeremy.”

But luckily with the help of an attorney, the couple were able to traverse through all the seemingly endless paperwork and legal disclosures. A judge did grant them a court order, meaning that both men would be listed on their son’s birth certificate. “That court order was the only reason why we got to be allowed in for appointments,” said Adam,  “And then court order was the only reason why we got to be present at the birth and that court order was the only reason why we were there to sign our names on the document.” However, even despite of the legal ruling, it took the county clerk’s office several times over 16 weeks before everything was correctly in order. “That was either because someone was incompetent or it was done intentionally,” Adam said, adding that they kept making mistakes when it came to listing “parent/parent” versus “mother/father.”  

Through surrogacy, the couple would like to have a brother or sister for Jeremy but Becky likely won’t be their surrogate again, in part because she is currently expecting her second child. If they go out of state, they worry about missing many of the aspects of the pregnancy they got to share in person. This has led them to become active not only in being mentors for other same sex couples going through surrogacy but also working to change Michigan’s surrogacy law, which included them participating in Michigan Infertility Advocacy Day in September. Adam also brought the subject up with Governor Gretchen Whitmer when he walked next to her during the Motor City Pride Parade. “I said, ‘We are having advocacy day in two days,’” said Adam, adding that she was interested in hearing their story. So watch this space. 

Cherish the joy: A Kalamazoo mom’s holiday miracle baby

 Born 10 days before Christmas, Ryker Christopher Paska is his mother Cherish Paska’s holiday miracle. At the age of 32 Cherish— who lives in Kalamazoo, Michigan—went to see her obstetrician because she and her husband, who had already been married for nine years, were having trouble conceiving. After running a series of tests where everything looked fine, she was diagnosed with unexplained infertility and she started down the assisted reproductive technology (ART) path. She got pregnant after one of the cycles in December 2019 (a year after she had been diagnosed with Hashimoto Thyroid Disease) but sadly miscarried. She was suspicious that she had endometriosis. After advocating that doctors needed to look into this, they discovered that she had in fact correctly diagnosed herself and she had surgery to remove it.  Fast forward to the spring of 2021 when she got the wonderful news that she was expecting her dearly longed for baby. She spoke with MFA’s media consultant Ginanne Brownell a week before Ryker was born, discussing how different the holiday season will be for her this year. EXCERPTS: 

BROWNELL: The holidays are already very hard for people suffering from infertility but I would imagine the holiday season of 2019 was doubly tough after the miscarriage?

PASKA: Yes, the holidays were hard that year, especially because while our immediate family knew what was happening my extended family did not. We are the ones in the family that don't have kids, and we're always questioned like “your time's tickin” and stuff like that. So that year, I mean, I couldn't even look at people in their eyes because all I do is cry. So it's tough. This year is different. We're just over the moon. 

You were the one who first figured that you might have endometriosis. How important is it for women –and men— to advocate for themselves when it comes to their fertility health?

I think about stuff now and I just don't know why these tests are not done to women in their 20s as a routine. It just blows my mind. But we also in America don't have a great healthcare system. My doctors would constantly say for my IUI [Intrauterine insemination], “Oh, you’re textbook, this is gonna work.” And it didn’t. And I'm like, “You can't put that in someone's head going through this because then you have so much hope.” What infertility did to me is it stripped me of hope, it stripped me on my confidence as a woman. I mean my absolute darkest days of my life. Thank goodness I believe in therapy because I don't know if I would have gotten through without therapy. And the support from these internet friends I've made through the infertility community.  You know, it wasn't my doctor that got me through it. 

It sounds like that community has been very important for you—talking, sharing, a place where people understand. 

I tell you what these women that I've met have been like my rock. I mean, I talked to some of these women every day and I've never met them. And I think if I didn't have that community, I would be lost. And I would not have advocated for myself because you learn so much in this community. Of course I have my friends and family. I mean, thankfully, none of them have ever had infertility issues. But they don't understand. So to have the support of this community has got me through some dark days. 

After IUI you moved on to IVF?

I'll be honest, I always said, “I'm not going to do IVF because maybe I'm not meant to have kids.” Well, that's really easy to say until you're in the thick of it. And you know, you want to have a baby. After the IUIs failed, we moved on to IVF. And of course I have no insurance that actually is going to cover my IVF. So thinking about the financial part was probably the most exhausting decision we had to make. But my husband just kept saying, “We will do whatever we have to do like to fulfil your heart.” So we paid our deposits and I started the shots but my body did not respond well. So they cancelled my egg retrieval, which, that's one thing that I never was emotionally prepared for. When you go into IVF, you don't think about the chances of your body not responding, you know that there's a chance you might not get embryos, you might not have a transfer. But I didn't know that I won't even have an egg retrieval. 

This is the thing that no one ever tells you—we are led down the IVF garden path that we will get pregnant, but really a lot of clinics are using stats that fudge the truth. Like, “We have a 99 percent live birth rate.” But that’s a stat for those who actually get pregnant.   

Oh, yeah. And I actually talked to my doctor. I said, “Why don't you guys like prepare people that you might not even get to an egg retrieval?’ And they were kind of just not sure how to respond. And I'm like, “I feel like you like bamboozle people into this. And we go in with so much hope these meds are going to work and we're going to get a baby. And then we can't even get the eggs out.” So for the next round they put me on the strongest amount daily for that. We did an egg retrieval on my 35th birthday, which brought a lot of emotions. And on the transfer day, our doctor came out and said that we have one embryo that made it for the transfer. And that too, is just love emotion because you hear so much of failed transfers. And my whole thought process was, “This isn't going to work.”

Fertility treatments becomes a numbers game doesn’t it? 

I was already in the mindset of, “We have to now financially figure out how we're going to do another retrieval.”  I already had my next appointment scheduled to talk to the doctor in case it failed. I was one step ahead of because that's what infertility does to the trauma and the pain. But then we found out we were pregnant and I was thinking, “Oh my gosh, this really did happen.” I'm 38 weeks pregnant today. And it's still hard for me. I feel like this whole process of pregnancy you carry your trauma with you through it. And it's scary. Every morning, I still check to see if there's blood.

You are on the leadership committee for Michigan Fertility Alliance and have said how much you want to continue to be involved on many of these issues.  

I've been very open on my Instagram (@cherishyoureggs) on every step of my journey. And I've put on there that I want to continue to advocate, be there for support. Even though I've made it to this side, I mean, infertility is still part of my life. I just want to be there for someone for hope. And I know everyone's different and everything we go through doesn't mean that it's going to work for them. But I just want to be that rock for people. So definitely, I mean, real estate is my career. But [this advocacy work] this is my passion. I'm not embarrassed of my journey, [it's] who I am.

Two Men and Three Babies: Identical triplets and a “one in a million” odds

Eric Portenga, Maureen Farris and Kevin O’Neill

Glaswegian Kevin O’Neill laughs at the cliché that he first met his future husband Eric Portenga in a Scottish whisky bar. Originally from Muskegon, Michigan Eric was doing his doctorate in Glasgow and from early on in their relationship, the couple talked of having children. Because of visa issues, Kevin and Eric decided in October 2016 to relocate back to the United States where Eric got a post doc position at the University of Michigan. Within a few months of being in Ann Arbor, Kevin became the chief administrator of the school’s Women and Gender Studies department. Once settled, the couple began seriously investigating the options around surrogacy and adoption. 

 For a number of reasons, the couple decided to pursue surrogacy. “I felt like with surrogacy, in terms of control, there were more parts we could manage,” Kevin said in a video interview. Living in Michigan, however, they knew surrogacy could be a big risk for a number of reasons, not least of which was that they were a gay couple in a state where LGBTQ couples have faced issues adopting. Earlier this year, the couple became fathers to identical triplet girls-- Parker, Robin and Sylvie-- who were born via surrogacy in Akron, Ohio. Kevin spoke with the MFA’s media consultant Ginanne Brownell about the couple’s journey to parenthood and the “one in a million” chance of getting identical triplets. EXCERPTS: 

BROWNELL: How did you start investigating surrogacy? 

O’NEILL: COVID allowed us to do research. And also we were saving money because we weren't travelling all the time, we weren't hosting parties or going out. And it gave us a gift of time to interview surrogacy agencies and just understand the roadmap because surrogacy is a very complicated process. There’s almost too much information. But at the same time the information isn’t actually always clear.  There's no way you can really go step by step or with a flowchart because everyone's situation is slightly different. We kept hitting brick walls, we didn't think we'd ever find a surrogate. It just seemed implausible that someone out there would help us. And then all of a sudden, out of the blue, one of our good friends connected us with Maureen Farris, who became our surrogate. 

How soon into your research did you see Michigan was the U.S. state equivalent of persona non grata in terms of surrogacy? 

Very early in the process. I was in a lot of support groups and Michigan often pops up as avoid, avoid, avoid, like red flags. I read some of the stories of things that have happened in the past and we just decided, “Okay, we can't do anything here, it’s too risky so Michigan's off the table.”

You’re from the U.K. where non-compensated surrogacy is legal but surrogacy contracts are unenforceable. Also, though it looks set to change in the autumn of next year, at the moment the U.K. adheres to mater semper certa est, meaning that the surrogate is considered the legal mother at birth. My husband and I therefore had to go through the courts to get a parental order.  Despite all this, did you ever think about doing surrogacy in the U.K.? 

 I listened to a couple of podcasts and interviews with [British gold medalist] Tom Daley and his husband. But I was still unsure as the contracts are actually just a bit of paper. And so that also seems hard. 

You found an egg donor, met and liked Maureen and did the embryo transfer—but how long did it take before you found out you were expecting identical triplets? 

I'll never forget when we went through the contract and it said that multiples was a less than 5% chance, and Eric and I joked like, “What if we had twins?” I was actually in Scotland when they did the transfer but I was there on FaceTime. And we got the news that the embryo was likely not viable, so I was disheartened. And Maureen took three pregnancy tests that came back negative. And then she went to take a blood test and the doctor called me in the U.K. and said, “You’re pregnant.” Six weeks later we went for the scan and the doctor said, “Oh, they have split, you are having identical twins.” It was just the best news because we wanted two kids so it was phenomenal. Five days later Maureen was having some bleeding and they did an ultrasound and the doctor said, “I think I may see a third heart or it could just be an echo.” We had to wait another two weeks to see an ultrasound specialist who went, “there is Baby A, Baby B and Baby C.” And then we had the ultrasound printed. I mean, it was a ream, it was like it was twice the length of my arms. 

Like what are the chances? 

It's really hard to find accurate statistics on it because it is so incredibly rare. And numbers I've seen go from like one in 100,000 to one in 100 million, which I actually think is way too high. We’ve just been settling on like one and a million. One of the technicians we met had been at the Cleveland Clinic for 24 years— and we were the only set of identical triplets that she's ever come across. 

Your girls were born via C-section in September—how is it going so far? As a mother of multiples, I know those early days can be rough and tough. 

You know, it's all about the preparations. Knowing that we're going to have three babies, we knew we had to be organized. We had to have the nursery ready, the bottles stations had to be set up, everything we could do we did beforehand. If I wasn’t such a planner, it could have been a disaster. We feel like sometimes we are walking a tightrope and we are just one step away from it all unravelling very quickly. A few days ago we took the girls to see some friends for a Christmas kick-off and it was the first time we had gone with them to someone’s house. And it went so well. Then when we got home, we had 10 minutes to spare before the next feed and it was frantic. And that is when I felt like we are running close to a knife’s edge. 

I think one of the biggest perceived barriers to surrogacy is the expense of it—and that it’s only available to couples of certain means who can afford it. Did you grapple with that? 

It's so expensive and I do think that middle class families, if they are sensible about their finances, can do it. But what about families that are not making a decent income? And that is what is really hard about this. I can't speak to for the U.S., but I can speak to it in terms of the U.K. with the National Health Service (NHS). Because with couples that have fertility challenges, if you have a miscarriage or if you have some other pregnancy issues and they are over a certain age, the NHS will take them on and help with a couple of rounds of IVF. That is amazing. And it begs: Why is this not standard? Why does the U.S. not have systems like that? Why are gay men not classed as having infertility challenges?  My own healthcare from the University of Michigan and Blue Cross/Blue Shield doesn't recognize me as having any fertility issues.  Yet I don’t have access to a womb and I'm not attracted to people that have wombs. So I do think I have some fertility issues. 

Considering not only the job that you have but also having gone through this whole social infertility rollercoaster do you feel like you have become more of an activist on some issues? 

With things like parental leave in the U.S., I do want to start to challenge it. It’s ensuring that paternity and maternity leave isn't just kind of black and white, which I feel it really is.  There needs to be a more niche grey area. Especially  for parents who have multiples. There should be different times off and for parents that have their babies in the NICU.  There should be different times off for parents that are suffering loss through miscarriage or anything like that. In the U.K. maternity leave is standard six months and then often six months half pay. That's great. But here [in the U.S.] it’s a minefield so that, along with surrogacy, needs reform. 

What will the holidays look like this year for you, now that you and Eric have completed your family?

We usually either spend Christmas in Scotland or in west Michigan with our families but this year will be our first time in our own house. We are so excited for our first Christmas as a family of five, plus Max our dog, and starting our own family traditions. We've already made the first one by getting a big real tree for the house which, with some help, the girls hung their first ornaments.

Our Bun, Her Oven: One state, two conflicting judicial opinions

Aubrey Gojcaj, who lives in suburban Detroit, was unable to have any more children after her daughter Iris—conceived through IVF— was born in 2018 because of afterbirth pregnancy complications requiring a caesarean hysterectomy. With two embryos left, Aubrey and her husband Pete decided to look into surrogacy. Both their first and second potential carriers had to back out last minute because of personal issues. Heartbroken, Aubrey met her sister, Sarah, for a playdate in the park with their children a few days after the second potential surrogate had had to cancel the embryo transfer. While Aubrey thought she would be commiserating with her sister, in the end Sarah told Aubrey she wanted to be her surrogate. Though their first attempt did not take, Sarah is now pregnant with a girl who is expected to be born in the beginning of next year 

Right before Thanksgiving, the couple got the great news they had been waiting for - a judge ruled they would not have to adopt their own baby. In surrogacy lingo, they were granted a pre-birth order, something Michigan law does not guarantee. This, of course, is in direct contrast to what happened to Tammy and Jordan Myers, a Grand Rapids couple who, because of a judge's ruling, are being forced to adopt their biological twins born via a gestational carrier. These two opposing rulings highlight how uniquely confusing and gray the surrogacy law is in the Great Lakes state. Michigan's Surrogate Parenting Act, Act 199 of 1988 criminalizes a surrogacy contract (the only state in the U.S. that does so). It ties the hands of professionals who can assist, limits access to gestational carrier surrogacy and the law is unclear regarding the rights of parents, surrogates and the children born through the gestational carrier surrogacy process. Ginanne Brownell spoke with Aubrey about how she came to surrogacy and why she became an advocate for changing the law (Both Aubrey and Ginanne are members of the MFA’s leadership committee). Excerpts: 

Brownell: What did you know about surrogacy before you started looking into it?  

Gojcaj:  Almost nothing. I knew the science behind it but that was just about it. I had started with calling our fertility clinic and asking them questions, taking their guidance. And I was shocked. They were like, "Okay, this is the lawyer you're going to need to call and this is where you need to start." So I called and lawyer and she said,  “Well, you're going to want to start with finding an insurance plan, because a lot of these insurance plans are going to have exclusions for surrogates." And it's like, why? Well, because insurance companies don't want to pay anything. And that's a little way that they can get out of paying more bills. It’s so crazy because if a surrogate gets pregnant naturally, they cover her pregnancy. But she's doing this the most selfless act in the entire universe and [insurance companies] are saying, "We are not going pay.” 

Once you were armed with that information, what was the next step? 

The lawyer really gave me a lot of guidance on where to go starting to look for insurance. And she told me that you can't compensate. And I had my whole binder together of all my information, everything I had learned. We did have one woman who came to me but in the end she wasn't able to do it. So [the idea] kind of just sat on the backburner for a while. We kept renewing the yearly fee for the embryos. Pete wanted to keep them. And I got to the point where I just needed closure either way.  

Did you ever ask Sarah outright to be your surrogate? 

She had a kid six weeks before I had Iris. She had two children of her own. Her husband owns a business. So he's busy, works a lot of hours. She didn't like being pregnant, didn't have easy pregnancies, both were C-sections. I never ever blamed her for not wanting to be my surrogate. I respect that. And she didn't want to and I knew that and that was okay. So then another woman stepped in but right before the transfer she also decided not to do it for personal reasons. This was on a Wednesday and Friday, I took Iris to my parents’ house. My sister was there with her kids, we took them to the park. And I was just talking about it, being so disheartened.  And my sister's like, “Well, you know what, it's okay that this happened because I want to be your surrogate.” It was such an emotional roller coaster getting here. So while I was excited, I was also cautiously optimistic. And I went home and told Pete and he was cutting the grass. He just started sobbing. 

So how did things progress from there? 

Our first transfer did not take. That obviously heart-breaking because then we only had one left. We had decided to do the transfers separately because our fear was if we implant them both together, and it doesn't take, that’s it.  But the second one took and we were thrilled when we finally got the results. 

After that initial excitement, however, often comes the reality of, “Oh boy, now we have all this paperwork and logistics.” How was that? 

It didn't deter me from wanting to go through the process. We knew that there is no compensation allowed in Michigan but there is still cost involved. I guess a majority of my frustration came with how do you budget for potentially needing to adopt your children back? Where do you start? I think so far we've already spent $50,000 on the surrogacy journey with my sister [in terms of the transfers and health care bills] and now she's having the baby at the end of January so we have to pay for the insurance. 

You found out recently that you would not have to adopt your own child because you received a pre-birth order that will list you and Pete as the baby’s parents on the birth certificate. 

We were elated. Because we were trying to budget and put to the side another $30,000 to $40,000, which is what our lawyer said it we would be looking at approximately for that process. So like how do you plan for that? I very much a planner, I do not like things just left to figure out along the way. I like to know the information. Then it's like the fact that you guys won't allow this contract to be brought into court is causing me and everybody in this situation such turmoil. It was infuriating. 

You started a petition on change.org to update the surrogacy law in Michigan. How did you connect with MFA, which has been working on exactly that?  

I started Googling and there were no other petitions for Michigan surrogacy law. And I thought, “All you women out here that have gone through it, nobody has thought, “let's start a petition?”  So I was even more infuriated. I started looking up Michigan surrogacy groups, literally anything I could join. And Stephanie Jones [MFA’s founder] ended up messaging me on Facebook. And she said, “I saw your petition, I'm hearing your frustration and you're the exact type of person that we want to join us. This is what we need, somebody like you that's over here, rattling cages.” I was so desperate for somebody to feel my pain and be vocal with me. So when she called me we talked for over an hour. And I was so relieved. After I got off the phone with her I felt so happy and such a sense of peace because all of a sudden, I wasn't alone anymore. Somebody understood.  A roomful of women and men that understood this fight. And so I joined up immediately. 

Last Christmas: Struggling with Infertility Around the Holidays

Last Christmas, my partner and I spoke out loud all the things we wanted in 2021 and toasted to our best year yet.  It was our version of manifesting, and it centered heavily on becoming parents. Here we are almost a full year and a miscarriage later, still childless and counting the days until my next IVF protocol begins.

Generally, I love Christmas time.  The holidays represent warmth, quality time and joy to me.  Over the years, my partner and I have created our own special traditions that we enjoy each year as a family of three (our dog, Ellie, is our first baby), and we long for the day that we can include a baby in our existing traditions while adding new ones as a family of four.  

Infertility can complicate the holiday experience in a way that only fellow warriors understand.  Gatherings with extended family and friends can invite personal questions that aren’t easy to answer or are just plain inappropriate to ask (note: it is never okay to ask someone when they plan to have children).  For me, I have a love/hate relationship with buying gifts for nieces and nephews: I love finding something that I know they will enjoy while simultaneously dreading watching them open it because it puts a spotlight on the fact that I don’t have my own child to delight with presents on Christmas morning.  

I know that some of us warriors live in a constant state of anxiety leading up to the holidays because we think a family member might announce a pregnancy. I’m sure many of us dwell on what we thought this holiday season would have looked like or should look like, and reconciling reality with those wishes can be deflating.  These added emotional challenges create an extra layer that we must simultaneously sit with and work through while also ensuring we don’t “ruin” the holidays for others.

This time of year can be a reminder of what we’re missing out on, that another year has passed and we’re still trying to build the family we so desperately desire.  Someday, it will be our turn to don matching family pajamas for photos, to take our children to see Santa, to decorate our tree with colored lights and wild abandon instead of our carefully curated approach, and to view the wonder of the holiday season through their eyes.  For now, the holiday that normally fills me with such joy is a time that amplifies the missing pieces in my life.

Chelsea’s dog Ellie ❤️

This holiday season, guard your peace.  As some fellow warriors told me recently, it’s okay to say, “we’re taking a break from talking about infertility.” It’s also okay to talk about your journey with as much detail as you want with anyone who will listen. It’s okay to decline invitations if attending isn’t going to serve you. It’s okay to protect yourself first; everyone else will get over it.  It’s also okay if this season does not send you into a pit of depression.  As my partner told me, not having a baby highlights some of what is missing from the season and makes him want new traditions with a child, but it doesn’t necessarily ruin the holidays for him.  A baby would just enhance his experience.  My point is that it’s okay to be at a zero on the festive scale, or a 10, or somewhere in between.  It’s okay if that changes day to day or event to event, too.

For those of you who aren’t infertile but know someone who is, please extend some patience, grace and empathy.  We might not be the life of the party, we might not stay the entire time, and we may not participate at all.  It’s not you; it’s infertility.

When the holidays roll around a year from now, I hope to be that new mom spamming folks with photos of us in matching pajamas, taking our baby to see Santa, and generally soaking up the season as a family in awe of our newest addition.  Until then, here’s to all you warriors: the ones struggling with the decision to attend a family gathering, the ones actively going through a treatment cycle or reading through surrogate profiles or researching adoption agencies, the ones waiting for it to be their turn to announce a pregnancy, and the ones who are living it up now in the hope that next year’s celebration looks a lot different.  I wish you a very merry Christmas and happy holidays filled with whatever it is you need in this moment plus a stocking full of baby dust. 

—Chelsea Lantto, who serves on the MFA leadership committee, is a manufacturing executive on a journey to persistently pursue parenthood, currently via IVF. You can find her talking about all things infertility on Instagram: @thepersistentpineapple.

Meet the hosts of “I Want to Put a Baby in You”

Jennifer White and Ellen Trachman, the hosts—who are sisters—of the podcast “I Want to Put a Baby in You.”

If never have you ever had the pleasure of listening to the podcast I want to Put a Baby in You, you’re in for a real treat. When researching my book “How I Became Your Mother: My Global Surrogacy Journey”, a number of the experts that I interviewed on surrogacy told me about the podcast. Ellen Trachman, a family formation lawyer, and her sister Jennifer White, who runs the surrogacy agency Bright Futures Families, in their relaxed, funny and thoughtful style interview some of the top experts in the United States and across the globe about infertility, surrogacy, egg and sperm donation and assisted reproductive technologies (ART). But they also talk to everyday people who have gone through the trauma of infertility and come out on the other side. I spoke with them about their podcast and what drives them to try and make surrogacy a more transparent space. Excerpts: 

Ginanne Brownell: So I have to ask, where did you come up with the name for the podcast? 

Ellen:  I write a weekly column for Above the Law on legal issues and the original tagline was "I want to put a baby in you." 

Jennifer: And I bought her the web address as a joke for Christmas. And so that's how we came to have the title for it because we had all the rights to it anyway. I'm pretty sure Ellen said, “We should do this thing, a podcast.” I said, "That seems hard, but let me have think about it.” Yet here we are almost four years later.  

How did you come up with the idea in terms of the focus? 

Jennifer: It wasn't about any specific bent except to talk about all things assisted reproductive technology because people who go through this feel like they're alone. And we just didn't want people to feel like they're alone any longer. We do a number of stories from every direction we can possibly pull, be it parents who've been through surrogacy, egg donors, attorneys, any professional who vaguely touches on what we do. 

I have had the pleasure of having been on your podcast, as has MFA’s founder Stephanie Jones. How do you find guests? 

Jennifer: A lot of people are from our own circles and experiences. So of course, gestational carriers that we've worked with or we go to a lot of conferences and beg people we meet at these conferences to come on the air. 

Ellen: Some are from the stories that I write on for Above the Law, like Derek Mize and his partner, who are U.S. citizens, but had an immigration nightmare in the U.K. where their daughter was denied American citizenship. I was very fortunate that he reached out to me to tell their story. 

Jennifer: And we get rejected too.  I’m not ashamed to admit I reached out to Michelle Obama and her team rejected our pitch. But I will follow people's stories. There are so many surrogacy message boards out there. So I'll see people who will write,  “Oh, you know, like, this person had this horrible experience, and this person had this weird experience” or things like that. I have found a number of people that way.

One of the things that really bothers me about surrogacy is how it’s portrayed in pop culture. It’s always that the surrogate is a stalker or the parents are unstable or that someone is being taken advantage of. 

Ellen: The reality is there's very little drama in a typical surrogacy story. So then you have things like the Jessica Allen story where she gave birth to twins but one turned out to be biologically her child. And you have tears on all sides. And you know, my goodness, that is heart wrenching and that's why that stuff gets picked up. And then suddenly that becomes the next Lifetime story because it has those levels of drama. 

Jennifer: Phoebe on “Friends” for example or Kim Kardashian, those are like the two big culture references I hear over and over again. But definitely there are misconceptions. Somebody came to me trying just having a casual conversation about Kim Kardashian and they said, "Well, but she just did it because it was vanity."  And  it wasn't vanity. She had placenta accreta. So there are the misconceptions that she just did it because she had money, not because she actually had a medical need. 

Heather Jacobson from the University of Texas in Arlington told me that she thinks we need to change the terminology – to avoid that “single story” of who a surrogate is and why she is doing what she is doing. There are surrogacies, not surrogacy, and drawing the same conclusions of how surrogacy is in the United States or the United Kingdom versus Ukraine is rather ludicrous.  

Jennifer:  In New York, for example, Gloria Steinem came out against the then proposed statute making surrogacy legal in the state. [Compensated surrogacy became legal in the state earlier in 2021]. She said that it's just exploitation of women, and it was a complete misunderstanding of the reality. People who are against surrogacy try to claim women are being exploited. And that has happened in other countries. But the women that we work with day in, day out, they are the opposite of exploited. They are very strong women. The reasons why they are doing is that they want to do something amazing. They want to help someone. I feel like it’s very often being inaccurately portrayed as women being used. No, that’s not the experience we have seen at all. 

General Motors, headquartered in Detroit, announced in October that starting in 2022, employees struggling to expand their families could get up to a combined $40,000 benefit to reimburse costs of things like fertility treatments and surrogacy. It seems that there is more and more recognition of how these costs can feel overwhelming.

Jennifer: People are fighting for fertility coverage and insurance. To be a parent can be a very strong driving force and you're willing to go through anything. We know people who have  rented out their house and moved back into their parents basement and gave up everything just to save a pennies so they could go through fertility treatments. And then with surrogacy, of course, it's even worse. There is definitely is a realization that it's expensive and that it is difficult to reach. And I don't know that any of us have hit on a bucket solution; we [as agencies] end up referring intended parents to the same places like the Cade Foundation or Men Having Babies. We spend a lot of time counselling people on how to save money or how to find the money for it. I try to encourage people to do it in manageable chunks, because I think people think that it all has to be done at once, especially if you need an egg donor.  And so what I'll tell people is, "Maybe right now, all you can afford is to make your embryos. So do that and freeze them. And then hold on, and get ready for that next step when you're financially ready.” Break it down into more manageable pieces."

This year you, Jennifer, helped found the Reproductive Alliance, an organization whose mission is to establish an accreditation process for the surrogacy field. Tell me a bit more on this.

 Jennifer: Change only comes from within. I mean nobody outside, unless there is government intervention, is going to actually work on making this change. We've set it up as an organization that includes doctors, lawyers, mental health professionals, insurance professionals, escrow professionals, representatives of intended parents, and representatives from gestational carriers. The goal is to give Intended parents and gestational carriers a way to “look under the hood” and know which surrogacy programs are adhering to best practices. We feel strongly that this will lift up all surrogacy programs as well as make surrogacy a better and safer experience for everyone.