Gestational Surrogacy - Triplet Pregnancy

 

Our gestational surrogate triplet pregnancy ended in tragedy. This has been a hard letter for me to write but I do so in hopes that I may help prevent this tragedy for others. Triplet pregnancies are complicated, to say the least. A surrogate triplet pregnancy can be a recipe for disaster and one needs to look long and hard at each situation and all of the issues at hand in order to maximize the chances for a positive outcome.




OUR STORY



Like many infertile couples we wanted so much to have our own child. After thorough infertility workups we knew that the next step was to locate a gestational surrogate. To find that person we used a surrogate finding agency that was the least expensive we could find because money was a major factor for us. The only qualification that the surrogate finder had was that she had been a surrogate herself and had on hand a large pool of surrogates to choose from. In retrospect, we would have either used an experienced surrogacy agency or found a surrogate ourselves. We reviewed files of various surrogates and chose one to interview. We liked her and her family. We started to become friends. We had her psychologically screened by a psychologist and she passed the interviews with flying colors. We trusted the psychologist but the psychologist did not suggest in depth personality testing such as an MMPI (Minnesota Multiphasic Personality Inventory). We should have requested in depth personality testing. This may have indicated that she would not be able to make the great sacrifices that are required to carry a triplet pregnancy. It may have also uncovered her primary motivation for being a surrogate. Our surrogate had a conflict between taking care of her own family and taking care our children which she was carrying. In addition, money can be a motivating factor. If a surrogate is on bed rest due to a triplet pregnancy financial problems could increase as wages can be lost and there may be an increased cost to hire child care for her own children. All of these factors which may exist even in a singleton gestational surrogate pregnancy are exacerbated in a triplet pregnancy.

In our case, after accepting our surrogate we underwent an in vitro cycle. My eggs were retrieved and fertilized with my husband's sperm. After two days three embryos we transferred to the surrogate's uterus. None took. Then we found out that the surrogate had not stayed on complete bed rest for the required three days. That should have been our first clue. We all went through counseling to discuss our feelings and what we would do differently. We genuinely believed that since she was a decent person things would work out better the next time.

Seven months later we underwent another in vitro cycle. Six embryos were transferred. If three were transferred and none took, why not transfer six? That was a big mistake. Infertile people are so keyed in to infertility that the concept of multiples is something they just can't fathom.

Three weeks later we learned that we were expecting triplets. We were thrilled. We did everything we could to educate ourselves. It helped that I have two friends who are triplet moms. I received the Triplet Connection's Expectant Mother's Packet and read it immediately and gave it to the surrogate. She started reading it and said that she couldn't continue reading it because it depressed her and she thought the information was negative. She said that she preferred to think only of the positives. My husband and I are educated and believe in continuously educating ourselves about everything we can. We were disappointed by her attitude but could do nothing to change it at least her husband read the information and tried to pass it along to her.

Next, after we were about one month into the triplet pregnancy a bomb fell. The surrogate's husband lost his job. We subsequently learned that they had planned on using surrogacy as a means of making up for the surrogate's salary as a child care provider so she could stay home with her own two young children. The loss of her husband's job put huge financial pressures on them. She now had to stay at her physically demanding job in child care and take care of her own two young children an night all while carrying our triplets. She felt under extra pressure to work hard at her job to keep it due to the financial uncertainty of her husband's future employment opportunities. We offered to make up the difference between disability and her salary as well as to pay costs to take care of her own children but she declined. She wanted to work as long as possible.

We all continued to go to the infertility physician until about 16 weeks gestation. The infertility specialist told us that he thought that baby C looked like it might be a little too low In the uterus and that we should discuss this with the high risk obstetrician.

At about week 16 we started going to a high risk OB. I had done research and located one that was supposedly one of the best in our geographic area. My husband repeatedly asked the OB if baby C was positioned too low in the uterus and the physician said that in wasn't. In fact, the OB encouraged us not to reduce the triplet pregnancy to twins. Of interest neither the surrogate nor I believed in the selective reduction of triplets to twins and we had covered that subject before signing a contract and beginning the in vitro process.

The surrogate did not pay attention to our strong encouragement to go on bed rest by week 20 and declined all of our offers to help out additionally financially. She continued to work at a physically demanding job and take care of her two children in the evenings. She would casually tell us that she was tired and mention that she had been out to the mall until 10:30 the night before (while 19 weeks pregnant with our triplets). We could not require the surrogate to go on bed rest. Our contract said that she needed to follow doctors' orders. The doctor would not require her to go on bed rest until week 25 as he said it was not medically necessary. We pleaded with him and he still would not require it. This is a shame but I suspect it is common. One of my triplet mom friends told me that if she had listened no her doctor her three children would not be alive today.

At 23 1/2 weeks gestation the surrogate began to lose blood and was hospitalized for preterm labor and put on magnesium sulfate. She had a placenta previa. Contrary to the medical advice we had been given it really had been necessary to selectively reduce baby C to save the lives of baby A and baby B. In a singleton pregnancy a placenta previa typically occurs at 34-36 weeks gestation. The mass in a 24 week triplet pregnancy is roughly equivalent to the mass in a 36 week singleton pregnancy. This is another reason why bed rest should be required. Aside from preterm labor another risk in a triplet pregnancy is placenta previa at week 24 threatening the lives of all of the children and possibly even the mother. Why haven't high risk specialists figured this out? My husband is an engineer and it didn't take him long to figure it out. Even common sense says, " Lie down, if you do gravity won't pull at things".

At 24 weeks the surrogate started to hemorrhage and our three beautiful daughters were delivered. They lived for only 2, 9 and 11 days. Along with the placenta previa the surrogate also had an accreta where the placenta would not detach from the uterus and she ended up having a hysterectomy and being transfused with 7 liters of blood.

I cannot begin to explain the depth of pain my husband and I have experienced at losing our three girls. Added on top of the pain is the horror we experienced at seeing the very invasive medical techniques doctors performed on our daughters to try to save their lives. I am very concerned that their short lives were miserable and they only experienced the love of their mother and father as we held them when they died.


WHAT ADVICE WOULD I GIVE TO SOMEONE WHO IS CHOOSING GESTATIONAL SURROGACY?

'Consider finding a surrogate yourself or go through a reputable, experienced agency rather than using an inexperienced surrogate finder. Often the inexperienced ones do not provide the services promised. Ours was an advocate for the surrogate but did not look out for us and our children.

'Make sure you get legal advice from an attorney experienced in the surrogacy field. Many attorneys in my geographic area advertise themselves as expert in this area when in reality they have had little experience in it.

'Make sure any psychological professionals you use are experienced in surrogacy.

'Review the contract wording closely; especially require bed rest in the event of a higher order multiple pregnancy. You may want to also asses contractually your financial obligations to the surrogate if the child dies prior to the 27th week. Even if you are already expecting a higher order multiple birth it is possible that you may still be able to change contract language if warranted.

*In addition to "normal" psychological screening, make sure that the surrogate gets a personality inventory (such as an MMPI) to uncover true motivators and to look for the ability to follow instructions. Try to have an expert screen to see if the surrogate will protect your unborn children when conflicts arise with her own family. This may help you even if the surrogate is already pregnant in this event it might help you to know how to manage the pregnancy as best as you can.

*Analyze the type of job that the surrogate does and how necessary to her family it is that she work throughout the pregnancy.

*Watch the number of embryos transferred. Surrogacy overcompensates for infertility problems and higher order multiples are common.

*Prescreen your high risk OB to determine how they feel about bed rest and make sure they will require it at 20 weeks.

*Consider selective reduction. I am not necessarily in favor but in hindsight I would have done this if 2 of my daughters lives would have been saved. Some people may have a moral objection to the process; if that is the case I suggest that one consider that in vitro fertilization is an artificial process which interferes with nature anyway. Because it is a man made process perhaps it may be subject to a more complicated and different set of morals. In vitro fertilization is very inprecise. Understand the tough choices you and your surrogate may have to make when undergoing assisted reproductive technology to save the lives of some of your children. Remember that placenta previa is fairly common and will typically occur at 34-36 weeks gestation in a singleton pregnancy and 24 weeks gestation in a triplet pregnancy. Be prepared.

*Consider the psychological issues involved in the selective reduction of multiples. Ask yourself, "Can this surrogate do what it takes to carry triplets?" The sacrifices required in a triplet Pregnancy are huge. Are these sacrifices too great for anyone other than a mother to make?

*Consider other parenting options including adoption. As an infertile person I used to hate to hear, "Why don't you adopt?" We chose adoption and are now blessed with a 7 1/2 month old son. While my husband and I will always grieve for our three daughters, we rejoice in the love of our son. For us the process of adoption was considerably less expensive and less painful than gestational surrogacy.