What to Expect on Your Surrogacy Journey

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How to Hire a Surrogate

September Burton: Hello everyone. And welcome to this episode of the Colorado Fertility Conference Podcast. I’m your host, September Burton. And today I have with me, Andrea McAfee, and Andrea, is the owner of Hawaii Surrogacy. She founded Hawaii Surrogacy in 2008. And she says she did it to meet the need for gestational carriers on Oahu and neighboring islands. Many local families were going to the mainland for services leading to expensive and impersonal surrogacy journeys. Over 10 years, she established strong working relationships with every fertility clinic in Hawaii, as well as nationally and internationally renowned legal professionals specializing in Assisted Reproductive Technology. Hi Andrea, thank you so much for coming on today. How are you today?

[00:00:43] Andrea McAfee: I’m doing well, thank you so much for having me.

[00:00:45] September Burton: Yeah. It’s an honor and a privilege for sure. So will you tell us a little bit about why you decided  to open up a surrogacy agency?

[00:00:55] Andrea McAfee: Sure. So I actually entered the world of assisted reproduction several decades ago. I was an egg donor myself three times, and that experience was something very special to me and I, in fact, still have a relationship with my recipient families, so it was kind of unusual. Yeah, we all have teenagers now. And so, that whole experience was really incredible and through it, I ended up actually meeting a lot of professionals that worked in this area, and so I ended up talking at some conferences and meeting other folks and just speaking about my egg donor experience. And through that, some colleagues said, you know, there aren’t surrogacy services that are available cause I’m originally from Hawaii, in my hometown. So I started talking with them a little bit about it, but still wasn’t quite, I was like, look, I don’t know too much about this. I do know one side of the equation as an egg donor. But I was like, I’m not sure, but as I started to talk to more folks, and clinics and parents that were going through IVF and egg donation and then eventually getting to surrogacy, the need became incredibly clear to me that it was really important that a local agency was established and that local agencies exist there at the time were mostly some of the bigger national agencies and they would match someone with a surrogate that would be clear across the U S. And that meant a lot of things for our family, a lot more expenses and costs. And for them also sometimes risks because you’re dealing with multiple states, contracts, and multiple levels of lawyers having to review contracts, and having to get there on time when the baby’s born and, and jump planes and all that. So I realized that it was something that I had to do and the more that I talked to folks that we would be well supported in Hawaii and it would be kind of a needed service. And so I established Hawaii Surrogacy Center in 2008, and we’ve been going strong ever since.

[00:02:47] September Burton: That’s so awesome. So you said you were a three-time egg donor. What made you decide that you wanted to be an egg donor?

[00:02:53]Andrea McAfee: I had a friend that was dealing with infertility. she was a little older than me. She was actually a mentor of mine when I was in college. And she was Asian and I’m part Asian, and she said that it was, at the time and again, this was several decades ago, at the time it was really hard for her to find an Asian egg donor. It was really, really difficult  and so she was like, you know, you would be great for this. I actually would thought I’ll, should I help her? Or what’s the deal in the end? She actually ended up getting pregnant naturally, which sometimes happens, right? And so, but it kind of put the idea in my head and so I contacted a pretty big well-known agency at the time, and talked to them and they were like, yeah It’s pretty rare to have an Asian egg donor and kind of a diverse background that you have, and you would certainly be able to help a number of families. And so I went through the process and it was wonderful. I had wonderful coordinators, I really loved it my body responded well to it and I was able to help three different families.

[00:03:48] September Burton: Wow. I love that. And you still keep in contact with those families today?

[00:03:51] Andrea McAfee: Yeah, we actually, we do. And usually it’s anonymous, but in the case of my families  I did indicate that I was open to contact. My first two families, it’s not like a super close relationship, but my third family, I’m like actually quite close to them. The mom and I are close and we keep in contact and send letters and pictures and have kept in touch for almost 14 years now. So yeah, it’s been, yeah, it’s been incredible.

[00:04:20]September Burton: So why is it if somebody chooses to go the surrogacy route to become parents, why is it important that they work with an agency rather than trying to do it on their own?

Becoming a Surrogate in Hawaii

[00:04:29] Andrea McAfee: Sure. So there are a number of benefits. I mean as an agency, our job is to be kind of this impartial advocate and so parents will do a lot of internet research, as they should. You really need to educate yourself about the process and really learn about all your options. But in the end, it is a very complex process. There are a lot of players that are involved and having an agency in the middle is really kind of like a spoke and hub system, right? You have your clinic, you have your lawyers, you have your surrogate, you have escrow agencies, insurance issues, all of that is happening. And we as an agency are at the center of this, coordinating all of those different pieces, and it’s important to have somebody who can seamlessly hand off each part of the process, one to the other. And so,  it really helps we help take the stress out of it. If you have a good agency, that’s the case, that they are there, we’re a value added. And we are a neutral third party. So, we’ve had instances where families come to us and maybe they’ve worked with one particular fertility clinic and followed a particular protocol for a certain amount of time and they want their surrogate to go to that clinic. And we found that maybe that clinic , the success rates aren’t so good or maybe that clinics doing something unusual. We can ask those tough questions and we can give them some options. We can say  have you considered this other clinic? And it’s not, we don’t get any benefit from that , we are just the agency in the middle, but we’re able to see across the board when it comes to costs and success rates and really look across and advise families and say hey, you have a lot of options here, have you considered X, Y, and Z? And so that’s certainly something that when you’re working with a good agency, they can do that for you and they can ask tough questions and they can giggle test things. I always tell parents I’m like, show me the numbers, I can tell you if they look crazy to me, because it’s hard to know, there’s a lot invested financially into infertility treatment, and people aren’t super open about it and so you really have no idea, like when you’re going in what are those numbers looking like? You’ll get a financial estimate and you don’t really kind of know like, is this average, is it not? And so, because we do see those numbers, we can tell you, and sometimes we’ve had families go back to a clinic and ask a question and magically that number changes. So, it’s good to have an agency by your side, because we are really kind of this resource for you.

[00:06:51] September Burton: I like that. That’s really cool. I recently actually interviewed Denise Steele from SeedTrust. You work with SeedTrust escrow agency. Is that right?

[00:07:00] Andrea McAfee: That’s correct. Yes.

[00:07:01] September Burton: Awesome. So why is it important to have an escrow agency?

Hiring a Surrogate in Hawaii

[00:07:05] Andrea McAfee: So important. Doing this long time, and we as agency owners and directors we see what a lot of folks do and what we’ve been in this industry a while, at least I have, and we’ve seen those horror stories where you’ve seen the headlines in the news, and we hear about  money going into an account that’s supposed to pay your surrogate or pay for medical bills and then suddenly magically those bills aren’t being paid and that money all just disappears. There’s a reason for that. And that’s because somebody mismanaged the escrow account. Now for us, we make it really clear that, we don’t just set up a separate escrow account that we have control over, we actually use an independent, licensed, bonded, and insured escrow agency, which is SeedTrust. That is so important because you will hear of like, Oh, as an agency, we have a financial manager or an attorney on staff and they can hold escrow for you, and that’s going to save you money. Well, maybe, but maybe not, because an agency like SeedTrust–they have account managers, they’re completely independent, they have the contract already, they know what the contract terms are and they disperse according to those terms. And they require the documentation. So they’re very careful about not making mistakes and it’s completely transparent. You can log in any time and see your account balance. We’ve worked with other escrow agencies and for us as a surrogacy agency, it’s annoying having to Email and be like, can we have a balance for our parent and wait until we get a scanned PDF and send it along to the parents. And then we all have to check to make sure it all looks right. That’s not 2020 we need to get with the times and have total financial transparency for families and an agency like SeedTrust really offers that. Because intended parents can log in, but surrogates also, it goes both ways can log in and see everything and see their direct deposits and see where funds are scheduled to come to them. And I think that that gives surrogates also a peace of mind cause they, they know that they are going to receive their compensation on time.

[00:09:06]September Burton: Yeah, that’s fair. I think it gives the surrogates that peace of mind and then it also gives the intended parents more space to open up and just focus on growing their family rather than worrying about the money and what’s happening with  things like that.

[00:09:18] Andrea McAfee: For an international parents, especially, when they’re wiring funds overseas, it just feels good to know that you’re sending those funds into like a secure, independent account and that you’re not  wiring your life savings over to an agency in a different country that promises to pay your bills for you. I mean, it’s just, that’s very stressful and risky and I totally understand how parents feel.

[00:09:39]September Burton: Yeah, for sure. So you mentioned that the whole surrogacy process is a very complex process. Will you give us, obviously not going into the complex details, but just kind of a brief synopsis from the intended parents perspective? Like what does it look like if you decide to go the surrogacy journey?

[00:09:56] Andrea McAfee: Sure. So the first thing you want to do is, do an intake or a consultation with an agency or several agencies. I think that families should actually meet with several agencies and try them all out and see what they’re all about. You can go with a local agency or a larger international one. But they all have kind of different program cultures, and so it’s important to have a consult and really meet up with the case managers and the intake coordinators and see how they manage your entire journey and what the expectations are. So as a parent, what you would do typically is fill out an intake form and an application, with your agency. And that lists out some of your preferences, your medical history, and gives the agency a good idea of what you are looking for in a surrogacy journey and in a relationship with a future surrogate, because for us as an agency, we want to make sure not only are we meeting everyone’s basic preferences, it really is a relationship. And so we want to make sure that everyone’s preferences match up nicely. I always kind of joke around and say, it’s a little bit like matchmaking because it’s about personalities and everyone’s syncing up really well together, not just on paper, but like really like long-term what does this look like and how will these folks interact with each other in a healthy and supportive and loving way? And so because of that, we really want to get a good idea when we do an intake for a family on what their expectations are in the surrogacy process. Once we get that intake on, then we’re able to look across our surrogates and say, okay, who do we think is a good match? And again, it is on important issues, like level of communication, selective reduction, whether or not someone’s willing to carry twins, budget, all of that. But then also the soft stuff of personalities and how they all will emotionally mesh together. If we think we have a few good matches, what we do is we actually swap profiles so everybody first  sees each other on paper. And then if they like each other, then we actually do a facilitated meetup, where we help as an agency with that first conversation, because we know it’s like super awkward, like, hello, you carry my baby for me. And so we’re there to help that conversation along, and talk and just get to know each other, but also to talk about those important points, right. And those expectations, the journey. Once everyone is set and everybody’s excited, and usually what happens is everyone comes out of that meeting just wanting to get pregnant. So I have to do a lot of other things. But once everyone  comes out of that, that’s when we then get to  the contracts and  really getting things on paper. Because just because we all like each other, it doesn’t mean that we’re ready to go get pregnant together. So, we have to put the gestational carrier agreement in place, and that is the big  mother contract, right? That has everything in it–compensation, issues about parental rights, contact, all of those details are in there. And as an agency, we help that process. So we take contract questionnaires, we help get all the inputs that attorneys need to put that contract together. In the case of our agency, we actually contract out that work. So we, as an agency cover attorney’s fees, not every agency does that, but intended parents and surrogate both get separate attorneys. And they work over several weeks to really get that document completely the way everyone wants it. It’s a collaborative document, you’re not negotiating down the price of a house. It’s something that everyone has to put in all their needs and wishes so that they feel really safe and supported within that document. Once the legal piece is in place that’s when we get to the medical piece, because the clinic won’t really do much on a surrogate until that contracts in place to protect everybody. So we would then move them over to the clinic. Our agency works really closely with a clinic coordinator, it’s either a nurse coordinator, third party coordinator, surrogate coordinator, these are all the names, but it’s usually one or two people that do all the surrogacy work within a fertility clinic. So we work really carefully with them so that the surrogate can go in, they have all of her information already. They’ll do some additional checkups for the surrogate and for the intended parents, they’ll just be explaining to you what the process looks like. And everyone agrees to consenting on, okay, are we going to transfer one embryo or two? What do our timelines look like? Et cetera. The protocol is several weeks long. And hopefully your surrogate gets pregnant on the first try. And so we’re all kind of waiting on pins and needles and following along with the cycle and all the appointments. But hopefully she gets pregnant. There’s a couple, actually four weeks after the confirming blood work then we do a confirming ultrasound to get a fetal heart rate. At that point, then she’s official, she’s pregnant. That’s when then we see some of the larger compensation going to the surrogate in terms of her pregnancy compensation.

[00:14:31]As intended parents, you’re journeying along now. So you have a pregnant surrogate, she’s going to her regular OB, usually, for her appointments. As an agency, we are either attending those appointments with her in these COVID days, that means attending virtual usually, but we’re there, we’re checking in with her, making sure she’s feeling great. We’re helping along with the compensation and the escrow account. And then in the middle of the journey, we then loop back with the lawyers, and they work on the parentage work. Depending on what state you’re in, that Parenthood work looks a little different. In the case of Hawaii, it’s a post-birth state–doesn’t mean baby’s not yours just means it’s a different vehicle that we need to get that parentage work done. But some States are able for a judge to issue a decree saying “yep, these are the parents” before jr. comes out. Hawaii says “can’t do that until the baby comes out”. So it just, it just depends on what state you’re in. But your agency needs to be very familiar with that and understand the legal implications of  which state you reside in to make sure that the proper legal paperwork gets done. The attorneys usually get it done well ahead of time. We also do a birth plan and that’s also ahead of time because sometimes babies arrive early, not often, but occasionally they do, and so we want to make sure that everybody knows what’s happening in that birth room, as best as we can. So we get the birth plan in place early. We work with the parents to make sure that their preferences are in there and that in terms of the care of their baby and who gets first contact in terms of skin to skin contact, what things you want to administer to your child. And for the surrogate, what are her comfort measures? How does she feel she can labor comfortably and safely? And so we put that all together as an agency, make sure that documents together. And then we work with the delivery hospital to make sure that everyone’s needs can be met per the birth plan and that we can navigate our way around the hospital very well on the birthday. So we let them know,  this is a surrogate birth, these are the intended parents. It is their baby. Can they have their own room please? So they have some quiet bonding time with their child afterwards. It’s also the boring stuff, but the hard stuff of  insurance and financial, and we make sure that that is all put away cleanly so that billing doesn’t get scrambled up and needs to be untangled after the fact cause nobody, nobody likes confusing hospital bills. So we help with the hospital and talk to the financial office, as well, making sure that all of those plans are clean, ready and in place. And then we’re there, of course, the birthday. We, as best as we can be we’re present at the birth, make sure that everyone goes home, everyone’s healthy. And then we check in with all parties, in the following weeks, making sure parents feel very well supported. If they need additional resources, like a postpartum doula, we help provide that. If the surrogate needs some additional TLC, we also make sure that she gets lots of care and good postpartum care, not only doctor’s appointments, but if she needs a good massage, nutritional support, all of that happens after the birth, because we really want everybody to come through this happy and healthy and feeling like they really went through an incredible experience. So that’s really a surrogacy journey, end to end, with our agency. Of course, like I said, every agency’s a little different. They do various things that are special but we really try at Hawaii Surrogacy to make it a very personal experience. And, our case managers are very close to the parents and the surrogates that they work with.

How Has COVID Affected Surrogacy?

[00:17:55] September Burton: Yeah. I love that. You mentioned COVID a couple of times, I’m curious how COVID has affected surrogacy and are there any permanent changes that are going to be coming about or do you see everything  going back to normal once COVID ends?

[00:18:08]Andrea McAfee: It’ll be interesting to see. So for our agency, we actually weathered COVID very well, obviously it’s still ongoing, but we were and have been extremely busy since last March and we’ve been set up kind of as a virtual setup. We have all the right tools to continue to function, and  all of our coordinators  work from home. So, we have been able to weather COVID and continue on just fine. In terms of the clinics, there was that hiccup in the beginning when everyone was trying to figure out, okay, what are the guidelines? Are we able to continue to transfer safely? What’s going on here? So there was like a pause, with the clinics and cycling, for several weeks, in mid, late spring last year. But since then, the clinics that we work with have all reopened and resumed normal operations. Though there are some restrictions in terms of who can be there and when. So no one can hang out in the waiting room. They space out all their appointments. We’re pretty limited in terms of, what rooms we can go into physically, as case managers were used to  being there physically all the time. And it really just depends whether there is one caregiver or adult companion rule or no one other than the patient. And it does of course change based on the threat level, right? And if we’re looking at and dealing with a significant shutdown, if that’s the case we would never put anyone at risk. We want to try to minimize travel and minimize exposure, both for our staff, but also for the surrogates and their families and for intended parents and the medical professionals that help us. So, on the clinic side, there was a hit , like a brief stop, but since then everything’s been going fine. People are able to cycle and travel inter island. We try to minimize that by doing as much like lab work on the neighbor islands as possible so that our surrogates, which normally they can hop on a plane in 30 minutes and get to Oahu , we’re trying to minimize that, even though it’s a, quite a short commute by plane, essentially. But we just want to try to minimize that. In terms of the deliveries, we’ve been able to work with the delivery hospitals to ensure that parents are there when their babies are born. They understand that, the hospital staff understands that. We just can’t have a ton of visitors. So basically everyone COVID tests, and then it’s just the intended parent and/or parents, that are there when their baby is born and a support person for the laboring surrogate. And so that’s how we’ve been doing it. I don’t know how things are going to change. I mean, I think that we, as an agency, certainly have added to our capacity to kind of manage things remotely. We’ve done it in the past and we’ve just added more. I think that we don’t want to lose our personal touch. So as soon as we can get back in and start attending appointments again, we certainly will. I don’t think that we are going to stay physically away, even though COVID has caused that. I think that we’re going to jump right back in because that’s just who we are.

[00:21:02]September Burton: I think that, that’s so telling of the Hawaiian culture, all the way around is that personal touch. That’s so much of how the Hawaiin people are really, in general. So one question that I think a lot of people will have on their minds is do you work with surrogates and intended parents outside of Hawaii? And how does that work?

[00:21:20] Andrea McAfee: Yeah, so we definitely do, and as we’ve  grown over the years, that’s certainly expanded. I would say over half our clients and surrogates are still local to Hawaii. But since then, we have expanded to the mainland. We do have a Pacific Northwest coordinator because there’s actually quite a community of Hawaii folks that are living in the Pacific Northwest–Washington state and Oregon. So, we felt it made perfect sense for us to expand into that area, because people would be familiar with us if they’ve left Hawaii but they still have ties to the islands. And so we’ve grown certainly to the mainland and a lot of people do leave. But maybe they’ve done their IVF cycle in Hawaii and so they still have their frozen embryos there, even though they’re physically on the mainland. And so we do a lot of cycles like that and we are quite comfortable now working with mainland and international parents, as well as surrogates.  We provide all kinds of extra supports and it’s not anything that we charge extra for. We’re certainly there at appointments, as best as we can, like if your parents are on the mainland and then surrogate is local to Hawaii, again, , we’re there and supporting her and really communicating constantly with parents and FaceTiming and using every technological tool we can to make sure that they feel completely involved and up-to-date, and connected with their surrogate in the whole process. For international families , we provide all kinds of assistance and support. We often will take lots of videos and document everything and actually , they have their own secure folder on our system where we put all of their baby updates and all of their videos and pictures, which parents love, cause it’s a great keepsake for them. And then, when they come to Hawaii we have arrangements with lots of local businesses to really support them well. So , most of them are staying for several weeks,  before baby arrives and then several weeks after. And so we have a beautiful rental home, for example, in Kailua that people stay at for a very reasonable cost and it has everything that a family would need.  Because we don’t want you to stay in a hotel with a baby. We also have all kinds of baby supplies that we provide to families so that they don’t have to haul things on an airplane, awkwardly. It’s just a lot of stuff. So, strollers and car seats that are s afe and standard for the US , pack n plays, you name it, we’ve got it all, so parents don’t have to buy that and lug it on a plane. We have all of that for them. And we’ve been able to  just adjust as need be, with COVID and the travel restrictions we’ve gotten really smart. Working with a lot of folks, on Oahu that have been very supportive of our agency and our families that we work with, making sure that they get the documents that they need, even if maybe it would normally take weeks and weeks and weeks and weeks. They can’t just live in a rental in Hawaii forever, as much just some people would like to do that , and so we’ve been able to support them, making sure things are getting done. And we work really closely with a lot of the international lawyers and others and immigration attorneys to make sure that people can get home in a timely manner. I mean, I think that that’s been kind of sad to watch, you’ve been hearing stories of babies that have not been able to go home with their parents during COVID and  I understand some of those restrictions, but at the same time, I struggle with it because we’ve bent over backwards and got every single family home. And we had seven births at the peak of COVID in one month. And I know that every single one went home. So like I’m a little bit like, Ooh. So I just,  I really hope that parents are working with agencies that are willing to go the extra mile to make sure that their families are united and are able to be home and they can complete the process successfully. We certainly do everything that we can to make it happen.

[00:24:59] September Burton: Yeah, for sure. That’s amazing that you guys do that for the families and make sure that everybody is taken care of. I love that. Well, thank you, Andrea, for coming on today. I always ask our guests, do you have any final words of wisdom that you would like to leave listeners with?

[00:25:14] Andrea McAfee: Sure. I would say just educate, educate, educate. Talk to lots of people. Be open about it. Talk to your peers. You’d be shocked at how many people have actually been on the same path that you are on and maybe weren’t open about it at the time, and I would say like, don’t feel ashamed to just reach out because you’ll be amazed at what you hear from other people and you can really learn from them. And ask the hard questions. I know it’s tough and it’s awkward because you’ve been through so much, but just, feel free to push back and ask a tough question. If something isn’t sitting right with you, whether it’s from an agency, or a clinic, or an attorney, just ask. And what, if your guts telling you something’s not right, then get a second for a third or fourth opinion. There’s nothing wrong with that at all. I always just encourage families to do that because in the end, I don’t know, I just go with your gut. Sometimes it just really, it can really lead you to the right place. So , we need to remove the stigma about infertility and surrogacy and get people talking about it so that people feel comfortable asking questions and really starting to learn to advocate for themselves.

[00:26:23] September Burton: Yeah, I love that. Talking about it, sharing stories, asking people for their stories. I think  there’s so much power in sharing your story and being able to reach out and have somebody share their story with you. And then what you were talking about with following your gut.  once you become a parent,  you really have to learn to rely on your intuition. And so it’s almost like practice before that even happens. So start practicing, trusting that intuition now. Well, thank you again for coming on. It was an honor to have you on, and  this was a great conversation. I think people are going to learn a lot from this, so thank you so much.

[00:26:55] Andrea McAfee: Great. Thank you so much for having me.

How to Become a Surrogate in Colorado and How to Hire a Surrogate in Colorado

For information on surrogacy in Colorado, please click here

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