David and Claire came to us looking for an egg donor who not only looked like Claire, but also had blood type A negative (A-). For this German couple, finding a donor with the same blood type as at least one of them, was extremely important. “I asked them why they wanted an egg donor with a specific blood type, encouraging them to be a little more open,” says Krystal Lemcke, a Senior Case Manager at Donor Concierge. Krystal emphasized that many donors, especially first time egg donors, don’t always know their blood type. “David and Claire were concerned that because blood type is a common subject for elementary school science classes in Europe. They didn’t want their child to be faced with awkward questions from teachers or friends.” Gloria Li says blood type is very important to many of her clients, particularly those who come from China. “Many people in Chinese culture feel the stigma of infertility and want to keep their fertility journey a secret from not only their family, but often the child themselves.” We recognize that finding a donor with a compatible blood type is important to some families, so we’ve broken it down below. What is Blood Type? A person’s blood type is a blood classification based on the presence or absence of two antigens – A and B – on the surface of red blood cells. The blood cells also can contain a protein called the Rh factor, which is either present (+) or absent (-). The combinations of antigens A and B and presence or absence of the Rh factor create the 8 most common blood types: A+, A-, B+, B-, O+, O-, AB+, and AB-. How is Blood Type Inherited? Every person’s blood type is inherited genetically. Each biological parent carries two alleles for both blood group and Rh factor, of which only one is passed on to their offspring. The chart below shows the different possibilities of child blood type, based on parents’ blood type. What Does Blood Type Mean for Egg Donation? The blood type of an egg donor does not have a medical bearing on the outcome of fertility treatments, or health of the child. Therefore, it is not often considered important criteria for parents seeking an egg donor. Many donors, especially first time donors, don’t know their blood type so trying to find someone with a compatible blood type to you, can add another layer of complexity to your choice. Agencies may require a fee to have a blood typing test, which can delay your cycle. And if the donor has all the characteristics you’re seeking, but isn’t the ‘right’ blood type, you may be left disappointed. Choosing an egg donor with a different blood type may mean being honest with the child about their unique creation. The child may require future medical treatment where blood typing is necessary. We encourage parents to look holistically at each egg donor, and keep in mind that seeking a specific blood type will greatly reduce their egg donor options. The conversation around egg donation will often happen naturally, without parents feeling their hand is forced by their child’s blood type, and there are plenty of resources for parents who may be struggling with how to start the conversation. We know that cultural restraints and each parent’s unique background can play a role in how transparent they are willing to be about their child’s creation. Ultimately, parents will make the decision that is right for their family in choosing how and when to speak with their child about egg donation, and whether their child’s blood type will play a role in that conversation.

Most babies are born healthy, but 3-5% have a birth defect or problem with development. Some of those problems happen by chance, and some can be inherited. For those building their family through egg or sperm donation, how can a genetic counselor help to avoid the risks? We talked to Amy Vance, of Bay Area Genetic Counseling  about her role in the fertility journey and how genetics and family health history play a role in the journey to becoming a parent through egg donation. What is a Genetic Counselor? Genetic counselors are masters-trained licensed health professionals with expertise in the science of genetics who are trained to translate technical and complex science and research into user-friendly terms for patients and providers. Genetic counseling is not the same thing as genetic testing. With the vast amount of genetic information and testing available, Genetic Counselors are an invaluable resource for the IVF clinic However, one basic component of risk assessment before a pregnancy for all gamete providers that’s important, and often overlooked, is the family history evaluation. Family history is the cornerstone of the genetic risk assessment. A thorough family history evaluation by a Genetic Counselor provides the foundation for evaluating risks for genetic conditions and offering appropriate testing before undergoing fertility treatment and before a pregnancy occurs. What happens when an egg donor meets with a genetic counselor? First, the donor will complete a health questionnaire through her agency. Collecting family health history involves asking questions about a person’s health and their family. Most people have family members with different health issues, some of which can be inherited. Most of these inherited genetic conditions are not detectable by standard genetic screening done by fertility clinics. For an egg donor cycle, both the egg donor and the sperm contributor may provide this information. Next, the questionnaire is reviewed by the genetic counselor Taking a detailed family history helps ensure that important genetic information is not overlooked and that any appropriate testing and/or information is provided to the patient or donor prior to pregnancy. Guidelines from the American Society for Reproductive Medicine (ASRM) suggest a review of personal and family history of genetic disease and prior genetic test results that may affect the course of treatment, with patients being counseled about additional genetic testing that may be indicated before starting treatment relating to their personal or family history. Genetics Consult After the review of the questionnaire, the donor is provided with detailed instructions about the purpose of the consultation, how to prepare, and some tips about talking with family members. I’ll schedule a call with her and we’ll have the Genetics Consult. Family history risk assessment for ovum donors by a genetic counselor provides a thorough, standardized method of screening ovum donors. This is a really important step because the consult, combined with the health questionnaire, identifies at least 20% more important family history information. One reason is because of the preparation and instruction given to the donor prior to the consult. The conversational nature of the consultation allows for additional information to be requested as needed. I may ask her to follow up with family members to gather more information based on what comes up during our session. Occasionally I may even request a medical document on a family member if there is a condition that requires that level of detailed evaluation. But I had Genetic Carrier Screening, isn’t that enough? There is a misconception that genetic carrier screening panels take the place of a family history. The family history seeks to identify actual conditions that may run in a family that increase the risk to offspring. The genetic carrier screening is for hidden genetic traits and is used for matching purposes. Most of the diseases on the carrier screening panels are recessive, and carriers for most recessive diseases don’t have symptoms- that is why the testing is used. Conversely, family history can’t identify which recessive traits a person carries. There are other patterns of inheritance such as autosomal dominant (when only onegenetic parent is a carrier and therefore there is a 50% chance of the child inheriting thegene) and multifactorial (inheritance pattern involving multiple genes - most common diseasesare inherited this way -there is a risk to close relatives of affected individuals) which the familyhistory is meant to capture since these can confer a risk to offspring. Real Life Cases As the following cases demonstrate, implementation of a routine genetic counseling screeningprogram for all egg and sperm donors is an important step in identifying possible genetic riskfactors that may be present in the donor’s family so that the intended parents have anopportunity for informed decision-making about potential genetic risks prior to donor selectionand pregnancy. Case 1 : A 5-time egg donor was referred by a clinic for genetics consult (family history assessment by genetic counselor). During the consultation, it was discovered that the donor’s maternal grandmother and maternal great grandmother have a genetic eye disease. The donor’s mother is too young to have symptoms appear and there has been no genetic testing in the family and the mother has not been evaluated. This condition follows an autosomal dominant inheritance pattern and there is an increased risk to the donor’s offspring. According to the ASRM criteria, she is not considered an ‘eligible’ donor (IPs can still choose to use the donor after comprehensive genetic counseling). The donor asked me, “why is this the first time I am having the genetics consult? Why have I been allowed to donate 5 times before and this has never come up?” The answer is that the consult was not required as part of the other donations. Unfortunately, now the previous intended parents must be informed of this new information and the potential risk to their offspring. This puts everyone in a difficult position that could have been avoided had this information been available from the beginning. Case 2 : A Donor’s paternal uncle has a brittle bone disorder, diagnosed as a teen, causing over 20 broken bones. This condition is autosomal dominant and can be highly variable even within a family. Some people have symptoms that only a trained geneticist may identify, but even mildly affected people can have more severely affected offspring. The donor’s father has not had a genetics evaluation and there has been no genetic testing done in the family. As in the case above, this condition is autosomal dominant and there is an increased risk to the donor’s offspring and by ASRM criteria, she is not considered an ‘eligible’ donor. The question from the agency was, “why don’t we screen for dominant conditions (by genetic testing).” Genetic testing for dominant conditions is not part of carrier screening, because that would be ‘diagnostic testing’, since people with a single mutation for a dominant condition are ‘affected’. That is not the purpose of genetic carrier screening for egg donors but it IS the purpose of the family history. As a side note, none of the information above was included in the donors’ profiles. This information became available as a result of the targeted follow-up and detailed information requested as part of the genetic consult. Most of the time the donors don’t know this information about their own family until the consultation process is complete. Is a genetic consult with a genetic counselor required? A genetic consult is not always required but I feel it's good practice. I think that many clinicians don’t understand the value of family history evaluation and there is an ongoing misconception that carrier screening identifies all risks to offspring. Additionally, there is a cost for genetic counseling, but it is minimal. In my practice a donor family history is $325. The turnaround time for the reports is less than a week. If the consult is factored into the overall cycle as part of routine screening, there is no time delay. Even if the clinic does not require the genetics consult, if the intended parent feels it would be desirable they can always request it. References: Family history risk assessment by a genetic counselor for ovum donors: data for 582 in house ovum donors from a single clinic demonstrates its value. Amy Vance, MS, LCGC fertstert.org Family history by a genetic counselor is a critical step in screening all patients in the ART clinic. Amy Vance, MS, LCGC www.ncbi.nlm.nih.gov The importance of family history risk assessment in the infertility setting. Fertil Steril. 2005;84(Supplement 1):S125. doi: 10.1016/j.fertnstert.2005.07.305. [ CrossRef ] [ Google Scholar ] Vance A, Zouves C. Family history risk assessment: data for 723 consecutive ovum donors from a single agency demonstrates the value of the genetics consult. Fertil Steril. 2011;96(3):S218. Vance A. doi: 10.1016/j.fertnstert.2011.07.839. [ CrossRef ] [ Google Scholar ] Amy Vance is a licensed, board-certified genetic counselor in practice for 32 years. She founded Bay Area Genetic Counseling  in 2001, a boutique private practice focusing primarily on serving couples and egg donors pre-IVF, but also offering cancer risk assessment and genetic counseling for other genetic indications. Her passion has been continuing to educate providers about the value of genetic counseling in the ART practice, focusing specific attention to family history. She has authored several articles and abstracts and delivered dozens of invited presentations on the topic of the importance of family history for egg donors and couples preconceptionally, genetic testing and carrier screening, cancer risk assessment, and preimplantation genetic testing.

The journey of infertility often begins with the who, what, why, when, and where: you build your fertility team, figure out what fertility treatment you will pursue, and make a plan for timing. Then comes the how . As in, “How do we begin, and how much will fertility treatments cost?” Approximately 10 percent of U.S. women of childbearing age have used assisted reproductive technology . Here are some tips about fertility options for financing your fertility journey. Below, we’ve laid out some of the most common third-party fertility financing options and financial avenues for intended parents. Sperm Donation The cost of sperm donation can range from under $1000 for at-home insemination to upwards of $50,000 if you require IUI or IVF with sperm donation - this is the cost for your clinic fees, medications, egg retrieval, embryo creation and transfer. Your fertility doctor is the best person to advise you on which treatment will be most effective. How much does it cost to use a donor egg and/or a surrogate? Many intended parents with diminished ovarian reserve use egg donors to conceive. Whether you find a family member who is willing to donate her eggs, or go through an egg donor agency, there are many parties involved. Egg donation usually requires intended parents to finance the donor costs, lawyer fee, clinic costs, psychological and medical evaluations, insurance plans, and more, which can cost from $20,000 to $40,000+. Donor Concierge provide intended parents with streamlined support navigating the complexities of this process and can in the end save money by ensuring that intended parents choose an egg donor who is likely to provide optimal results. Surrogacy can often go hand in hand with egg donation, and is also a complex process, involving many moving parts. Common costs associated with surrogacy include: Agency fees of $20,000 to $30,000 to match parents with a surrogate The surrogate's compensation, which can range from $35,000 to $60,000 depending on experience and location. life and medical insurance for the surrogate can range from $5000 to $30,000 the IVF transfer to the surrogate which ranges from $7,000 to $9,000 per cycle The medications at $600 to $3,000 depending on insurance lawyers and escrow fees from $15,000 smaller needs of the surrogate like a clothing allowance and parking fees for doctor's visits. Estimates for the entire surrogacy process range from $100,000 to $200,000. HERE ARE SOME FINANCING OPTIONS: HEALTH INSURANCE and Company Benefits: To finance fertility treatments, first check your insurance coverage in your state. California and Texas have laws that require insurance companies to offer coverage for infertility treatment. The remaining fourteen require insurance companies to cover infertility treatment. Arkansas, Connecticut, Delaware, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, and West Virginia have laws around infertility diagnosis and treatment coverage. Many larger companies are now offering generous fertility benefits through companies like Carrot Fertility , hoping to attract people who understand the value of preserving their fertility. Always check with your HR department and see what fertility benefits are offered. Resolve , the National Infertility advocacy organization, has information available to help you ask for fertility benefits and insurance coverage. FERTILITY FINANCING LOANS: Organizations offering these loans include Sunfish Prosper Healthcare Lending),New Life Fertility Finance), and CapexMD. Many of these plans depend on estimated costs provided by doctors or agencies, and offer access to loans up to $100,000. EggFund and EmBorrow are additional state-specific fertility loan resources. Fertility loans can be a good option, but some of these loans can have high interest rates, so make sure you know what you're accepting before moving forward. And if you’re having difficulty navigating the financials of your fertility journey, companies like Seed Coach , offered through surrogacy agencies can help you make a plan. With awareness of surrogacy and egg donation growing, more options are becoming available to intended parents. Aside from insurance coverage and fertility loans, fertility and surrogacy grants are becoming an increasingly common option. The Tinina Q. Cade Foundation , Baby Quest Foundation , Pay it Forward Fertility , Family Formation Charitable Trust , Journey to Parenthood Grant , Parental Hope , and Life Grants are foundations that offer grants to intended parents who are unable to cover costs of IVF or surrogacy. Many grants typically cover up to $10,000. OTHER ROUTES Many intended parents save money by using less conventional avenues, from finding egg donors or surrogates through personal connections, fundraising, or comparing costs of medications in other countries. One mother even set up her company as a C-Corporation , so she could run all surrogacy-related expenses through the business, deductible as employee benefit expenses. While the DIY approach may seem like a cheaper alternative, remember that you get what you pay for - experts in the field, like agencies and reproductive attorneys can help you save money by not making common mistakes. Tread very carefully if you try to do this on your own. OVERVIEW While there are options for parents struggling with infertility, the best way to ultimately save money across the board is to reach out to experts, ask questions, and research. Every family is different and every intended parent’s situation is unique -- some may save money by opting to “DIY” aspects of their journey, while others may save money by finding an agency or organization that can do the work more quickly. Additionally, there are some grants and foundations specifically catered to certain regions , religious groups, and communities. The key is to communicate with doctors, professionals, and your own support system, so that you can begin this process with as much information about your needs as possible. Luckily, there is a great community of other parents and experts who are eager to offer advice and resources as you start your journey. And above all, know that you aren’t alone in this process. Many out there are facing the same struggles, and parents, legislators, doctors and experts across the country and world are advocating for more fertility support and access.

At Donor Concierge, we love to highlight parents’ egg donation stories. Thank you Georgia* for sharing your experience with us, and allowing us to be a part of your journey. I had my first child at 42 years old, which in this day and age, I thought was “no big deal.” But little did I know that with my age, FSH levels and stressful lifestyle… He was literally a miracle baby. When we learned all that, we had to consider our options. Egg stimulation wasn’t a good way to go given my age, but I was devoted to my son having siblings, so we began looking for donors. The egg donor process was complicated, but throughout it all, I learned three important things. First, I was picking a donor for my son as much as for us parents. Second, I wanted to meet our donor in person for a “gut check.” And third, I realized that as much as we try to “line everything up,” there is no magic formula to guarantee having a child. It’s in God’s hands. I believed that regardless of the medical intervention, these were MY children, and I had faith that God would give us children if he chose. Having faith throughout the process was key for me, because we did four cycles, all to no avail. Luckily, our donor agreed to do another round for us, and thank goodness she said OK! On the first transfer of the second round, I did the one thing I had never done before: After the transfer, I immediately took a cab to the nearest hotel in San Francisco and I literally LAID DOWN FOR 24 HOURS. Literally. I got room service, so I got up to answer the door and had them put the tray on the bed so I could lay back down and eat. It might be crazy, but… it worked! We got pregnant at first with triplets! My doctor talked with me about "reduction." I said NO WAY! But I did start praying that God would only allow two, since I thought triplets could be a huge strain on our family. A month later there were only two embryos. We went 39 weeks and they were born 7lb 5oz and 6lb 11oz - two baby girls! And I was 46 years old. It was awesome!! During all these attempts, we leaned on the support of friends. I kept asking for more and more prayers. However, this had one negative effect – a LOT of people knew our business. First, a good friend came to see us at the hospital, and asked, “What does their mom think?” I said, “"I think they are awesome! I am their mom. The other person is a donor." Wow. Second, a few weeks after my girls were born, a friend came to me. She said she had run into someone in the grocery store and said, "Georgia had her babies!!" To which the other woman remarked, "You know those aren't hers, right? She used a donor." This INFURIATED me! So I called that gal later in the day and said nicely, "Please do not discuss my personal information with anyone. How could you do such a thing? These are MY babies!” What a ding dong! She apologized and learned something new that day, if only to keep her mouth closed. NO ONE Had gone to more trouble than us to have those babies. Goodness gracious! To others going through this process, be mindful of how many people know about your story and how you foresee it playing out in the future. The two situations above made me believe that I needed to be forthcoming with my girls to avoid a "bombshell" incident later in life. (Such as, "You know she isn't your real mom, right?) So I always told them there was a woman who "helped us have you." When they got older, into middle school, this came up and I always treated it as if it were no big deal, just matter-of-fact – yeah, this great woman helped daddy and I have you. One day one of the girls said, "But she didn't give you an EGG, right?” I said, "Yes, she did." OH. MY. GOSH. BIG. ISSUE. After that conversation, we had a few months of "You're not my real mom!" when they were angry, to which I would always answer, "Yes, I am honey. In every way. I am as real as it gets." Later I said, "You know that really hurts me when you say that. No one wanted you girls more than me. And I am so blessed that someone helped me to have you!" And within 6 months or so, they never said this again. My donor lives about 40 miles away and we are friends on Facebook. She is now married and has two boys about 7-8 years younger than my girls, and her husband knows about the donation. She is so gracious and has said if my girls want to meet her someday, she is open to it. Anyway - after I got pregnant and they were just little tiny beads-with-heartbeats, I never looked back. They were always mine. MY gifts from God to me as a mother, to their brother as siblings and to us as a family. That someone else contributed a microscopic piece of DNA was a blessing, but made them no less my own.

We know there is a lot of misinformation about egg donation and why someone would donate their eggs. We talked with an egg donor we know personally, about why she chose to donate her eggs. Here are Jewel’s answers to the most common misconceptions and why she decided to donate her eggs. Why would you ever choose to be an egg donor? I heard of a friend donating to a local clinic about 5 years before I actually decided to donate. She was a young single mother and after hearing her experience, I understood it to be very clinical and did not even contemplate the intended parents' perspective at that time. It wasn't until several years later that I was faced with the idea that I might not be able to have children with my husband. In a specialist waiting room, I was reintroduced to egg donation. I understood donation on a completely different level. If there was someone out there who could help ME have children, wouldn't that be a beautiful thing? Egg donors only do it for the money, right? I'm not going to pretend that the compensation doesn't play an important factor. In many places across the world, compensated egg donation is illegal, and in those places, the waitlist for an egg donor can be years. Egg donors are typically establishing themselves in life and the compensation they receive may help pay down student loans or go towards important purchases. They commit a significant amount of time and energy into a cycle, for which they should be compensated. Many donors feel that is what they are being compensated for and not for the eggs they donate. With that said, being selected as an egg donor was an incredibly emotional experience for me and I've found many donors have similar experiences. They may wish to know more about the parents or child in the future. Many donors come to egg donation after seeing a loved one go through the struggle of infertility and wanting to help someone else going through a similar struggle. I believe that we are all wired with this innate desire to want to help others. Egg donation can be an incredibly fulfilling and rewarding process, with or without compensation. But compensation definitely helps. Anyone can be an egg donor? Not true. Let's run through the qualification process quickly. You apply to a clinic or agency to be an egg donor. Right away, they ask initial questions that can immediately disqualify you. Questions on your basic health: how old are you (over 30 need not apply!), are you currently taking any medications (anxiety, depression and sometimes even acne medication can disqualify you!), etc? Based on your response to these questions, they might invite you to complete a more thorough questionnaire. They want to know about you, your immediate and even extended family health. They want to know education, personal philosophies, reproductive health. If the preliminary review of your profile passes the mini requirements set forth by ASRM, you are able to create a profile. If and when you match with a couple, the fertility clinic that the intended parents work with will thoroughly vet this donor. They used to run a genetic panel of 10 genetic mutations that would disqualify a donor. They are now screening for hundreds of mutations to give the intended parents the best insight into the donors' health. On top of genetic testing, donors need to have a good ovarian reserve and appropriate hormone levels. Donors undergo Psychological screening and Genetic Counseling (different than genetic testing!). Donors typically have to complete FDA screening twice throughout the duration of a single cycle and will be tested for drugs and nicotine. Is egg donation really painful/dangerous? It can be. As with any surgical procedure or medication, there are side effects and potential complications. Most often, I see donors concerned about the injections, which are really quite painless. The surgical procedure usually takes 10- 15 mins. Most donors complain of mild cramping, similar to that of their menstrual cycle the day of. OHSS (Ovarian Hyperstimulation Syndrome) can be dangerous and painful. Clinics take great measures to ensure they are stimulating donors properly. The monitoring appointments that take place throughout the cycle provide them crucial information as to how a donor's body is responding to the medication. They may increase or decrease medication based on how a donor is responding. Donating my eggs will mean I will deplete my own egg supply and I will become infertile, right? I see this question/ concern all the time and it was a concern of mine as well. With the first egg donor cycle completed in 1984, researchers have had time to study the effects of egg donation on women's future fertility. So far there is no evidence to support any claims that donating eggs will harm future fertility. *Jewel has since given birth to two healthy children of her own - Donor Concierge Being a donor means I will have to travel and take time off of school or work? You have the option of going to a clinic near you and registering to be a donor with their program- in which case travel would not be needed. If you decide to register with an agency, then travel is likely as the chances of the couple being local to you are small. Most of the egg donor cycles take place at the fertility clinic where the intended parents are established, patients. If you match with a couple not local to you, you will need to travel to their clinic on two occasions. Once for a "donor day" where you complete your screening, sign medical consents and have injection training and then again for the retrieval week (plan on 7-10 days for travel). It’s only older women who need egg donors. There are a number of women who cannot conceive using their own eggs and for a variety of reasons. The most common reason we see women decide to work with an egg donor is egg quality (which decreases as you get older- but this can affect younger women as well). There are also women who chose not to use their own genetics due to health concerns in the family that would likely be passed down to their children. *Not the only reasons, others include: cancer treatments in females, same-sex couples, Premature Menapause among others - Donor Concierge Can an egg donor might be responsible for any child born from the donation? When you decide to be an egg donor, you will enter into a legal agreement transferring the custody of the eggs to the clinic or intended parent. *All egg donors should have their own attorney who specializes in egg donation, help them to review the contracts. The fee will be covered by the intended parents when they sign the agency match agreement. - Donor Concierge Is egg donation anonymous? You can choose to have an anonymous or open donation. The majority of donations are anonymous. Keep in mind in this day with ancestry kits and reverse image searching capabilities, complete anonymity is very difficult to promise. This is why the legal agreement is important - to establish mutual boundaries for the type of relationship you will have. Did you tell anyone? What did your family and friends think of you being an egg donor? I shared with my immediate family only. My husband fully supported my decision. I had various responses from my family. Some had some health concerns and while others had emotional concerns, wondering if I would regret my decision later in life. With that said, I've never regretted my decision to donate. I hope that my participation in the cycle process brought happiness to another family.

Many intended parents looking for an egg donor are scared when they find out that their egg donor is a carrier of an inherited disease. This information may be on the donor’s profile, after she’s been through a successful donation cycle. They often make a rash decision not to match with a donor who has a known carrier status, fearing that this means their child will be born with a non-treatable genetic illness. But this fear may also mean they lose out on a great egg donor whose carrier status implies no significant risk to their offspring. We all have a number of recessive genes mutations that do not cause disease as we have a normal functioning copy of the gene that is enough to avoid the disease. Many types of genetic disorders are transmitted by the autosomal recessive pattern. It means that if a person has both of the defective genes from their parents they could develop the disease. However if they are only a carrier they won’t show any sign or symptom of the disease but there is a chance that they transmit the carrier status to their biological child. So the short answer to this question “would my child get the disease if my egg donor is a carrier?” is NO, if the genetic transmission pattern is autosomal recessive and the father is not a carrier of the same disease. It is important for intended parents to understand that there is a difference between being a carrier of a specific disease and having the actual disease. It is also essential for them to understand the chances of having a baby with that particular disease when the genetic maternal link – the egg donor - is a carrier. If intended parents are worried about anything, we always recommend that they consult with a genetic counselor, who will discuss their family history and that of the donor. Our advice to intended parents is always to refer your fears to your fertility doctor and a qualified genetic counselor . While some of these genetic markers may sound ominous, they could be a normal part of our own genetic makeup with no bearing on the health of your future children. - Dr. Shiva Fate is a Medical Consultant and Senior Case Manager at Donor Concierge. Shiva holds a Medical Doctorate degree from Azad Medical University of Tehran and also a Masters degree in Counseling Psychology from Dominican University of California.

We are often asked which is better: a first-time egg donor or a repeat egg donor. The short answer is one is not better than the other. There is no difference in success rates between using a first time egg donor and a repeat egg donor. Donors of all kinds have to go through the same egg donation process, though there are unique considerations for each type of egg donor candidate. Repeat egg donors Why did my doctor recommend a repeat egg donor? There are pros to choosing a repeat egg donor that your doctor is aware of. Your fertility team has information about how her cycles have gone in the past, which is appealing. Record of previous responses to stimulation and/or positive pregnancy. Your egg donor was able to follow through with the protocol and make it to retrieval, all reassuring data to have before heading into a cycle. What your doctor is focused on is science, not the financial, emotional or issues of human nature. A repeat donor can be a great choice if you can find someone that you like, who is available to travel to your clinic and is can cycle when you are ready to cycle. She'll often have had her genetic and fertility testing completed and will understand the process and how she will respond to the medications. Here are a few drawbacks to a repeat donor that you may encounter: Repeat donors are in high demand Their fees are higher Finding a repeat donor who you like and is available can be challenging Waiting for your turn to work with the repeat donor of your dreams can fall through. Being an egg donor is not a walk in the park it is not unusual for donors to decide they don’t want to do a future cycle when it’s your turn First-time egg donors Here are a few reasons to also look at first time donors: Every egg donor was a first time donor at some time First time egg donors are excited about the process and the possibility of helping you First time egg donor fees are usually significantly lower than a repeat donor First time egg donors can be tested for ovarian reserve prior to you committing to work with them First time egg donors may be open to doing an exclusive donation arrangement with your family We always recommend that intended parents look at both first time donors egg donors as well as repeat donors . It is hard enough to find candidates that feel “familiar” you don’t want to eliminate the majority of candidates because they have never done this before it may even be a plus when creating your family. Interested in building your family with Donor Concierge? Schedule your free consultation today .

How DO you choose the best egg donor for you? It seems easy at first – someone who likes like you, lives near your clinic and is healthy? Soon, many intended parents become bogged down in the finite details of individual donors and come to us, overwhelmed by the decision making process and worried that 'the one' just isn't out there. Think again. As corny as it may sound we are all far more unique than we realize. When it comes to choosing an egg donor you can desire anything you want but you can’t have everything you want all in one person. Here are a few guidelines: • Choose a donor who is healthy and has a good family health history • Make sure she is available to cycle now not some time in the future • If she is a first-time donor, ask to have her ovarian reserve checked • Make sure she can travel to your clinic • Choose a donor who looks and feels like they could fit into your family • Find someone who you like for who she is not because she is just like you Out of the six guidelines, the first three are must haves from a medical perspective. But if that were all future parents cared about all intended parents would be able to find egg donors from their clinic’s database. For most of our clients, it’s finding an egg donor that feels “familiar” that gets them to let go of their genetic connection so that they can go to cycle. They want to feel a connection to the young woman who is taking their place in the family genetics. Many intangible characteristics help future parents feel they are ready. While we are always checking the donor’s health information, it is the look and feel that helps the prospective parents to decide they can let go of their reservations. Start with your ultimate egg donor wish list. Then decide what qualifications are the must-haves or deal breakers and which are the nice to have or icing on the cake. A client came to us with a lengthy ‘must-have’ list of his perfect egg donor – she had to be Jewish with an SAT in the 90% from a top 30 college. While many Jewish women are bright and highly educated, those with SAT scores in the 90% rarely sign up to be egg donors. There are bright young women who have excellent scores, but they may not be Jewish. Many intended parents may then decide qualification is of greater importance to them. For some, the egg donor's Jewish heritage is more important while for others it’s the academics. When you start to review profiles, you will quickly realize which of these qualifications is going to be the deal-breaker or the icing on the cake. Your Donor Concierge case manager will help you see all those candidates who come close to your desired criteria and ultimately, help you make the best choice for you and your family.

Donor Concierge works with a variety of men - married and single , gay and straight. In our experience, men have a different perspective on finding an egg donor than women do. We’ve found that women searching for an egg donor tend to look for someone like themselves. Men, on the other hand, seem to be searching for the ‘ideal woman’ to be their egg donor. They often seek ‘perfection’, without understanding that although all egg donors are women, not all women are egg donors. Some common requests that we get from men who are looking for an egg donor: Model beautiful Ivy League education 90th percentile on SAT or ACT 5’7” or taller Plays a Division I sport While we can find very bright, university-educated women who are tall, healthy and attractive, someone who meets all of the above criteria is a rarity. Most women have absolutely no interest in being an egg donor, regardless of the compensation. Those who do choose to be egg donors have done enough soul searching to feel comfortable with their decision. Most egg donors are motivated both by altruism and the financial rewards. Many women would never entertain the idea of donating their eggs because they would see it as giving away their children. The time commitment and discomfort associated with the egg donation process can also be a deterrent for many young women. An egg donor must give herself subcutaneous hormone injections to prepare her body for donation. She will retain a lot of excess abdominal fluid during this process that may cause bloating, cramping and general discomfort. The donor also needs to limit her physical activity so that she doesn’t damage to her ovaries while they have swollen. There are risks involved in any surgical procedure and some women are not prepared to take this risk to become egg donors. Finally, social acceptability may affect a woman’s willingness to be an egg donor. While she may see it as a financially rewarding altruistic act, not everyone in the donor’s family and social circles will see it in that light. This is particularly true among more traditional Asian , Jewish , East Indian and Middle Eastern families and is a deterrent that keeps many women from wanting to be an egg donor. It can also be socially unacceptable at Ivy League or other top schools. Many of these highly accomplished young women are simply too busy with school and don’t have the time or the monetary motivation to be egg donors. While there are many wonderful, healthy, bright, caring and lovely women who are willing to be egg donors, it is a process of self-selection. For men, choosing an egg donor means understanding that we will always be limited to those women that choose to do this, and to focus on finding someone who is healthy, available and willing to donate who offers the best chance of a successful pregnancy.

When I was 39 years old and still single, I decided to move forward with my “Plan B” to have a baby on my own as a single mother by choice. After finding a wonderful and generous sperm donor, I learned that I would also need an egg donor. As a petite, well-educated Jewish woman, I wanted to find an egg donor who resembled me and my vertically-challenged extended Jewish family -- all of whom are descended from Eastern European immigrants. I found a donor attending graduate school who is also petite (but of course taller than I am!) and quite athletic, like myself. With all of the other concerns about logistics, injections, the timing of the retrieval and the pregnancy, whether my baby would be considered Jewish by my rabbi was an afterthought. Of course my baby boy will be Jewish, I thought, because I am Jewish - and I am his mother. As it turns out, there is little consensus among rabbis in the United States and Israel about whether a baby born to a Jewish mother with the help of a non-Jewish egg donor is Jewish or not. “If the egg is from a non-Jew, then the DNA is from the other person, says Rabbi Shaul Rosen, who founded a support network for infertile Jewish couples. “In order for that child to be Jewish, it would have to go through a conversion ceremony like any other non-Jew.” For babies, this requires immersion in a mikvah, and boys must have a bris. Other orthodox rabbis are taking this approach as well. I am affiliated with the conservative movement. I carried my baby, Solomon, and he had a bris with a Mohel. Eighty of my closest family and friends attended his bris and Solomon is Jewish, according to my rabbi. The question of a baby’s parentage may become more complicated when a Jewish couple uses an egg donor and a surrogate to have a baby, but it should not be. Placing emphasis on the baby’s genetics rather than on his Jewish parents is reminiscent of Germany’s nefarious eugenics program or the inhuman underpinnings of the genocide in Rwanda. Requiring conversion of a baby born from a non-Jewish egg donor and/or a surrogate places unnecessary significance on the genetics rather than on the child’s Jewish parents. Solomon is named after two of his great-great grandfathers who fought their way to United States in order for their Jewish children and grandchildren to have a peaceful and prosperous life. His bris was a huge celebration for me and my family. Solomon knows the Hebrew alphabet and sings “ Shalom Alechem” and “Shabbat Shalom.” He reminds me every Friday afternoon that we need to light the Shabbat candles. We do not need rabbis or Hallachic (Jewish law) scholars to tell us if our baby is Jewish. Our children will tell us themselves that they are Jewish. They have known all along. Jessica Rutzick is a trial lawyer and single mom by choice. She and her son, Solomon, live, ski and pray in Jackson Hole, Wyoming.

People form families in many ways: yes—through natural conception, through adoption and, more recently, through assisted reproductive technology (ART). Since the first birth of a child born by means of technology in the late 1970s, nearly 200,000 babies have been born, and 100 million procedures have been performed, according to an estimate by the International Committee for Monitoring ART. Many children have been born with the help of sperm or egg donation. The use of donor sperm as a treatment for male infertility in the United States was first reported in 1884, while the use of donor eggs was made possible in the United States more recently, in 1984. Psychology, however, has been lagging behind technology. Guidance for parents and follow-up of children born by means of a donor egg or sperm is just beginning. There's lots of expert opinion on how, what and when to tell most children where they come from, but expert opinion about conveying this information to children born as a result of egg or sperm donation is hard to find. AOK spoke about this issue with Margot Weinshel, LCSW, RN, Clinical Instructor of Child and Adolescent Psychiatry at the NYU Child Study Center and Membership Chair for the Mental Health Professional Group of the American Society for Reproductive Medicine. The interview was conducted by Anita Gurian, Ph.D., Executive Editor of AboutOurKids.org. Q: To tell or not to tell is a choice that must be made by heterosexual parents of children born by means of a donor egg or sperm. How can parents decide? A: Both psychological and medical experts advise parents to tell the child. There are several reasons for this opinion. First, every child has the right to know his/her genetic background, particularly since there have been many medical advances in identifying and curing genetically transmitted diseases. Second, keeping secrets represents a denial of reality and is likely to cause problems in family relationships. In addition, children's trust in their parents may be shaken, as they wonder if other secrets have also been kept from them. Q: Isn't keeping it a secret better for the child? Why look for problems? This is the only family she has ever known, and no one else has to know the details of how she was born. Why tell if the child doesn't ask? A: In the long run, not telling leads to more problems than telling. Telling early avoids the betrayal children may experience if they find out when they're older. The current opinion that the child has a right to know represents a shift from 20 years ago when people were advised not to tell. Q: What led to this change? A: At that time, the medical profession felt that since the mother became pregnant and gave birth to the baby, it was not necessary to tell. The current view advocates an open and honest attitude. Many adults who were born as a result of sperm donation, have stated that they wished that they had been told the truth earlier, that the love and respect they have for their parents would not have been lessened. Some felt they had been betrayed because their parents had not been truthful and might have withheld other important information. Since egg donation is a relatively recent procedure, children born as a result of egg donation are still young and have not yet expressed their views on this issue. Q: When do you tell a child? What's the best time? A: Child development experts recommend that the child be told as early as possible. Even at the age of three children the idea can be planted, for example, by reading a story book. (One example: Mommy was your tummy big ? lulu.com/content/365108 ). In this way, the story becomes part of the child's reality from an early age, and she won't be able to recall a time when she didn't know this aspect of her history. Q: Isn't the concept hard for young children to understand? A: Not if it's presented in simple language and is not too detailed. By age four or five, most children will ask questions about how babies are born, so parents can take advantage of their natural curiosity. Don't tell young children more than they can absorb or more than they're asking. Telling doesn't happen in just one session, so remain open for ongoing conversations as questions will keep changing. Young children usually don't regard the topic as a big deal and quickly move on to something else. Q: How do you tell? How much information is appropriate? A: Keep the child's developmental stage in mind. The specific information should be tailored to the age of the child in language he can understand. For young children, it's okay to use terms that may be somewhat inaccurate but familiar: for example, you might say tummy for uterus, or egg for ovum, and then correct it later on. Whenever possible both parents should tell the child together. Don't tell too much; just answer the child's questions. Keep the communication honest, open and age-appropriate. The underlying message should reflect the fact that the parent or parents needed help and some very nice person helped. It is recommended that the word donor be used to describe this person. Referring to the donor as the real or biological parent erroneously implies that the donor has a parental role in the family. Q: What about telling an older child? At the age of eight or nine a child is expanding his ability to tune in to the feelings of others and can understand why parents might need help to have a child. At this age children can understand about genetic connections and about sex and about egg or sperm donation. Make sure the child knows there was no sex between the parent and the donor. It's important to focus on the child's needs and feelings, not the parents'. Talk about the various ways that people form families, and that this is the way you chose, stressing the warm and loving feelings, not the technical process. Allow time for questions; it takes a while for the information to sink in. Then check in a few weeks, and talk again. Ongoing talks of this nature normalize the process and usually make the family feel closer. With adolescents, keep several issues in mind: adolescents are focused on themselves, and issues of trust and identity are prominent. They're dealing with pubertal changes in their brains and in their hormonal systems. The immediate reaction of an adolescent can range from apathy to shock and anger. They may question why they haven't been told before. As adolescents struggle to establish their identity and their independence, new knowledge about their genetic inheritance requires considerable adjustment on their part. Q: What about telling the child of single parents and gay and lesbian couples? A: It's clear that a single parent cannot have a child without a partner and that two same-sex partners cannot create a biological child with each other, so the child must be told that a donor was involved. The time when a child asks about her mommy or daddy presents a natural opportunity. A number of books for children are available on this issue. Q: What if the parents have other kids, either naturally or by adoption or by other forms of ART? A: Parents should share the information with their children about how they chose to make a family at a time when they're all together or shortly thereafter. If there are differences, they should be explained. In this way, the facts are out in the open. Since cultural values have become more inclusive and accepting of the many ways that families are made, children are less likely to feel different than their peers. Q: Is it ever a good idea not to tell? A: Under certain circumstances it's not advisable to tell: a) if a child is not capable of understanding because of mental retardation or other condition, b) if parents are in a state of conflict, such as divorce, when telling might occur in a moment of anger, c) if the child is going through a particularly stressful time, and d) if the family is part of a culture in which assisted reproduction is a taboo and the child would be ostracized. Q: Should other people be told? A: Some people must be told. Physicians, for example, need to know a child's genetic background. It may also be advisable to tell teachers if the topic is likely to come up in class. It's usually advisable to inform family members and friends. The child may wish to talk with them at some point, and family members and friends often create a support network. Some children may participate in the decision of who to tell. Around the age of eight a child can understand the difference between privacy (which is the individual's right not to divulge information) and secrecy (which is shameful). By this age a child can decide who to tell or to keep the information to herself if she prefers. Q: How do parents' experiences in the process of infertility and in considering the help of a sperm or egg donor or other form of ART affect their decision to tell and the way they tell? A: Anxiety and reluctance about telling are to be expected. Telling may reawaken earlier feelings of shame, blame, guilt and the emotional ups and downs regarding infertility. Parents have had to make hard choices and have had failures and disappointments in the processes involved. They have had to grieve for the fully genetic child they cannot have with each other and to adjust to the change in the future they imagined together. Despite the pain of re-experiencing these feelings, many parents report that they feel relieved after telling their child and that the family is stronger. Q: Research thus far reports that children born as a result of sperm donation are doing well psychologically. When should people consult a mental health professional for guidance in making decisions about telling children, family, friends and others? A: If parents are unsure or in conflict about deciding to disclose, need help with the specifics of how and when to tell their children, or tensions among family members are causing distress, consultation with a mental health professional with experience in this field can be helpful. Helpful resources Further information and bibliography for parents and children are available on the following sites: www.dcnetwork.org presents information about telling and talking to children as well as other donor issues American Society for Reproductive Medicine (ASRM) www.asrm.org presents multidisciplinary information in regard to education, advocacy and standards in the field of reproductive medicine. The ASRM Mental Health Professional Group deals with psychological issues in reproductive medicine About the Author Margot Weinshel, LCSW, RN , is a clinical instructor in the Department of Child and Adolescent Psychiatry, NYU School of Medicine, on the teaching faculty of the Ackerman Institute for the Family; and in private practice in Manhattan. She is Membership Chair for the Mental Health Professional Group of the American Society for Reproductive Medicine. Ms. Weinshel is the co-founder of the Ackerman Institute's Infertility Project, co-author of Couple Therapy for Infertility (Guilford, 1999) and author of Surviving an Eating Disorder: Strategies for Families and Friends (Harper Collins, 1988, 1997). She has also co-authored chapters about infertility in Couples on the Fault Line , edited by Peggy Papp (Guilford, 2000) and Handbook of Primary Care Psychology , edited by Leonard J. Haas (Oxford University Press, 2004). Ms. Weinshel has published numerous articles and presents nationally and internationally.

Shilpa is a mom via surrogacy who is currently expecting her second child with the help of a Donor Concierge surrogate match. Here, Shilpa provides excellent advice on managing the relationship with your surrogate. Hi Shilpa! Give us a little background on your story. We struggled with infertility for about three years when I found Donor Concierge. They found my first surrogate fairly quickly and we had the most amazing experience and now we have a daughter. And now I'm on my second journey, and my second one is due in December. I have a very close relationship with both surrogates and hope my story can help others. At the beginning, did you have ideas of what the surrogacy journey would be like? With our first surrogate, we were a deer in headlights and we didn't really know what that would look like for us. We didn't really know what we were going to tell our daughter. My advice is to start having those conversations early with your partner. We decided that we did want our daughter to know. So off the bat, we wanted our surrogate to have an open relationship post delivery. That is the first thing that we told Donor Concierge. We also wanted a close relationship during the pregnancy. I wanted pictures with her. I wanted to show my baby pictures of her growing in her belly. That was really important to me. I thought that was important for bonding purposes. And so, we started having conversations with my husband and I about what that would look like for our family. We were lucky enough that Donor Concierge was super respectful of that, and they found us a surrogate who was also really respectful of that and really wanted a relationship like that. Tell us about your daughter’s surrogate and how you established a close relationship with her? She had done a surrogacy journey before and did not have that closeness with her other intended parents. We established what we wanted from the beginning. We sent toys for her other children at Christmas time. We knew the names of her own children. We took her and her family out to dinner when we were with them. She ended up meeting my family when we were there for the birth before she delivered, things like that. And that meant a lot for us. We even did a photo shoot, so we had a maternity photo shoot and we will show our daughter those pictures as she grows up. How do you plan on talking with your children about their birth? How we explain it to our daughter now is, “we want to do so badly that we had to have an extra heart to create you”. * How did you handle a baby shower when you are having a baby via surrogacy? Both surrogates were included in our baby shower. She obviously didn't travel here for the baby shower, but we had her on Zoom and both of them shared the belly and each table wrote a message and we shared it to them. And my parents thanked her for making them grandparents and everything like that. We hope that our second surrogate will be able to meet my parents as well. During the pregnancy, what was the communication like? Our surrogate was kind enough that I would message her and be like, “Any pregnancy cravings?,” And she'd be like, “Cheez-its!” And so we would send her boxes of Cheez-Its, and then she'd be like, “Enough, please, this weekly order of Cheez-Its is getting slightly out of hand,”. We're like, “Oops, our bad”. And then she'd go to pickles. And so we would send her pickles and then she'd be like, “Okay, enough of the pickles”. We just kind of had humor about it. I would also be like, “I'm having pregnancy cravings for Ben and Jerry's ice cream. How about you?” She's like, “Oh my gosh, that sounds so great”. So we would eat Ben and Jerry's ice cream together as we watched a movie and we would do silly things together. Did you ever have uncomfortable feelings seeing your child growing in another woman’s belly? I think for moms especially, it can be hard. You can think you want one thing, which is a close relationship, but I think jealousy can come in the way of that. We are human beings. There were times that I would start to feel a little jealous that I didn't have my daughter growing in my belly and I would take a break and I would step back a little bit. Our surrogate didn't notice that I wouldn't message her for a couple of weeks at a time. She didn’t even notice that I would ebb and flow and then I would take care of myself and I'd put boundaries up that it might take me a couple days to respond to her and things like that. The second thing that I would add is - putting ourselves as intended parents in their shoes is also important. They're carrying a baby for you and they have to give up that baby. They have a connection to that baby too. Did you have a birth plan and how do you navigate that with your surrogate? Yes, you're going to want to have a birth plan. It answers the big questions -- who gets to hold the baby first, what exactly do you get from the GC right after such as colostrum (the milk that comes out right after the birth). Our surrogate gave birth very quickly. For my birth plan, I got to hold the baby first. My husband got to cut the cord and the baby came to me. At that point, there may be bodily fluids on the baby, but you just don't care - this is your baby. Our surrogate knew our wishes and she was supportive. My advice is to advocate for what you want. Another big part of the discussion about the birth plan is who can be in the room and where people stand? Can it be recorded and what can be seen? My husband was required to stay at the head and I could be at her feet so I could see the baby come out. After the baby is born, they do stuff to make sure the surrogate is okay. After the birth, she’ll want to catch her breath, maybe drink water. We were immediately given a separate room from the surrogate, which is pretty typical. You mentioned that the surrogate gave the colostrum - was that in the birth plan? Yes. For us, it was important that we got the colostrum. That's the milk that comes out of the breast right after birth. It's given to you in a syringe and delivered by a nurse by hand, and we would give our baby the syringe colostrum. You wake up the baby, you give the colostrum. Colostrum is very beneficial nutrition wise for your baby. Doctors will discharge you and the baby when you're ready. Our surrogate was discharged before we were. We had an agreement to get breast milk from our surrogate. She pumped and we shipped it from California to Michigan for a couple months. How far ahead do you make the birth plan with the hospital? It’s something you can do as early as the matching process. However, when there are things that are deal breakers, you want to discuss them early. A deal breaker for me was to be in the room. It was important to me that I got skin to skin contact with the baby when she was born. You have to think about what's important to you. The team at Donor Concierge was really good about walking us through essential parts of the birth plan. So we asked our surrogate if we could hold the baby first, and she agreed. And so those really important things to you, you want to discuss right from the start. What other things were important to you when matching with your surrogate? I don't think there's any right or wrong. I've talked to people where a vegetarian diet was important or who wanted them to take specific vitamins. This wasn’t important to us. We asked Donor Concierge to find us an experienced surrogate. That was extremely important to us. We wanted someone who knew what it felt like to carry that baby and who knew what it felt like to give up that baby at the end of the day. That was actually one of our deal breakers. However, there's a flip side that when you have more births medically, they can have more scar tissue and some other issues. But on the other medical flip side is they've already had an IVF protocol that has been proven to work and their body has been proven to handle a surrogate pregnancy. For us, we were just so scared of heartbreak because we've had miscarriages and we felt like babies were already taken from us. I'm getting goosebumps talking about this but, we couldn't bear that happening again. How did you know your surrogate was the right person or not? Do you have any tips or advice on how to trust the process? The mind can go in a lot of places. And one thing that I had to learn that was really hard for me when I was going through IVF, was to give up control. You have to trust the surrogate, especially if she's done it before. I'm an A-type personality that was very hard for me and I just had to let it go. You can't control when it's someone else, you just can't. Before we found Donor Concierge, we were with a different company. They presented us a surrogate who had one child, but she also had had a baby who died of SIDS. I knew that I couldn't give up control if I went with that surrogate. I told my husband, I'm sorry, I can't do it. If you're not comfortable with the person in your innate self, you shouldn’t go with them. You can also ask multiple times to meet with the surrogate if you're not sure. We met our surrogate on Zoom and we talked for an hour and a half. We did not have any doubts. The same thing happened with our second surrogate - we just knew. How do you navigate everything when you are not geographically close to the surrogate? ** At first, geography was a really big thing for us. But I think over time, after we found Donor Concierge, it became less important to us, but it was very important to us in the beginning because we almost wanted to keep tabs on the surrogate but I just had to let that go. Our situation is a little unique because Michigan is a very bad state for surrogacy. We were trying to find someone in Chicago, but it was really just really hard to find someone there. Two things that I would look into are direct flights to a big city and where you have family that you trust. At some point you have to fly out for the birth. Take the total flying time into consideration because what's closer might not actually be closer. You’ll have a timeline and when it comes close to your surrogate’s due date. So your doctor is going to predict that the baby is going to come early, and you'll kind of get a heads up. My husband and I planned to fly out a week and a half prior to the delivery date. Once the baby is born, you're in the hospital for three days until you get medical clearance to fly them home. So, you can kind of gauge as far as how long you're going to be there with those dates. The doctors work with you, they try to give you the best estimate time. Now obviously it's not perfect, but they're going to give you a generous timeline so that you don't miss the birth as far as doctor's appointments. Any tips for traveling with a newborn? ** We had a complication so we couldn't come home right away. It took us three weeks to come home. So we actually just looked at travel time and we found it was cheaper to get an Airbnb for a month and pay a month at a time and just pay for it. Having a base is easier because you can do all the bottle warming, and you can function better with multiple rooms so the baby can sleep and have the monitor and things like that. There are some tricks that you can do for traveling. You can buy sterilization bags that take up no room in your luggage instead of bringing a sterilization machine because you have to sterilize it for newborns. You buy bags, fill them up with water and they're like steam bags. Tell us about the first few months after you got home with your baby? ** I think it was easier in a way since I didn't birth medically, I didn’t have the complications, I didn’t have any weight restrictions, my body didn’t go through the hormonal change that a lot of my friends have gone through who have birthed. So medically and physically, I was okay. I was the same. Postpartum depression and anxiety is a very real thing for people that give birth and for people that give birth, they have that bonding experience of breastfeeding. If moms that give birth have a difficult time with postpartum anxiety and depression and bonding with their child, then one could expect that a mom that did not birth their child would also have those complications. To be quite honest, I did struggle with that a little bit. I noticed it and I asked for help because it's not something you should be ashamed of. I say that loud and clear, it's nothing to be ashamed of. If moms at birth struggle, then moms that don't birth, they struggle as well. So, I got a doula and I told her and she gave me some tricks. Some of the tricks were, take a bath with your baby, have someone watch you while you sleep with your baby. If someone's watching over you, it can make it feel more safe. So I would take a nap with her while the nanny was watching me very closely. I would take a bath with her. I would start to notice that I could get smiles and laughter from her. And something changed and I definitely bonded with her. It probably took me maybe three months. I still cared for her. I still loved her. But the bonding just took a little bit longer than one would hope. There's this expectation in society that it's love at first sight and they take their first breath, that you take your first breath when you see them and it's supposed to be automatic. Well, that's not everyone's experience. It's okay to acknowledge that and it's okay to need help. And it's definitely okay to ask for that help. And that's what I did. And now I couldn't imagine my life without her. Did you have any particularly uncomfortable feelings that came up for you after the birth?** I think I always felt a little bit of guilt for not being able to carry her that I've worked past now. I felt a little bit guilty that I couldn't breastfeed her. People who are pregnant have nine months of bonding, starting with the first pregnancy test, feeling the baby kick and on for nine months. Whereas when I didn't carry her, you can forget that you're pregnant. When I told people, I told people I'm pregnant, I told people I'm expecting, I would tell people that it wouldn't change the way I would say anything. I would say I'm pregnant, I had a baby shower. I might not have had a baby bump, but I had a baby shower. I experienced as many things as I possibly could that I could as if I was carrying. How did the family of the surrogate react, such as the surrogate’s husband. Were there any emotions or things that you've found interesting?** Our surrogate was married and had children at home. They talked to the children about it and explained, “we're not keeping the baby, this isn't your brother or sister, remember we're just helping out a family”. We took our first surrogate's family for dinner. So I did meet the husband, and he told us that he didn't want to go to the hospital for appointments. He would take her to the hospital, she would do her thing with her mom. Her mom was her support system, and mom would drop her home and then he would do the post care of her, but he just never wanted to be in the hospital. How did you handle the fear of complications?** No one can prevent any medical complications. And of course what gets publicized is the worst case scenario of everything. So one thing that my husband and I often did was we'd say, what if something happens to our surrogate? And then immediately we would say, what if nothing happens? Remember that the probability of a good thing happening is much more likely than the probability of something bad happening. In your legal paperwork, not that this is any real consolation of anything, it will outline what the family gets or what she gets. But again, that's not really any consolation, but it will be addressed if something were to be like that. But I think it goes along with trusting the process. Try not to get worked up in that. When you hear yourself starting to say those what ifs, it's so easy to immediately tell yourself what if something good happens. I know it's hard. I know it's really hard and it's really challenging for sure. What other things were important to you during this process? Maintaining a relationship with us after the birth was important to us. Getting the Covid vaccine was important to us, letting us make the decisions on medical stuff with the doctors. So that is, selective reduction, termination if something was wrong. Donor Concierge is there to support all intended parents . They're going to do what's right and they're going to advocate for you. And so there's no harm in asking for a specific thing you want. I mean, if it's something absurd like, waiting six months, the Donor Concierge team will be honest and help you with realistic expectations. If you have questions about surrogacy, talk to us today !