In vitro fertilization: And then there were three

There’s something about Jodi Goldstein that puts people immediately at ease. It might be her ready laugh, or her funky glasses and warm brown eyes. Or maybe it’s the no-nonsense way she describes even the most difficult and emotional matters.

Whatever it is, she seems totally assured when I meet her for lunch at a downtown Toronto restaurant in February 2006. But all of this only makes the story she relates even more unexpected. The tale, she tells me, begins four years earlier, when the then 31-year-old social worker and her husband, David, first learned the devastating news of their infertility.

After progesterone treatments, five heartbreaking attempts at in vitro fertilization (IVF), surgery for endometriosis and three miscarriages (including an ectopic pregnancy that resulted in the loss of one of her fallopian tubes), they decided they would put to rest the dream of Jodi carrying their child. But the thing she and David wouldn’t—couldn’t—give up was their desire to be parents. They were soon looking into what they saw as their last chance: gestational surrogacy or “carriage,” in which a friend, family member or complete stranger would carry their child for them, a baby created from Jodi’s egg and David’s sperm.

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In the summer of 2005, they met Leia Picard, a 30-year-old mother of two, happily married to a military man and living on CFB Borden near Barrie, Ont. She’d been an egg donor, as well as a surrogate once before. They talked on the phone for hours, discussing everything from their family backgrounds to the touchy subject of selective fetal reduction. (Surrogates are generally implanted with two to four embryos to increase the chances of success. This can result in triplets or even quads, leading to difficult questions of whether to terminate one or more.) Despite coming from different worlds, the two women clicked. Leia would be perfect.

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Then, a week before Jodi and David’s embryo was to be transferred to Leia’s womb, the marvellously unthinkable happened. Jodi discovered she was pregnant—without any medical assistance whatsoever. “I told David right away,” she explains. “And after all we’d been through—all the ups and downs—he said, ‘Don’t even allow yourself to go there. You have one tube, endometriosis. It might not work.’ And, truthfully, the chances of the pregnancy lasting were small. Plus, even if it did, we figured we’d want another child in a few years and would likely have to use a surrogate then. We had no second thoughts about proceeding with this surrogacy.”

According to Jodi, after recovering from the shock and learning that the Goldsteins were no less committed, Leia agreed to go ahead. She didn’t get pregnant that time, but during her next cycle four more embryos were implanted, and she conceived. Jodi, by that point, was about five weeks pregnant — farther along than she’d ever been without problems. Then she and David heard the latest bombshell in a litany of surprises: Leia was carrying twins. Jodi leans back from the table and, grinning, shows me her slightly rounded belly. By next summer, she says, they will be parents to not just two, but three babies all within the space of a month.

* * *

Leia Picard is feeling rotten. Three weeks ago, at 14 weeks gestation, she had severe bleeding, and her doctor put her on bedrest. She thought it would be OK because she has a laptop, TV and phone in her room, and her three-year-old daughter goes to daycare while her 11-year-old is at school. But it’s getting harder to manage everything, and she’s starting to worry about being a burden on her family.

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Still, when Leia talks about why she decided to become a surrogate, all those worries fade away. “I’ve always thought children are a gift, so for me surrogacy or egg donation for someone who can’t have their own is like sharing that gift. The first time I did it, I found it moves from there into something else: this amazing feeling of having someone trust me in a way I can’t compare to anything in my life. The parents put so much faith in me. As crappy as I feel right now, nothing outweighs that great feeling.”

Even so, Leia admits, learning Jodi was pregnant threw her for a loop. “I thought I had picked someone who couldn’t have kids. I guess I felt betrayed,” she explains. “After they told me, I prayed all night for guidance. But I kept coming back to this: My intention is pure. And that’s what you follow. I worried, I guess, that she wouldn’t live vicariously through me if she was having her own pregnancy. We struggled, but now it’s good. And Jodi is as excited about these two as her own pregnancy. They are all her babies and she loves each of them.”

Leia has made sure she has a strong support system with friends and family, as well as access to the counsellor she used during her first surrogacy. Even her husband, Martin, is on board. “He’s very understanding and respects me for wanting to do this,” she says, “though he doesn’t understand it all and has some ethical reservations about surrogacy being only for people who can afford the IVF and everything else.”

Leia’s husband isn’t the only one with concerns. In the highly charged arena of assisted reproduction, surrogacy has been the subject of some of the most intense debate. It was the case of Baby M in the mid-1980s that first drew widespread attention to this legal, ethical and emotional minefield. Baby M was carried by a traditional surrogate (the surrogate’s egg combined with the father’s sperm) and, though they had a contract, the surrogate refused to give up the infant. The case made it to the Supreme Court of New Jersey, where the father was awarded custody and the surrogate given visitation rights.

Opponents of the practice were outraged, condemning surrogacy as exploitive, akin to buying babies. Supporters pointed to the suffering of infertile couples and a woman’s right to do what she likes with her body. The most basic assumptions about biology and the nature of the bond between child and parent appeared to be up for question.

Over the last 20 years, as assisted reproduction has become increasingly common, surrogacy has also become more accepted. No one collects national statistics, but Toronto lawyer Sherry Levitan, whose practice is one of only four in the country that deals with surrogacy, estimates that there are nearly 100 cases per year in Canada. In contrast, lawyers that Levitan deals with in the US report 700 surrogacy clients a year in their Beverly Hills practice alone.

But even with wider social acceptance, surrogacy remains contentious. Abby Lippman, chair of the Canadian Women’s Health Network and a professor of epidemiology at McGill University, has long been involved in the debate, directing her efforts in part at lobbying governments to monitor and control the technology as well as the “industry” that has grown up around it. “My problem is not so much with the women and families who do this, who want children so much they’ll do almost anything. Rather, I think we have to ask more basic questions about the technology and about the social construction of fertility. In the old days, infertility treatments were not considered until two years of unsuccessful trying. Now it’s one, and sometimes less. We’re making children into a consumer item. And when you get into surrogacy, we have to ask what are the health risks to the surrogates of all the drugs, the pregnancy and labour? Who’s monitoring this? Who’s watching out for these women?”

Canada’s Assisted Human Reproduction Act, which became law in March 2004, is Canada’s legal response to such questions. Designed to protect the health and safety of people who use assisted reproduction, the act also banned cloning and other activities deemed “unacceptable,” and mandated the establishment of a licensing and monitoring agency.

The law made it illegal to pay a woman to carry a child—before 2004, a surrogacy fee in Canada was typically $15,000 plus an allowance for out-of-pocket expenses. That doesn’t mean you can’t use a surrogate, only that you can’t compensate her. Surrogates can have their reasonable expenses paid—though what is legitimate and the amount allowable has yet to be decided. In this atmosphere of ambiguity, surrogates and parents are understandably reluctant to say exactly how much money changes hands, but thousands of dollars are likely paid out for such things as maternity clothes, travel, special foods and child care for the surrogate’s own children.

According to Levitan, whose clients are primarily intended parents, because the law is still untested and there are not yet regulations on the table, the situation is confusing for everyone. “We’re in a very grey area right now. We’ve never had a disputed case in a surrogacy, so we have no common law. We actually have no sense of whether the contracts we write will be enforceable. It’s hard because I can’t make any guarantees.”

* * *

It’s the beginning of May and I can’t seem to connect with Jodi. She sounds exhausted in the phone messages she leaves. She’s “pretty much running,” she says, preparing for the babies. Plus, things have been tense because Leia’s pregnancy has been so rough. Over the Easter weekend, Leia was admitted to hospital at 24 weeks with what looked like premature labour. Doctors gave her a steroid shot to mature the twins’ lungs — just in case. At the same time, Jodi had to go into hospital herself after a bad bout of stomach flu had her experiencing contractions at 30 weeks. Luckily for everyone, all three babies stayed put, and Leia and Jodi were both sent home.

But things got so strained following the difficult Easter weekend that Leia and the Goldsteins got a mediator involved. Each woman spoke to the go-between; then they all sat down together to talk things through. “Here you have two pregnant ladies with all their hormones,” explains Jodi. “She’s feeling isolated and lonely. I’m feeling scared.”

Jodi is more relaxed when we talk toward the end of the month. The renovations are finished on the house she and David bought to accommodate their instant family, and she’s off on maternity leave in a few days. Even better, Leia’s doctor has given her the go-ahead to be up and around, though she still has to take it easy since her iron levels are low after losing so much blood.

“I’ve mostly had an amazing pregnancy,” Jodi tells me. “I think sometimes I’m having it easy because Leia has had such a terrible time. I couldn’t handle this if I was sick too. It’s very stressful. Not that I’ve had to worry about Leia feeling they are her babies — we’ve all been clear about that. But it’s hard for her because of the bedrest and the high risk with twins. For us, it’s the fact that someone else is holding our babies and we have no control.”

When I reach Leia at home, she echoes Jodi’s sentiment. “We’ve had our struggles. I guess I wanted them to be more available to me, plus I needed them to understand how much I was missing doing things with my family, how much pressure bedrest was putting on my marriage, my kids, even my sex life. But things are much better now that we talked, and I’m able to get out of bed more. It’s all about trying to find some sort of balance.”

* * *

Jodi’s family room looks like a plush, multicoloured jungle gym. Two play mats take up the middle of the room, and a combination crib and change table perches beneath the window. The late August sun falls on two swings, two bouncy chairs, a bassinet, and a glider so cushy it looks like it would put even the most colicky infant to sleep. The babies are all, finally, here.

Nathan arrived by Caesarean on June 20 when Jodi’s doctors realized at 40 weeks that she had no amniotic fluid left. Leia delivered the twin girls, Leila and Eden, less than a month later, also by Caesarean because they were breech.

“The twins’ birth was really emotional,” Jodi tells me as she and Rolita, her live-in “supernanny,” tag team feeding, burping, changing and soothing. “Leia was very anxious about the surgery, but when it came I was in the room with her; David and her husband were outside. She was great. The doctors treated me like the mother from the start and gave me the babies right away. I started to cry, I was just so relieved.” Later that evening, Jodi and David brought the girls to Leia. Exhausted and sore, but content, she held the babies she’d carried for nine months and quietly said her goodbyes.

I spoke to Leia two days later, while she was still recovering in hospital. She was physically uncomfortable after the surgery but feeling well. “I prepared myself for this emotionally,” she explained. “I have a sense of completion. I’m ready to get back to my life.”

Leia and the Goldsteins talked regularly in the days after the birth, but within a week Leia and her family were packed and off to Courtenay, BC, where Martin is now stationed. Leia’s had moments of feeling sad since, but nothing she didn’t anticipate from postpartum hormones. Jodi says they’ll continue to update Leia and send photos at holidays. They also have to have Leia (who is legally considered the twins’ mother until proven otherwise in court) sign forms and provide a DNA sample showing she was their gestational carrier, not the genetic parent.*

Tinny classical music plays from one of the mats on the floor as Jodi offers a bottle of pumped breastmilk to a slightly fussy Nathan, and dreamy, dark-haired Leila sleeps draped over her knee. Over by the window, Rolita changes and soothes a crying Eden. “I think one of the most important things I learned through this experience is to accept that you don’t have control,” says Jodi as she expertly manoeuvres Nathan into the bouncy chair and shifts Leila onto her shoulder. “You have to let go of things because if you worry too much, make too many demands of the surrogate, it will affect your relationship negatively. I thought before that it looked so wonderful, but it’s very bittersweet. Someone else is carrying what you should be carrying.”

Jodi pauses, her face tired, but her voice deliberate. “Now that they’re all here, though, I love it. It’s a handful, but it’s my pleasure.”

*Jodi Goldstein was legally recognized as the twins’ mother in early November 2006.