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.
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
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