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Donor/Surrogate Relations Part Two

March 21, 2006 - Tuesday
7:52 PM to (EST)
Guest Speakers: Mindy Berkson
Lotus Blossom Consulting, LLC

Categories
Donor Egg • Egg Donation • Gestational Carrier • Insurance • Pregnancy • Surrogacy


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deb_capone I apologize for the delay. I got kicked out of the system and lost all of my stored data...
Mindy Yikes!
deb_capone Thanks for joining us, Mindy.
Mindy It's a pleasure to be here.
deb_capone It looks like we will have a few minutes to get organized.
Mindy That's fine.
deb_capone Welcome to tonight's Online Education Session, hosted by The American Fertility Association and sponored by Serono and Fertility Lifelines.
deb_capone Tonight we have the pleasure of welcoming back Mindy Berkson from Lotus Blossom Consulting. Mindy in an infertility consultant and helps people navigate the sometimes treacherous waters of fertility treatment.
deb_capone Is that an accurate representation of your role, Mindy?
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Mindy Yes, that is a short and sweet description of what it is that I do.
deb_capone Good evening Stacie.
Stacie Good evening
Mindy Welcome.
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deb_capone We know that the relationship between a donor or surrogate and a fertility patient can be tricky. It is inherently complicated and can be expensive as well.
deb_capone Mindy, can you give us an idea of what we can do to manage these relationships and where we can find the resources to help.
tenayagirl2 what is the average cost for a gestational surrogate including the IVF process in CA?
Mindy It can be and truly my role is to make sure that couples avoid the treacherous waters and experience smooth sailing through the process by having very clear expectations before the relationship with the surrogate becomes too involved.
tenayagirl2 i could not find part 1 of this discussion in the transcripts...
deb_capone Good evening qpnmwzni. Welcome to our session with Mindy Berkson.
Mindy The cost in California as with any state is variable depending if this is an independent or an agency arrangement. The compensation for surrogates (except family members or friends) can be anywhere from $15,000 to $40,000 on average plus agency fees are anywhere from $4,500 to $30,000. Plus other incidental expenses may arise such as an escrow agent, attorney, insurance for the surrogate, etc. In addition there are the medical costs.
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tenayagirl2 well who can afford this?
Mindy Managing these relationships involves a team approach. You need to be comfortable accepting the process itself, which a mental health professional can assist with. You need to be sure that you are legally protected. You need to also work with a medical team that you are comfortable with . And, .most importantly you need a good relationship with a surrogate with whom you have clear communication before and during the process.
deb_capone Mindy, Tenayagirl2 has a valid question..and it is one we get asked a lot. Are there any financial assistance programs or grants available to people?
Mindy This is a very costly endeavor. Some of the expenses may be tax deductible and that raises yet another team member . . .a good accountant and financial planner.
Mindy There are some financial assistance for medication and through some fertility programs. There are also a handful of "grant" programs available.
deb_capone to your point about clear communication with the surrogate....how do you really establish clear communications-the entire relationship is stressful and complicated.
Mindy Keeping a mental health professional involved throughout with regular check ins during the pregnancy can be very helpful. Clarifying everyones expectations at the outset is also essential. This is one thing that agencies can be very helpful with. Even with friends and family it is somethimes helpful to have a neutral intermediary.
deb_capone What kinds of questions should we ask a surrogate? And can you focus on the questions that we should ask that we may not know to ask.
Mindy Before even beginning the process it is important to know where everyone stands on such things as compensation, prenatal testing, termination of pregnancy, multifetal reduction, necessary expenses, carrying multiples.
Mindy Some important questions to ask include: are you flexible with your fee? What is your insurance coverage like? Who is there supporting you? Do you work outside the home? How do you feel about carrying multiples? How many? What type of childcare does she have or need? Does her employer support this? What is she planning on telling her children's teachers and caregivers? How do her children feel about what she is doing? Do they know? What kind of future contact, if any does she desire?
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Mindy Other considerations might be whether she has life insurance and if so, how much? Does she have disability insurance? How many embryos she is comfortable having transferred, which relates to her willingness to carry multiples.
deb_capone How often do surrogates desire future contact?
tenayagirl2 is there a website with california laws? from what i've seen, theere is no hard and fast codifed law on surrogacy sraangements, just case law?
Mindy That is often something that the Intended Parents and the surrogate discuss. Surrogates often want to do what makes the IPs most comfortable, but enjoy an annual photo or note.
Mindy There is not one place to find. To learn about the laws, it is always best to consult with an attorney . .. probably in family law, although there are some who work specifically in surrogacy in California.
tenayagirl2 have there been any large controlled studies about bonding issues with genetic parents aftr using a GS?
Mindy Unfortunately, there is very little empirical research that has been done in the US on this issue and just some very small studies elsewhere that may have touched on the issue generally.
Mindy The entire area of collabortive reproduction has not been the subject of much psychosocial research.
Mindy Concerns about privacy is one potential impediment to research in this area.
tenayagirl2 what has happened in situations where a surrogate wants an abortion because circumstances in her life "change"? does she legally have to honor the intended parents desire that their child not be killed?
Mindy This is a legal question which I really cannot answer. This is an issue that should be very clearly addressed in the surrogacy arrangement and will have been discussed at the outset.
Mindy It is not my intent to be evasive, but as I am not an attorney, I am not qualified to answer legal questions.
Mindy I recommend to all of my clients that they do not proceed without a legal consultation.
tenayagirl2 i appreciate your answer. this is the part that concerns me the most--is leaving literally the life of your child in another womans hands...questions like: if she is consciously trying not to bond with the child that she knows she will give up, how does that affect the child?
Mindy Well, something that might ease your mind a bit about that is that she will need to undergo a psychological consulation and evaluation in advance of being a surrogate and it is often a requirement that she have given birth to at least one child so that she knows what to expect. Also, in many instances the child is not genetically connected to her so she is not feeling that same sort of connection.
deb_capone Teneayagirl2, you might want to check out the last issue of The American Fertility Assoc's inFocus magazine. A surrogate wrote eloquently about her experience and her emotional attachment to the child.
tenayagirl2 is that issue available online?
Mindy This is yet another reason for clearly setting out expectations before proceeding with any surrogacy arrangement.
Mindy Surrogates also may have some concerns about intended parents changing their minds or backing out. So, it is really important to remember that this is very much a two-sided relationship with fears and expectations on both sides.
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deb_capone Yes, it is...I am going to look for the link right now.
Mindy Choosing a surrogacy agency is another important step in this process. A few important things to consider are the fee for the agency and what is included in that fee. How they recruit surrogates? What med. programs they work with? How do they manage the relationship? Do they manage it throughout the pregnancy or only until the match?
Mindy Does the agency do a criminal background check? Arrange for consultation with a mental health professional? Check on insurance coverage? Help secure insurance if necessary for the surrogate?
deb_capone I can't cut and paste the link, but if you are a free "No Barriers" member you will have access to all of our publications. The article by Serena Lugo, the surrogate, is in the Fall 2005 issue
tenayagirl2 will most surrogates medical insurance pay for all the same expenses of pregnancy/delivery if she is carrying a child as asurrogate?
Mindy This is quite variable. It will depend on the plan and many plans have gotten quite savvy and actually have surrogacy exclusions, so it is important to know this up front as there are policies that can be purchased specifically to cover a surrogacy pregnancy.
tenayagirl2 thanks deb
deb_capone That is a good reminder to everyone. If you aren't a "No Barriers" member of the AFA, there has never been a better time to join....its free! Go to www.theafa.org
tenayagirl2 deb, is there a specific message board/support group for women who are really struggling with coming to terms with ending fertility treatment and their hopes of their own pregnancy?
deb_capone And a good time to remind you that your feedback is important, too. Let us know what topics you want to see in future session. Email me at deb@theafa.org
deb_capone Tenayagirl2, The AFA has telecoaching groups that meet via phone for support and our message boards offer immediate support from patients and physicians.
deb_capone Mindy, I think that everyone would agree that this is complex stuff. What can a person like you do to make it the process easier. What are realistic expectations?
Mindy Realistic expectations depend on a number of factors including whether the couple are both on the same page; is each person ready to make the move to this type of reproduction; what is their financial readiness for such a costly undertaking. The IC can help to determine which agency if any to use, what to look for in a surrogate that is right for the particular couple (keeping in mind that the IC does not do any matching) . .. Many of the questions are specific to the individuals participating so my response may seem quite general. But what I do is talk with a couple at length and ask them to do a bit of a "needs assessment" so that what I am talking to them about is specific to them and not just generalized information.
Mindy Realistic expectations include accepting that not every step of the process will run smoothly or be exactly what was anticipated, but knowing this in advance can help to accept it when a glitch arises.
deb_capone Can an IC help couples get on the same page?
Mindy My own infertility journey made me realize how nothing goes quite as you plan in the process but if you are prepared for bumps in the road you can get over them more easily. Without that realization every bump becomes a stumbling block.
tenayagirl2 mondy, did you use a surrogate, if i may ask?
Mindy Yes, that is something that can come from the needs assessment and discussion. If it goes beyond that then I will typically refer a couple to a mental health professional who specializes in issues of fertility.
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deb_capone A question that comes up on almost every session is suggestions on how to keep on keeping on...
deb_capone Any hints in that regard?
Mindy I did not use a surrogate, but it was certainly a consideration and under discussion with my sister and close friend.
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Mindy There is no one answer to this, Deb. One thing that often helps is not only having a Plan A, but a Plan B and C as well. Always having a next step can be very reassuring.
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Mindy Because of my personal history, I am where I am today. In retrospect, I have been able to see what some of my pitfalls were and where some of the communication issues with my treatment team and my husband could have been avoided.
Mindy I was so emotional throughout the process and so single minded that I often could not focus on the bigger picture.
deb_capone Can you give us some examples of alternate plans?
tenayagirl2 for you, if i may ask, how did you finally become a parent?
Mindy On my very last attempt at IVF . . .attempt number 4. It was a complete long shot, but I had twins! I still think of them as my miracle boys.
tenayagirl2 wow! was it a long shot because of age?
Mindy Alternate plans depend what the initial game plan is. It may depend on finances, the age of the couple, the availability of embryos. Using an egg or sperm donor may become necessary or adoption may be an altenate plan. All of this will be very fact specific for every individual.
Mindy Age was not so much a factor as egg quality and sperm issues.
Mindy Sometimes just having an neutral outsider raise questions and facilitate discussion can help couples or individuals define what they want and come to terms with what they are doing.
deb_capone Mindy, how would someone go about selecting an IC?
Mindy Deb, there are not many of us out there. Right now, very much word of mouth. But if one cannot find an IC to work with, sometimes mental health professionals or attorneys can help guide someone through this process. My work is national and I make it a point to make myself available to people either in person, over the phone, or even via email to help them with this difficult process.
tenayagirl2 thank you for giving your time, mindy
Mindy Tenayagirl, I am always happy to help.
deb_capone How can we get a hold of you?
Mindy I can be reached at 847-989-8628 or via email at mindy@lotusblossomconsulting.com. My web site is www.lotusblossomconsulting.com
deb_capone I would like to thank our guest, Mindy Berkson from Lotus Blossom Consulting. Your expertise and insights have helped us all. Thanks for taking time out of your life to enrich ours.
Mindy Thank you for having me.
deb_capone Please join us next week-same time, same channel! Until then....
deb_capone Good night!
tenayagirl2 thank you tooo deb
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