First in a four-part report
On a sunny weekday morning, Diane Hinson pauses at the door of a generic office park in Northern Virginia. It's a routine work appointment for her, but a potentially life-changing event for her clients.
"I'm here today for the transfer of embryos," she explains.
Hinson is one of a growing number of lawyers making a living by coordinating surrogacies — a pregnancy where a woman bears a child for someone else who can't conceive or carry a pregnancy to term. According to the Society for Assisted Reproductive Technology, more than 1,400 U.S. babies were born this way in 2010, and many more such births are thought to go unreported. This small, but fast-growing field is fraught with risk, and often intense coordination is the only way to avoid a legal nightmare.
Inside the Virginia Center for Reproductive Medicine, Hinson greets Joy, a confident and upbeat surrogate-to-be who has flown in from Florida for this appointment.
"I knew how much of a joy it was when I had my baby," Joy says. "I thought I'd love to do this for someone."
Hinson has matched Joy with Michael, a single man from Germany who wants to be a father. Surrogacy is banned in Germany, and both will only let us use their first names.
The two embryos ready for transfer were created using Michael's sperm and the eggs of an anonymous donor in Washington, D.C. Confused? The point is that — like almost all surrogacies now — Joy will have no genetic connection to any baby she carries.
Joy signs a consent form agreeing to carry twins if both embryos implant. With a hug and a quick "Good luck!" she heads back to an operating room for the procedure.
A Legal Patchwork
When surrogacy works, it's like a miracle for people who never thought they'd be able to have a child. But when it goes wrong, it goes terribly wrong. And though that doesn't happen often, those are the cases you're most likely to hear about — surrogates changing their mind and deciding to keep a child, followed by protracted custody disputes.
Surrogacy is largely unregulated and, thanks to the Internet, it's become a do-it-yourself affair with potentially disastrous results. A decade ago, Hinson started Creative Family Connections in Maryland with the aim of creating order in a reproductive Wild West.
"We actually made this map of the United States," Hinson says as she pulls it up on her laptop. It's a colorful display of varied and competing state laws on surrogacy. There are "proceed at your own risk" states, where surrogacy is prohibited, but goes on anyway; there are "green light" states that permit it and "yellow light" states that won't enforce surrogacy contracts; and then there are the states that allow it with certain restrictions, like you have to be in a traditional marriage.
"And then we've got a huge number of states which we call the 'vacuum' states," Hinson says. That means there is no statute and there are no published court cases. There's also one "red light" state where surrogacy is criminal — Washington, D.C., just down the road from Hinson's office. She says she once spent a panicked day trying to keep a hospitalized surrogate in Maryland from being transferred to D.C.
"They're like, 'Well, what would happen if this baby was born in D.C.?' because she was having contractions," Hinson says. "I'm like, 'I don't know, and I don't want to find out.' "
Visiting A Surrogate
According to Creative Family Connections, prospective parents can pay well over $100,000 in legal and medical fees. With all that at stake, Hinson must first figure out where clients can hire a surrogate; then she sets out to find a woman for the job. She and her colleagues place personalized ads and carry out an intense vetting process that includes a psychological evaluation and home visit.
At one such visit, Crystal Andrews welcomes Creative Family Connections partner Linda ReVeal and a case manager into her tidy townhouse in Bel Air, Md. "I feel like I need to hug you, I've talked to you so many times," Andrews says. Andrews wants to be a surrogate, and her husband, John Andrews, has taken off work to be here.
The couple meet crucial criteria for surrogacy. They already have children, so Crystal presumably understands the emotions involved in bearing a child; their home — or "in utero environment" as ReVeal calls it — is clean and happy; and they are not on government aid. While surrogates get paid about $20,000 plus expenses, the idea is to rule out anyone who's doing it only for the money.
John assures them he is supportive, another must. "I see it as a chance for her to provide for somebody else who can't have [a baby]," he says.
ReVeal presses: "You don't think it'll be weird or uncomfortable to have your wife be pregnant with a child that isn't yours?" she asks.
No, he says, and family and friends are also onboard. Crystal tells them she enjoys being pregnant.
"It's like I have a purpose," she says. "It's like I'm doing something important."
A 55-page contract will make sure surrogate and intended parents see eye to eye, spelling out everything from when they'd agree to terminate a pregnancy to how the surrogate will try to eat a well-balanced diet. ReVeal also asks what kind of people the Andrewses would like to help — a married couple, a same-sex couple or a single parent. Crystal says it's all good.
"I think people who are uptight might not jive with us very well," she says, "just because we're just very relaxed."
Hinson says she does her best to make a good match between surrogate and intended parents. But in the end, she says, this relationship depends on trust.
"I always liken it to parents who have a nanny," she says. "If you think you need a nanny-cam, you're getting the wrong person. You have to ultimately trust that this is the person who's going to take care of your baby."
The Surrogacy Bond
Back at the Virginia fertility clinic, the embryo transfer went well for Joy, the surrogate from Florida, and the doctor comes out to show off the ultrasound.
It's exciting, but if Joy becomes pregnant, there's always the risk that she'll bond with the baby she carries. Instead, Hinson encourages surrogates to bond with the intended parents. Joy has already spent time with father-to-be Michael and they talk on Skype. She also knows how she'll explain all of this to her own toddler son.
"I'm going to take pictures for Michael to see my belly," she says. "When my son gets of age, I'll tell him Mommy helped create a baby for someone else. I'm hoping I can say, 'See, this is Uncle Michael's baby.' "
If all goes well, today's black-and-white ultrasound will be the first photo for Michael's — and Joy's — baby book.
This story was produced for broadcast by Marisa Peñaloza.
Copyright 2012 National Public Radio. To see more, visit http://www.npr.org/.