 Good afternoon. Can you hear me okay? I think I lost my voice on the flight. All right my name's Erica Fuchs. I am a former compensated gestational carrier. I'm also a faculty at the University of Texas Medical Branch but today I'm going to be talking about my experiences a little bit of my research and how things worked for me and I was a carrier in Minnesota at the time. I want to list my conflicts of interest because in academic I have intellectual personal biases and I've been sponsored to attend today. So who am I? I'm the married mom of three kids 16 and 6 and almost 2. I'm a social and behavioral epidemiologist in maternal child health and I delivered twins as a gestational carrier in June of 2006. It's been a while. The goal in the US for compensated surrogacy of course is for all parties to be legally empowered and protected and this is really important because the ultimate goal is to have a healthy outcome for the gestational carrier and the resultant children. I sometimes feel like the carrier is left out of this a little bit with the supreme focus on the well-being of the child. So what are the steps and requirements? Well there's basic requirements that are listed by the American Society for Reproductive Medicine and SART. The gestational carrier should be between 21 and 45. The raising one of her kids at least have had one term uncomplicated pregnancy. Ideally being done having her own children that wasn't the case for me but I didn't know at the time life happens. In a stable environment then she should be financially secure. She will then go through psychological screening, some interview and testing with a qualified mental health professional. Hopefully they have experience dealing with fertility and fertility. Go through medical screening and then she will enter the matching process and the legal process and sometimes those steps are mixed up a little bit. So my experience here I put the basic age and financial requirements. I then had a psychological screening with a PhD licensed marriage and family therapist. I had an interview with her in person for about two hours I think and then I took the Minnesota multi-physic personality inventory the longest exam except for my dissertation. I had medical screening a records review of my previous pregnancy and delivery and many many lab tests and invasive tests as well. Everything to ensure the lowest risk of adverse events this is for the gestational carrier for the babies and of course an intended parent wants a good womb right. So the benefits of using an agency in the U.S. private businesses can help facilitate the process. Some of the things that these agencies do are schedule screenings, facilitate with the matching process, assist with legal representation for one party usually the intended parent or parents, coordinate travel and reimbursement and support the gestational carrier and intended parent or parents in communication and mediation when things come up. In a previous study that I conducted 71% of gestational carriers used an agency in their most recent gestational carrier arrangement. My experience with an agency which was Steve's so full disclosure extremely easy and the matching process was facilitated via phone because this was 2006 we didn't have texting or video chat screening travel hotels and reimbursements were all handled I rarely had to pay anything out of pocket I think I was telling somebody earlier today the only thing I recall paying out of pocket were cab rides from the airport to the hotel. So some of the matching preferences that people might look at when they are entering as being a gestational carrier the type of intended parent that they're interested in do they want to work with a couple hetero gay single person or some other arrangement they might have religious preferences some people want to work with somebody who is their same religion or lack thereof they might want to work with a domestic or international couple as far as compensated surrogacy goes it's usually an astral process sometimes people want to talk ahead of time about the relationship that is desired from the end of this agreement some people want to have a really close relationship with the intended parent or parents and some people want to have more of a hands-off relationship and have it be a little bit more of a professional relationship and then of course talking about termination of pregnancy is really important ahead of time and hopefully everybody discusses that. Some of the other matching preferences the desired communication frequency which I already mentioned diet or exercise preferences some intended parents really want a woman who has a specific diet or is willing to have a specific diet during her pregnancy these aren't really things that are legislated so much but you know might be talked about or discussed during that matching process birthing preferences some women really want to get birth at home or in a birthing center some intended parents aren't into that or vice versa pumping and breastfeeding is really hot topic in this area as well some parents really want their babies to have breast milk for the first few days or weeks whether a single or dual embryo transfer will occur is important and the number of attempts that they may be willing to go through so if you agree on all of these congratulations so the legal experiences already has been talked about by the other speakers it varies widely by state from prohibition of compensated gestational carry or arrangement to pre-birth orders Minnesota was in between which doesn't prohibit but didn't have any case law Steve already talked about this my case was a single intended parent and so once my rights were removed there was no mother to be added to that birth certificate afterwards there's a great map of the state laws on the creative family connections website so other important legal considerations reimbursement or compensation how much insurance coverage for health and life which is necessary in the US establishment of parentage how that'll work again multiple embryo transfer if you're willing to undergo that or not and then talking about termination or reduction in what kind of circumstances that will occur there are risks of multiple gestation the top five risks are preterm birth low birth weight preclampsia gestational diabetes and cesarean section in the previous study that I did the percentage of carriers with multiple births was 35 percent which is 10 times higher than the population overall but this is actually half as much as it was in the early 2000s so single embryo transfers have gotten much more popular and so therefore the multiple birth rate has gone down substantially so again terminal termination agreements cannot be enforced so the woman still has autonomy over that choice regardless of what they talk about or agree about prior to the pregnancy occurring so my experience I was 22 years old and I became pregnant as a gestational carrier I had one child that I was raising I did a frozen dual embryo transfer which failed and then a dual fresh embryo transfer that resulted in twins so in the mid 2000s it was still really common to do dual embryo transfer my delivery experience was very easy twins were born a little bit early but they were very healthy I put my conversion up there for you uh Kilgram users um the intended parent was able to attend their birth which was really great um and I delivered in a large metropolitan area in the Minneapolis area of Minnesota but at the time it was still kind of unusual for them to be dealing with this but everything went very well so in my case there were three major necessities that made it very easy for me I had a supportive family I had financial security and a lot of backup child care which was very needed especially um at delivery so some difficulties that I uh incurred during the process life kept happening so things come up my mom was diagnosed with terminal cancer during my surrogate pregnancy so that was difficult um attending court during recovery can be tough um I was sick during one of my court appearances but I did make it there so having to go to court you know three days after you have a baby not the most comfortable experience so here's a picture of me one of the babies I used in an emoji to protect a baby's privacy but uh they're 13 years old now so I don't think you'd recognize them um baby's spent I think 12 days in the nursery they were not in the make you at all and I just got back to my usual life going to school and parenting so in in hindsight the things that I found very important for me personally was screening is very important for everybody's protection while being I really think that's important um agency support made the process super easy I mean a lot of people do these things independently but I was too lazy for that so um agency support was great legal contracts are important for when things go right or wrong and without interpersonal support stability the process could be very stressful so that's it you can ask me invasive or non-invasive questions at the