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By Gretchen Wetzel

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In December, 1992, two families decided to embark on a pioneering adventure -- surrogacy. How did we come to the decision that led to the birth of a very special little boy, my nephew, in the spring of 1995?

My sister Sis and brother-in-law Jack had undergone several IVF attempts that appeared to run "perfectly" except that implantation did not occur. I watched this expensive, and physically and emotionally painful process with anguish. I knew how much my husband Don and I loved and cherished our own family, and I wanted my sister and brother-in-law to have the same joys. At that point in time, I was a student nurse-midwife, and every time I helped a new family come into being, my happiness was mixed with grief for my sister.

I believe that all surrogates would agree that they could not succeed without the support and help of their own families. I did not come to the decision to be a surrogate on my own. Don and I discussed the possibility of traditional surrogacy, and we briefly described our intentions to our own children (then ages 7, 10, and 12). Don immediately agreed that we should do all we could to help Sis and Jack, and throughout the following years he never wavered from that stance. We are both chronic "planners", so we knew that we would not embark on surrogacy without researching how we could make it successful. Therefore, our decision was not off the cuff, but was carefully thought-out.

In August, 1992, I asked Sis if she would consider my helping her through traditional surrogacy. I was unsure how she would react to the thought of having an infant that was not completely biologically hers. I thought having a baby might decrease some of her anxiety and sadness and could help her face future IVF treatments, if she decided to have them, with less desperation. To my surprise, she seemed very receptive to the idea and said that she would discuss it with Jack.

Four months later, Sis, Jack, Don, and I sat in by the fireplace after Christmas and discussed our plans. We had not been able to find much information in the popular literature about surrogacy. We were like most people -- when we thought about surrogacy we thought about Baby M. How could we avoid such a horrible outcome? We had contacted a lawyer who specialized in adoption; she was enthusiastic about our plans but admitted she had little experience with surrogacy. She told us that in our state, a surrogacy contract could not be legally enforced, so she did not recommend that we spend thousands of dollars preparing such a contract.

We tried to think of everything that might be included in a surrogacy contract, and to talk over our feelings and put them in writing. We agreed that, while a contract would not be necessary within our family setting, we wanted to consider any controversial points and air them in advance. I still have the list of topics Jack initially wrote down on the back of an envelope! We decided against payment of a surrogacy fee -- I believe this is common practice with interfamily surrogacy. Sis and Jack would pay any medical expenses that were not covered by my medical insurance. Sis would attend prenatal visits with me whenever she could, and both Sis and Jack would be present at the baby's delivery.

At this point in the process, Don and I asked our minister for his advice. We are devout Christians, and we knew that surrogacy was a controversial subject for some religions. After hearing about our plans, our minister said that he was supportive of our individual case. I am not certain how or even if a negative response from him would have changed my decision, but Don and I were glad to have his support.

I had never had difficulty conceiving and had had trouble-free pregnancies and deliveries, but traditional surrogacy was a frustrating experience for me. We tried home insemination with a syringe after using an ovulation predictor kit. I experienced some of the anguish my sister had gone through, as months of inseminations went by with no pregnancy. Sis and Jack lived six hours away, and it was not easy for us to plan time away from work for the inseminations. I dreaded doing the home pregnancy tests and felt over and over that I was failing Sis and Jack. Sis had no more success convincing me that they appreciated what I did regardless of the outcome than I had convincing her that IÌd have no trouble Ïgiving upÓ a baby to her.

Sis asked her infertility physicians if they would be willing to help us, but the practice had never done a surrogacy before and was reluctant to begin. The chief physician called me and tried to help us time our inseminations more accurately. I could tell that he was torn between fear of legal repercussions from surrogacy and a sincere desire to help us, but I also seethed inwardly at yet another roadblock. I bit my tongue, however, and did not react angrily because I thought I might need this physician's help in the future if I ever decided to try gestational surrogacy.

Finally, I asked an obstetrician I knew if she would be willing to try intrauterine insemination. She agreed, and I was extremely grateful for her willingness to take the risk. One of the topics we'd discussed at our first family meeting was "how long should we try?" As the months passed, we had decided that if two intrauterine inseminations were not successful, then we would stop.

In July, 1993, two weeks following the second intrauterine insemination, I flew to Michigan to take the national certifying exam for nurse-midwives. Relief and elation that the exam was complete were obliterated by the arrival of my period. I was overcome with sadness. One of my midwifery classmates tried to console me, and she wrote me a heartfelt note of love and admiration that I still cherish.

Thinking I'd closed the door on surrogacy, I returned to my hometown to begin work, and Sis and Jack continued their IVF treatment. For ten months, things were on hold. Don accepted a European position in his firm; the children and I decided to remain in the U.S. for one year so that I could work. Sis and Jack had more IVF cycles without success and more testing that found no treatable problem. At work in a world of babies and families, I never stopped thinking, "I wish there was something I could do."

In the spring of 1994, Sis and I met with Dr. Munson, the psychologist who worked with Sis' infertility practice. Sis had been seeing Dr. Munson on a regular basis since beginning her infertility treatment, and Dr. Munson knew of our attempts at traditional surrogacy. Sis and I asked Dr. Munson about trying gestational surrogacy, and she agreed to ask the physicians to consider our case. Dr. Munson and the physicians were impressed with the work and planning our two families had done, and with the special closeness that we sisters shared. They agreed to try gestational surrogacy, and we had our first meeting to discuss the medical protocol in late May, 1994.

The summer of 1994 was very busy and very exciting. Daily shots and pills had to be juggled with my midwifery work schedule. Fortunately, Sis' doctors knew of a wonderful infertility practice in my town that helped me with a lot of the diagnostic testing, so that I would not have to make the long commute to Sis' town. Many times, I was very glad of my experience both as a midwife and as a nurse. It really helped me understand the needed testing, and I had very few qualms about giving myself shots. After the first few times, it was routine.

My body seemed to respond very well to the "mock cycles", and soon Sis called me to say she was ready for her egg retrieval. A few days later, on a beautiful August morning, Sis, Jack, and I drove to the hospital for the embryo transfer. The doctor showed us a picture of the four embryos; I'd seen many ultrasound photographs, but never any pictures of such young babies!

Jack, Sis, and I held hands during the transfer. We used every mental imagery we could think of, but I remember one in particular. I'd read a book about near-death experiences in which a little girl had drawn a picture of heaven. She explained, "Here's Jesus, and in all of these boxes are the little babies waiting to be born." So, during the transfer and for several days thereafter, my imagery was "If there are any babies up there willing to try this unusual method of being born--jump right in!!!"

Twelve days after the transfer, my three children and I moved to Europe to be with Don. In my carry-on bag were the medications needed to--hopefully--sustain a pregnancy during the initial weeks, and two home pregnancy tests that I'd been ordered NOT to use until two weeks after the transfer. The old fears about doing the pregnancy tests resurfaced, but early in the morning of the fourteenth day I was astounded to see a faint, positive, blue line on the test. I called Don and each of my children, individually, into the bathroom and asked, "Do you see ANYTHING there?" Once they'd all said, yes, they saw a blue line, I called the U.S. It was only 2 a.m. at Sis and Jack's house, but they were thrilled to get the news.

When Sis and Jack reached their doctors' office later that morning, they received excited hugs all around. Meanwhile, Don and I drove to the local obstetrician's office for the first of serial HCG levels. When I told the doctor what our families were doing, there was a long, shocked silence. "But," he stammered, "embryo transfer is illegal in this country." He seemed to collect himself after about 30 seconds and continued, "But that's all right. You got pregnant in the U.S., and we're going to take care of you here." So began the next chapter in our pioneering journey--but that's another story.

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