The Lone Wulf: Meet the Father of Gestational Surrogacy

Sometimes, history is made when alphabetically you come last but you end up first.

The 1986 Baby M case marked a major turning point in the history of surrogacy in the United States, not only because of the ethical quagmires it exposed but also it coincided with the beginning of (mostly) the end of traditional surrogacy in the United States. In 1985, a South African-born Cleveland- based gynecologist and reproductive biologist named Dr. Wulf Utian wrote a letter in the New England Journal of Medicine. In it, he stated that he had created a baby using a surrogate’s uterus, another woman’s egg and her husband’s sperm.

Before he fell out with the Apartheid government back home, Dr. Utian had been doing most of his research in menopause, being the first to describe way back in 1967 that it was a health-related issue. (Dr. Utian told me that because he happened to work at the same hospital in Cape Town as Christiaan Barnard—the first doctor to do a human-to-human heart transplant—he benefitted from all the research money the hospital started receiving after that successful surgery). 

When he arrived in Cleveland, Ohio in the mid-1970s, Dr. Utian helped to set up a fertility clinic at Mt. Sinai Hospital, which became one of the most successful fertility clinics running in an academic center in the country. “And out of the blue one day I got a phone call from a cardiologist from New Jersey,” he told me in a Zoom call from South Africa where he now spends part of his retirement. “And he said, ‘I will be honest with you, you are “U” in the alphabet so you are the fifth person I am calling.’” Everyone else had said no.  

The cardiologist, Elliott Rudnitzky, told Dr. Utian that his wife had had a Caesarean hysterectomy and that their baby had died soon after. However, his wife still had functioning ovaries. The cardiologist said they had a good friend in Michigan—which turned out not to be the case—and she was willing to be their surrogate.

Turns out, Noel Keane (the Dearborn-based lawyer who had been the first person in the U.S. to write up a commercial surrogacy contract back in 1976) had actually found them a willing surrogate in Michigan. “It was sort of [the cardiologist’s] idea in a sense because even though people probably talked about this before, he was the one who [proposed it],” Dr. Utian said. The idea of implanting embryos from one womb to another had been done on animals for years. “So,” he said, “it was not a unique concept.” 

Pieter van Keep, at the time Director-General of the International Health Foundation, with Dr. Wulf Utian

Dr. Utian told Dr.Rudnitzky that he was interested. But the hospital board at Mt. Sinai said before Dr. Utian could proceed, he needed to get the permission of the local religious leaders, as the hospital had seen protests over their assisted reproductive technology (ART) work. “The rabbi, to my surprise, told us ‘you know it’s written in the Torah be fruitful and multiply onto the land so therefore since you are helping people get pregnant, it’s kosher,’” Dr. Utian said, adding that while the Catholic bishop never got back him, years later the bishop’s secretary became one of his patients.  

The hospital, of course, required psychological screenings on both the gestational carrier and the couple.  They also wanted airtight contracts that considered things from whether the surrogate should take prenatal vitamins to if there was a fetal anomaly would the couple consider termination. “We actually fell out with Noel because we were very keen about certain rigid ethical issues,” Dr. Utian said. “And with all due respect, he skirted to the edge of a lot of that stuff.” 

They knew that they wanted to use the surrogate’s natural cycle so, “we manipulated the cycle of the biological mother, coinciding cycles,” he explained to me. “And then we did the embryo transfer and so that was all I was responsible for. And then we followed the pregnancy and once we were happy with [how things were progressing] she could deliver wherever she wanted.”

The 7-lb 3-oz baby girl, who in the press was called Shira, was born in suburban Ann Arbor, Michigan in April 1986. “It was the first time in world history that a woman who gave birth to a baby was not the [biological] mother,” said Dr. Utian. Shira was also the world’s first baby where a judge ruled that her biological mother and not the surrogate should be listed on the birth certificate.

The birth—and the court ruling—were watersheds in changing how surrogacy worked. “There was a lot of excitement from people because suddenly you had this whole group of women out there who had uterine abnormalities or recurrent miscarriages or other reasons why they couldn’t carry a pregnancy but they still had eggs and ovaries,” Dr. Utian said.  “So I mean, we were inundated with phone calls.”

After her birth, Mt. Sinai became the center for gestational surrogacy for a number of years. “We started getting patients from all over the world and I recorded a couple years later our pregnancy rate I think was around 25%, which was at that time was an outstanding,” he said. “I sort of stepped away from it later because it —developing the technology, the way to freeze the eggs and store them— became a recipe. And I like to think of myself more as a clock maker than a timekeeper.”

Dr. Utian said he is still in touch with the family (they send holidays cards each year) and even attended the girl’s bat mitzvah where her mother made a speech. “She called me up to stand next to her,” Dr. Utian told me, “and she was crying, everybody was crying and I had tears running down my face.” He was also invited to Shira’s wedding a few years ago but he and his wife were in South Africa so they could not attend. According to a 2016 CDC report, 95% of all surrogacies in the U.S. now are via gestational carriers. 

—This story is kindly excerpted from Ginanne Brownell’s upcoming book “How I Became Your Mother: My Global Surrogacy Journey.”