A nurse’s introduction to surrogacy
Stepping out of nursing school I expected I would start my career working in a busy hospital medical unit. After all, that’s where all of my peers started out. In Toronto it was a different story, the competition was high, and hospital work was hard to find. Never would I have dreamed of where my career would eventually lead.
I was hired at a fertility clinic in the most advanced form of reproductive health — egg donation and surrogacy — at a busy downtown Toronto clinic. I had barely heard of this field, let alone know the nursing it would involve.
I eventually learned the medical aspect and became very knowledgeable about the reproductive technologies involved with these services. What took longer was to learn the delicate nature of working with intended parents, surrogates, and egg donors, each with their own complex psychological and communication needs.
I quickly gained a respect for surrogates, especially. While egg donors have a huge role to play emotionally and physically, they are often not in it for the long haul (especially when anonymous). Surrogates, or gestational carriers, in Canada often have a very intricate, close relationship with the intended parents they are carrying for.
There are six main stages of surrogacy.
It is a long process for a surrogate to build her profile and be matched with the perfect family. First, she must fill in a lengthy application, including personal, medical, and psychosocial information. Often, this is the point when the woman might decide it is too much. It is much like building a dating profile, but far more invasive. Of course, this is warranted because the agencies must be able to make a well-rounded decision about whether it would be safe for her to become a surrogate.
While each agency has its own process, the consideration that goes into matching a surrogate with a family who needs her is delicate. Will their personalities be a good match? Do they have the same preferences regarding the level of contact they would have with each other throughout the pregnancy? Do they have the same values related to invasive testing and termination, if needed?
Would-be surrogates must complete extensive screening to ensure they are in the best shape to carry for another family. They will complete blood work, urine tests, swabs, and an unpleasant ultrasound called a sonohysterogram (or HSG). If the surrogate has a partner, the partner must also complete blood work to screen for infectious diseases. The results can take up to three weeks, and during this time, the intended parents and the surrogate are all anxiously waiting for the physician’s clearance to move forward.
4. Legal agreements
Great news! The surrogate has been medically cleared to proceed. Now comes the arduous task of agreeing upon a 40-page legal agreement. Each party will have its own lawyer, and the agreement will be passed back and forth for a few weeks until the contract is complete.
5. Getting pregnant
Even though a surrogate might have naturally conceived pretty easily in the past, it isn’t always the case with the surrogacy itself. She must take medications for about two weeks before the embryo transfer, and continue on these medications up until 12 weeks of pregnancy. Still, it isn’t 100% certain that she will get pregnant, and so she might need a few attempts. Most often, she will be given estrogen (in pill form, Estrace) and progesterone. The progesterone may be taken via various routes, but the most common and, unfortunately, the most effective is by injection. The intramuscular injection in the upper buttocks is a painful, uncomfortable one that surrogates endure.
Not much needs to be explained here! The surrogate will hopefully have an uneventful pregnancy and delivery, with the support of her intended parents and her family.
There are so many moving parts here, not unfamiliar to the average family that experiences infertility. The fact that Canadian surrogates altruistically take on this endeavor is something that, surely, anyone would admire. Every day, I am in awe of the selflessness of these amazing women who, while juggling their own lives (children, a spouse, bills, a job, daily responsibilities), want so badly to help another family become complete.
Let’s take a moment and thank these amazing women! It might be a sister, a friend, or someone who decides to help a complete stranger. All of these powerful women are the superheroes of my day-to-day work, and I am so happy to share just a little bit of their journey with you today.