#16: Reproductive Reshuffle: Mary Fusillo Decodes Egg Donation and Surrogacy

Navigating the world of assisted reproduction with Mary Fusillo

In this episode, we speak with Mary Fusillo, a practitioner in assisted reproduction for over 25 years. Mary shares insights on her company, Family Solutions International, which provides egg donation, surrogacy, and fertility consulting. She contrasts US and European practice, particularly around donor compensation, and details the screening and selection of egg donors. We examine financial, logistical, and emotional aspects of egg donation and surrogacy, including cost breakdowns, roles and expectations for surrogates and intended parents, and ethical questions around donor anonymity. Mary also highlights psychological impacts and common challenges for all involved. This episode gives a comprehensive look at the complexities, joys, and ethical considerations of assisted reproduction

Timestamps:

00:00 Introduction and guest introduction
00:08 Mary’s background and career in assisted reproduction
00:52 Focus on egg donors and surrogacy
01:17 The egg donor process in the US
01:38 Compensation and selection of egg donors
03:41 Fresh vs frozen eggs
04:59 Costs and European perspective
06:11 Ethics and anonymity in egg donation
08:54 Logistics and travel for egg donation
16:03 Progesterone support in early pregnancy
21:03 Donor-egg cycle timeline
22:44 Age and ethics in donor-egg usage
25:46 Reasons for choosing donor eggs
28:09 Attachment to DNA and family
30:23 Introduction to surrogacy
33:11 Cost of donor-egg surrogacy
34:26 Typical surrogate profile
36:05 Surrogate relationships and dynamics
43:00 Cross-border surrogacy trends
47:49 Single men and surrogacy
50:23 Genetic testing and embryo screening
53:39 Ethics of telling children about their origins
56:33 Regrets and relief in egg donation and surrogacy
01:00:04 Final thoughts on third-party parenting

Social Media Links

Facebook:

https://www.facebook.com/familysolutionsinternational/

https://www.facebook.com/DonorSolutionDotCom/

Instagram:  

@the_eggsplanation_pod

@familysolutionsinternational

@donorsolution

Resources Mentioned in This Episode

1. Egg Donation & Surrogacy Pathways

• Egg Donation – Discussed as a family-building option for individuals and couples facing infertility, genetic conditions, or age-related fertility decline.
• Gestational Surrogacy – Explained as a process where the surrogate carries a pregnancy but has no genetic link to the baby.
• Key Distinction Covered:
  • Traditional vs gestational surrogacy
  • Donor eggs vs intended mother’s eggs
    
    

2. Legal & Ethical Considerations

• Importance of legal contracts for:
  • Egg donors
  • Surrogates
  • Intended parents
• Discussion of cross-border surrogacy risks
• Emphasis on using licensed agencies and fertility clinics
• Consent, autonomy, and long-term wellbeing of all parties involved

3. Medical & Screening Processes

• Psychological screening for donors and surrogates
• Medical testing and fertility screening
• Hormonal stimulation and egg retrieval (egg donation)
• IVF processes involved in surrogacy journeys

4. Emotional & Human Aspects

• Emotional readiness of intended parents
• The lived experience of donors and surrogates
• Importance of counselling and emotional support throughout the journey
• Reframing stigma around non-traditional family building

Insta/TikTok: @BiohackingEve
Website: www.BiohackingEve.com

Transcript

Judith Mueller 0:00

So for listeners who are new to, so can you step out the medical steps, legal contract costs, et cetera, et cetera?

Mary 0:07

Okay, so surrogacy that I'm discussing is gestational carriers surrogacy, which means that the surrogate has no genetic connection to the child, so it's somebody else's sperm and eggs implanted in her. And so finding a surrogate takes several months because there's a. fewer surrogates than there are people that are needing surrogates. We have a wait of anywhere from two months to six months to match with a surrogate. Once you guys have matched, each person decides if they wanna match. So it's a much more open process than most egg donation is at this point. Then you're gonna go to your clinic, you're gonna be screened, and you're not gonna do genetic screening or anything like that, but they're gonna look at your uterus. They're gonna do all these blood tests. After that, then you do legal. Legal takes the longest. In my company, we have a worksheet that the surrogate has already filled out with her compensation, that she wants her choices about all these things. It's six pages long, when will you allow them parents to make choices for you? How much compensation do you want for a c-section? Do you wanna pump breast milk? So all these questions are in there that goes to both couples, the couple and the. Surrogate and her husband, if she has a partner, have signed this and it goes to the attorney. The attorney then writes the contract based on this, the intended parents approve the contract. Then the surrogate and her attorney approve the contract. They write a letter saying everybody is happy. Now the intended parents fund the escrow account with her compensation and the miscellaneous stuff. And then the clinic says, okay, we received the letter, you're ready to go. And they can have an embryo transfer no sooner than 14 days after the signature on the, because that gives people time to change their minds. Okay? So soup to nuts. Some of the time you have matched until you have a transfer is probably five to six months. People want it to be faster. It's the dang lawyers that take up all the time. Okay? So they take a long time to do their stuff. So all in right now, I'd say that without the cost of IVF, because remember that changes from every different clinic has their own price range. But if you're gonna do agency fees, secret compensation insurance,'cause you have to have insurance, it costs a lot of money. Legal, psych, medication, travel, all that. You're talking probably somewhere between, I'd say 105, 110,000 to 130,000, depending on if you need more than one transfer of embryo. So the first time doesn't work. You're not starting all over again. She's coming back. But you're gonna make payments, she's gonna get paid for the transfer, the clinic will get paid. So that's what we call, so when you throw in the IVF portion, you're asking another 25,000 or so. If you throw in donor egg. can see that cost. So you would say if a donor egg surrogacy pregnancy for say two same sex. Same sex couple, you're looking at 160, 175,000

2:54

Welcome back to Biohacking Eve, health Optimization for Women with Judith Miller, where we shine a light on everything that will help you reach your best self. As a woman, as unique and individual as then you can be live long and prosper my friend.

Judith Mueller 3:14

Hello. Welcome back everyone. Today I've got Mary Fusillo with me. Hi Mary.

Mary 3:20

Thanks for having me.

Judith Mueller 3:22

So Mary, you've been a practitioner in assisted reproduction for the last 25 plus years, so tell us about what you do.

Mary 3:29

Okay. I own three companies under the umbrella called Family Solutions International and we work with people that need an egg donor that's the donor solution. They need a surrogate that's three sister surrogacy and then if they just don't know which way to go, we have the fertility consultants that helps them navigate it. So I've owned this business for 18 years. I started it after a career in both nursing in the hospital and then managing IVF clinics and doing consulting. So this is the end, end part of my career.

Judith Mueller 4:00

You've seen quite a tectonic shift in the industry. I imagine today I actually wanna focus on egg donors and surrogacy.'cause I think they're topics that are really not looked at that much. And as you say, end of career in the sense that it's the end of the line for many couples that have, try to conceive naturally they've gone through IVF, et cetera. So let's start with egg donors. I appreciate that the landscape is quite different in the US than it is in Europe. Tell us a bit, what is the process in the us? How do people actually come to you? What are they looking for? What are they confused about?

Mary 4:34

Okay, it is totally different. And being a member of esra, which is European Society for Reproductive, whatever, the whole long thing, Esra. I know I see the European side too,'cause I go to the meetings and I'm part of that group. But the biggest. I think difference is a, we compensate donors and we compensate them well. Okay, not just a token, they compensate. Two, you have a large variety of donors. You can pick somebody who could be your double basically. And that's the goal. So what we're doing is we are recruiting young women between say, 21 and 29 to be donors. We're looking for people, they have to have a minimum of two years of university or college education or be in a trade. So they could be an esthetician or they could be a hairdresser, but they can't, they have to have something that they do that would appeal to others. They also had to have a clean family history. So we're checking medical records. We have a very large intake form. It's 26 pages long that talks about all their family members and diseases. And did grandpa have diabetes and does your sister have this? We're also looking for disease states in people. Although there is genetic testing now, we wanna kind of weed them out early. We probably receive with my company. Five or so, six applicants a day. Sometimes if we're doing a big advertising blitz, we'll get 10 or 15. Usually that kind of translates to five or six that actually make the cut and not because we're so tough. Yeah, we are tough, but it's because people drop out. They're like, oh, this sounds fun. And then they go, oh, I don't wanna fill out this paperwork, or I don't wanna have to get my college transcripts and I don't wanna get my medical records. So that's how come we end up with that. So we usually range between 250 and 300 egg donors at any one time. We have multi-ethnicity, we're based in Houston, Texas, which is a very international city because of the oil business and the medical business. So we have a lot of people from there, but we are across the country. So that's the egg donor side.

Judith Mueller 6:36

And when you say you've got a certain number of any one time, does that mean donated eggs are always fresh or would they come from frozen as well?

Mary 6:45

We do fresh. The pendulum has swung back and forth repeatedly. I would say that people a lot of private equity money, which is one of my favorite subjects, got into the egg freezing thing. This is good. We're gonna make it just like sperm donation. The issue was that when you retrieve the eggs, then you freeze them, then you thaw them to inseminate them down the road, then you freeze them again because remember, you're gonna have to do genetic testing. So now you've thawed and froze. Thaw, andro, I always use this analogy that, think about it. When you leave the ice cream out, out, you go, oh, I forgot to put it away. And you put it back in the freezer and then you eat it again and it's gross and it has ice crystals. my, now the scientists would go, oh, you're wrong. But the pregnancy rates are lower per transfer. It's better to do a fresh donor per transfer at the end of the day. If you use up all your embryos with frozen eggs, you will achieve a pregnancy about 60, 60% of the time, whereas you're gonna achieve that same percentage at one transfer. So the bottom line is you don't get as many eggs with frozen, whereas you get all the eggs from that cycle with a a fresh donor.

Judith Mueller 7:58

And what are the costs that a couple or, someone who's looking to use an egg donor would have to look at in the US and in Europe.

Mary 8:09

I would say we do get European, we get a fair amount of Europe,

Judith Mueller 8:13

I.

Mary 8:13

20, 25% European couples, mainly because they want to be able to choose their genetics for their child. They don't want someone else to choose them. Nothing against my Spanish colleagues, but they basically say, here's your donor. When I first got into this business in the late 1990s, there were clinics on the East coast, which we thought were so progressive, but they really weren't. That would sit down with a psychologist that I would like, I'm the patient, right? And they would say, okay, here's the egg donor we've chosen for you. that made me furious because I thought would you let the real estate agent pick your house? You're gonna let some other person that's met you for an hour pick your egg dough? I just, I hated that. So that's why, one of the reasons I went into my own business, I'm not the first one to do it. I didn't invent the wheel, but I really tried to make it so that you had massive amounts of information, you have lots of pictures. You had really, truly informed consent. So with the European model A, there's not compensation like we have in the US and B, there's a lot less information, a lot more emphasis on the altruism and where my argument from an ethics standpoint is, okay, so you're asking the egg donor to be altruistic. Everyone else is making money. Okay? The clinic's making money. The people that work at the clinics are making money. The drug people are making money. The people that freeze the embryos are making money. But you are asking the donor not to be compensated. So the cost factor in the us, if you use an in-house donor, let's say it's a clinic that has maybe 15, 18 donors I started out in that world, so I'm really, I appreciate it. You are talking, you're not gonna pay an agency fee, what you're gonna pay us. So I'd say you can probably get out, for$30,000. So that'd be the egg donor, her compensation, the whole thing from IVF to making the embryos genetic testing to transfer of the embryos, gonna probably add five to$8,000 to that on using an agency. But you're gonna have a wider choice. Agency donors pick their own compensation, and that's the difference. So we don't say you're gonna get this much. We say, what would you like? And then we have to educate them and say, you're not really gonna get picked at that compensation level. This is probably more appropriate. So that's what our job is.

Judith Mueller 10:31

And the 30,000 step per round is that to have the baby.

Mary 10:36

That's to get all the eggs. That would be like, let's say you did a fresh cycle. You would get the eggs from that fresh cycle. It could range from 10 to 40. Okay. And then they're gonna fertilize them and there's always a drop off. And usually the rule of thumb is that you get 25% the retrieved eggs turn into embryos. So if you have 20 eggs at day five, when they're blasts, and you're gonna freeze them, and you will probably end up with four or five. Okay? Now, in today's world with fertility, we're not trying to get these donors to make 40 eggs, it's not good for them. And the egg quality is lower. So the goal is you want to get. 3, 4, 5 really high quality embryos, which you get by less medication, less pushing the donors, and it's made it much easier. They don't get hyperstimulated, they don't get sick. So it is a great deal. People still have this mindset, oh my God, I need 15 embryos. Then what are you gonna do with them? You are gonna have a soccer team, a football team. So yeah,

Judith Mueller 11:41

Why not?

Mary 11:43

Yeah.

Judith Mueller 11:43

And you've mentioned that some people come from Europe to the S'cause obviously the, not obviously, but the anonymity rules are different in Europe than they are in the us. And how would you say advice, someone coming from Europe to navigate the whole process?'cause obviously there's the legal process, you've got the transport.

Mary 12:03

I would say. Okay, so let's say you are a couple from Spain. Okay. We do a lot from Spain because they don't necessarily like the system in Spain. and so they come and they're, let's say they're a heterosexual couple. They pick their donor, they're gonna have a VF clinic, so everything is done in the United States. They just fly over and do their thing in the United States. So the husband comes and he does his thing, and then they come over for the transfer. We have three levels of disclosure in egg donation in the United States. One is completely anonymous, so nobody knows anything. You have a dossier. We give the donor information that's generic about the couple. Number two, you have identity release. Identity release is when each side signs a contract that says at when the child produced from these gametes reaches 18, they can request to correspond with the donor. Okay. And then number three is an open donation where they actually have a zoom call or they meet in person with a chaperone. They trade all their information. I would say I've gone in my career since the late 1990s from a hundred percent anonymous, which was perpetuated by the IVF clinics. Okay. The people that work in it, the donors, we weren't all into this complete anonymity. It was the clinics thinking, no, no one will know. They used to preach, don't even tell your kid. And like in 2000 I was saying, you gotta tell your kid, come on. And then we've swung to more identity release. And even now, I would say the people who do totally open tend to be single people and same sex couples. The heterosexual couples are still in that identity release world, but very few are anonymous. So there's not the anonymity there was 25 years ago.

Judith Mueller 13:49

So that's interesting. We'll dig into the ethics of, telling kids, et cetera later on. But it's actually interesting to see that the donor gets a doss on the couple. So who picks whom or do they have to pick each other, if that makes sense?

Mary 14:04

No. Most of the time the donors the intended parents pick them, like they say, okay, here's my top five choices. We contact each of the girls and say, what's your availability? What's your blackout dates? Are you in a wedding or, whatever. And then we say, this is the information. And then the couple goes, okay, I want number 1, 2, 3. we tell number 1, 2, 3. This is a lovely couple. They're from York and they have no children and they've gone through IVF four times and he's an engineer and she's a nurse and they really are just desperate to have a family. They have two dogs. Okay. They don't get a full blown 26 page thing, but it gives the donor information that she can take and say, okay, now I'm helping, Sam and Sue. Okay. And I feel like I have this connection with Salmon Sue as I go through this process. I'm doing it for them. That's the difference with the egg freezing model. Seriously, egg freezing is you're just giving'em up and they're gonna be in a bank. And I think a lot of donors are I don't know how I feel about that because this is a very touchy feely business. It's not, I think here I am. Private equity again I think they try to turn it into this commodity and here's your, go into the store and pick out your eggs and go to the clinic instead. It's very much a female dominated area of fertility. Okay? This is woman to woman helping woman.

Judith Mueller 15:25

Interesting

Mary 15:25

So

Judith Mueller 15:26

there. There's a couple of points I wanna touch on later when we talk about the ethics. Something that I find interesting about the logistics, because the couple are going say to the states in this case, to have the embryos implanted. How does flying, obviously the whole back and forth, et cetera, how do you think that impacts the newly formed pregnancy, hopefully? Or do people just stay in the states for six months and see what happens or.

Mary 15:49

do anything. They've done studies on it and the best study I know is the fact that, I guess it was two Olympics ago, the one I forgot what they were, but it was two Olympics ago and one of the beach volleyball players, women, okay, so you think beach volleyball, they're in those little Skippy things and they're running and they're jumping and everything and she didn't know she was. Okay, so she was like blah every morning and didn't realize that she was pregnant and they won the gold medal. And literally eight months later she had a baby. Okay? So if you can go travel to the Olympics, back and forth, flopping on your belly, running around, God only knows what you were doing and you still maintain a pregnancy. The thing is, the embryo, when it is transferred to the uterus, I don't know if you have this in the uk, but we call it jello, it's gelatin. Like your mom or your grandma used to make it and they used to put fruit in it. It was like gross. You didn't wanna eat it. Okay? So think of gelatin, okay? Now think of the fact, think of the gelatin as the lining of the uterus. So in comes this straw with the embryo in it and it boom, and then it ejects the embryo into the gelatin, and then they pull it out. What happens? Is there a hole in the gelatin? No, it just covers it back up. So the embryo is put into this. Gelatin, mass, and then it takes about three or four days for it to actually make its way over to the wall of the uterus and implant. So there's really nothing you can do to dislodge it. So they usually come over, they'll have their transfer of embryos and they'll stay a couple days and then they'll go. Studies have shown that Lang still does not help implantation back in the day, they used to say five days laying down, You're better to get up and get the blood flowing.

Judith Mueller 17:30

Radiation for flying. If nothing else. So gamma radiation, if you've got a long distance day flight. Has anyone studied that?

Mary 17:37

No, I don't think, flying attendants are pregnant all the time on planes. People are on planes pregnant all the time. Yeah.

Judith Mueller 17:43

Fair enough. Okay. I stand corrected.

Mary 17:45

Everything in life is a risk. Okay. So don't think a one time flight back to the UK or to Spain from New York City and it's nine hours is going to impact your pregnancy because you probably haven't even had an implantation by the time you get back on the plane.

Judith Mueller 18:05

Fair enough. Okay. That's definitely something I want to look into. There's one episode we're gonna record with someone who's a space biologist and they've been having some issues, trying to, so the idea is that we can get to humanity into space, but reproduction apparently is very difficult for various different reasons, both radiation, anti-gravity, et cetera. So that's gonna be very interesting episode. I'll let you know when that comes. We briefly touched previously regarding progesterone support in early pregnancy. I think this might be a good point to pick up from here. So tell me, what does progesterone do? Why do you need it? Why would it help in early pregnancy?

Mary 18:39

Okay, so progesterone is what The follicle, okay. The follicle is the home of the egg. So when you think of a think of a chicken egg, and okay, inside is the yolk, and that's like the egg. Okay. On the outside is the shell, okay? And on the inside is like the white part. Okay? So when you take out the yellow part and you're left with the white part, then the, it starts producing progesterone. That's a super simplified thing. But progesterone the hormone that tells your body, oh, don't shed the lining of the uterus yet we're having an implantation. So if you don't have progesterone, the feedback mechanism in your brain goes, oh, we didn't get pregnant this month. We're gonna shed the line of our uterus. So that's why you take progesterone. When you're gonna do anything nowadays, people even using their own eggs are freezing and then they're transferring later down the road after testing. So you're gonna start taking progesterone five or six days before your transfer to mimic what happens when you have ovulation? Okay, so you ovulate the egg, supposedly goes down the fallopian tube. In the meantime, the follicle spewing out progesterone and it spews out progesterone until implantation occurs, when it starts making its own. Okay? That's super simplified, but that's the whole reason of taking progesterone support in an IVF pregnancy. They feel like they need to give it to you and everything, like they give it to you as deodorant and shampoo and everything, just so you can have massive amounts of progesterone. It does make you really cranky, but it's worth it. So you're gonna have more progesterone than you ever dreamed of when you're doing an IVF pregnancy there is a thing in surrogacy now where they're doing what they call natural cycles, and they don't give them extra progesterone. They let them ovulate on their own, and then they do it with the ovulation predictor kits, and then five days later they transfer the embryo. Some clinics have had good luck with it. Other people are like, no. So just an anecdote.

Judith Mueller 20:34

Interesting'cause that's, kinder on the donor, but then I guess if you are losing embryos that way, which, took a while to, to, so not kind on the donor, kinder on the birth mother, and

Mary 20:44

You're peeing on the stick on those ovulation predictor sticks, constantly. And a lot of, a lot, honestly, surrogates sometimes can't handle, they always, the surrogates usually have to do the injections. And the injections are either with sesame oil or peanut oil or whatever, and they leave, welts on your heine. And so it's not a good thing. They have tried vaginal progesterone and a lot of clinics like, Hey, it's nicer, but other ones go, you don't get the full effect. It's the big question.

Judith Mueller 21:12

So some more studies to look at. Let's have another look at the whole concept of donor eggs. So tell me about the vineyard graft analogy.

Mary 21:22

Okay. So that's one of my favorites.'cause I had just been in California and we stayed in a vineyard and then we went on a private vineyard tour and the owner of the vineyard gave this whole story about when they had this horrible something or other that happened in France and like basically killed all the vines. And they were taking the United States and they were making like eaux. Okay. And what they would do is, here's your vine, it's coming out and the roots are there. And then they would go and they would take this. Piece of a vine from France and they would cut a hole or like a little slit into the American one and they would then put this other one in there and lo and behold it would graft in and it would make that kind of grape. And I love that because I thought to myself, that's what you're doing. You are just grafting this lovely person who's giving you a piece of her DNA, your DNA tells you how to make an arm and an ear and whatever. It also tells you what color hair you have, but you don't get the girl. I always have to tell people, listen, I know you're real obsessed with her GPA and her college degree and what she majored in, but you don't get the degree. The baby does not come out and go, here's my diploma. Now you don't have to pay for college. No, it's up to you. So that's to me is really cool because this is not a one-off thing. Donor egg is your grafting new DNA into your family's DNA and I always feel really awful sometimes when people they just feel so. and so sad and it's oh my gosh, 50 years ago you couldn't do this. You get to be pregnant. This gets to be your baby. Without you, it would never be a baby. It would just be an embryo and a petri dish.

Judith Mueller 23:01

Good point.

Mary 23:02

about the subject?

Judith Mueller 23:03

I can, I love it.

Mary 23:06

Yeah.

Judith Mueller 23:06

So how long does it take for typical donor X cycle? Say from matching the donor to actual embryo transfer.

Mary 23:15

It depends on the clinic. So you have fast clinics and you have slow clinics. The slow clinics tend to be big, giant clinics that have, four and five satellites and they have one donor coordinator and they're doing, five, 10 cycles a month of just donor. Not to mention regular IVF. They take a long time'cause the donor has to be seen at the clinic and they get a big souped up Wellwoman exam and look at her ovaries and have all this blood test. And then they gotta wait two or three weeks for her to come back. And a lot of times if they have not had genetics yet, if it's a first time donor that takes a month to get those genetics back and then you find out that the husband of the intended parents he has some really weird esoteric genetic disorder. So now you gotta test her for a single gene test, which takes three or four weeks to come back So by that time, four months have gone by and everybody's a little tired. you have a clinic that I'd say has three or four doctors and they tend to not be part of a big network, you can pick the donor. They bring her in the next week, she has her. All the stuff she's gonna do, they do legal and seven weeks later you're having, a retrieval and then usually you as the patient have to wait a couple weeks'cause you have to get your testing back on your genetics or whatever. But I'd say speedy is three months. So from the time you pick the donor until they transfer the embryo into you 90 days, that would be super speedy.

Judith Mueller 24:40

Okay, and is there a maximum age for the birth mother implementation? There's obviously legal levels and there's, age you would recommend as after that you'd say maybe don't bother.

Mary 24:52

Okay, I will tell you in the United States, there are no rules. There's guidelines, but there are no rules. And so this is one of my all-time favorite subjects because I really feel that they do not look at the ethics of having a baby. I am all for reproductive justice. Okay. I believe that you should decide when, if, where, how, why you have your own baby. Okay. On the other hand, I'm also looking at, the justice for the child. So your reproductive autonomy, is that gonna usurp the for the child? Is it justice for a child to be born to two 60 year olds? Who are gonna be in their eighties when this child completes university? And I always think to myself, I remember when I was moving, I have 2 27 year olds are twins. And I was moving my son, helping him move out of his apartment when he graduated from college. And I was a spry young chicken then, right? And. I remember walking up and down the stairs. He went to college in Tucson, Arizona. It's not exactly a cool place. It's very hot. And I thought, how would you do this if you were 75? You couldn't do this. And this is a rite of passage. This is a thing that parents do. You move your kid in and then you move them out and they get their own life or whatever. And I thought, my kids actually need me more now at 27 than they did when they were seven. When they were seven. I was the carpool. I came to cheer'em on at the games. I made sure they did their homework at 27. They're like, mom, I don't know about the career I've picked. What am I gonna do? Oh my. And so it's bigger kids, bigger problems. Hence I can't imagine being 22 or 23 and your parents in their eighties and they're declining. They could be fabulous. But very few parents are Mick Jagger. Okay.

Judith Mueller 26:41

you might not want make Jagger as a parent.

Mary 26:44

No, but Paul McCartney, he's

Judith Mueller 26:46

fair enough? Yeah.

Mary 26:48

right? And so I think that people, they think this, and so for me personally, I believe in reproductive autonomy. But I go by the a hundred rule. And the a hundred rule is the two partners to get when you add their ages together should not exceed a hundred. Now, that's when I started in the 1990s. Now it's morphed up to 110. So basically most clinics will not let a woman carry the pregnancy if she is older than 55. Okay? So at 55 the door shuts. You can't, but that doesn't mean they can't help go have a surrogate. Okay? So that's the issue.

Judith Mueller 27:23

Which will come in a minute.

Mary 27:26

yeah.

Judith Mueller 27:26

Interesting. So let's stick with that for before we move on to surrogacy, we'll stick with that for a minute. So what are the main reasons that people pivot to donor eggs? Is it age and quality? Previous failures, or just emotional exhaustion?

Mary 27:41

The number one reason is age. Okay. They could, generally speaking, they could be in their early forties, which is not outta the real of possibility to conceive naturally. But if they haven't conceived and they haven't conceived, they show up in IVF and they're a MH, which is antimularian hormone, which is the marker to see how well your ovaries are performing is. Oh one, it's all over, but the shouting you don't have any follicles sitting on your ovaries. That then multiple miscarriages. And then I'd say back in the day when I first started, it would be because they carried genetic conditions and we didn't have the genetic testing. So they might be a carrier for Huntington's disease, they could be cystic fibrosis. So let's say two people married each other and they each had family members with cystic fibrosis. They didn't know were they gonna have a baby with cystic fibrosis, so they would go to that. I've had people that had been, I will say this, I actually had a couple years ago that I thought was a really brave thing. The husband had azoospermia, so he didn't have any sperm and so he was gonna use a donor sperm and she said, you know what, I will use a donor egg. That way, neither of us has priority. And I thought that was cool, right? That she said, I'm okay without I get to carry the baby this way. We have, reproductive autonomy. So that's it. One, people get older. I think I've noticed this trend, women that are like, say mid thirties, that have premature ovarian failure. They've had cancer and it's wiped out their, eggs or whatever. They're so excited about this, they're so excited to be able to have this opportunity, blah, blah, blah. Whereas for some reason, women like 45 plus lot more anger issues about it. They're looking for the perfect donor. It has to be perfect. And I always think to myself, which is probably not very nice, but I think to myself the reason you're in this boat is that you were too picky to find the right guy. Okay,

Judith Mueller 29:38

I hear you. Speaking of how attached do you find people are to their own DNA as it has to be my baby. What? What makes it my baby?

Mary 29:50

The people in their own DNA, they will, I guess I'm so jaded'cause I've been doing this for so long, it's this is my thing. You have to go in within yourself and maybe meditate on it. Do you want a baby or do you want a family? And a baby means you want a baby. You want that baby to be your baby. You want that baby to have all your DNA. It's like the actress Jennifer Aniston came out a little while ago and people jumped her for it.'cause she said the reason that she never did donor egg is she wanted a baby with her DNA. Okay, I respect that a hundred percent. Okay. and she also went through, a zillion IVF cycles and nothing ever happened. Okay. So she would've been a perfect candidate to donor egg. Okay. But she opted not to. I respect that. the other hand, I think that people get, if they want a family, they want the whole nine yards. They wanna drive carpool, they wanna go to, music practice. They wanna go watch the soccer game. They want the picture, they wanna have dinner at night. They're not just focused on my DNA and this baby. Okay? And I yell that. My last analogy I'll use, I've used this for 25 years, is an old analogy. So here you are, you're struggling with fertility and you're like, what am I gonna do? I dunno what I'm gonna do. I can't decide I'm gonna do donor egg or not. And I ask people this question, okay, so the doorbell rings and you open it and there's one of those adorable little Moses baskets with this beautiful white lace on it. And you look in there and there's this adorable baby and a big note that says, this is your baby. Would you go, oh my gosh, I can't, I'm so excited. I'm running out the door. I'm, this is my baby, I'm taking it. Or would you go, I really am gonna hold out for one with my DNA. the choice that you need to think about if you were faced with this dilemma of doing donor egg or not doing donor egg.

Judith Mueller 31:33

You seen both, I guess

Mary 31:35

I think that, when you sit and go, the baby is sitting right here. It really looks pretty cute, and it's all mine, and I don't

Judith Mueller 31:41

it's done.

Mary 31:43

I'm good.

Judith Mueller 31:45

Fair enough. Okay, so let's move on to surrogacy So for listeners who are new to, so can you step out the medical steps, legal contract costs, et cetera, et cetera?

Mary 31:56

Okay, so surrogacy that I'm discussing is gestational carriers surrogacy, which means that the surrogate has no genetic connection to the child, so it's somebody else's sperm and eggs implanted in her. And so finding a surrogate takes several months because there's a. fewer surrogates than there are people that are needing surrogates. We have a wait of anywhere from two months to six months to match with a surrogate. Once you guys have matched, each person decides if they wanna match. So it's a much more open process than most egg donation is at this point. Then you're gonna go to your clinic, you're gonna be screened, and you're not gonna do genetic screening or anything like that, but they're gonna look at your uterus. They're gonna do all these blood tests. After that, then you do legal. Legal takes the longest. In my company, we have a worksheet that the surrogate has already filled out with her compensation, that she wants her choices about all these things. It's six pages long, when will you allow them parents to make choices for you? How much compensation do you want for a c-section? Do you wanna pump breast milk? So all these questions are in there that goes to both couples, the couple and the. Surrogate and her husband, if she has a partner, have signed this and it goes to the attorney. The attorney then writes the contract based on this, the intended parents approve the contract. Then the surrogate and her attorney approve the contract. They write a letter saying everybody is happy. Now the intended parents fund the escrow account with her compensation and the miscellaneous stuff. And then the clinic says, okay, we received the letter, you're ready to go. And they can have an embryo transfer no sooner than 14 days after the signature on the, because that gives people time to change their minds. Okay? So soup to nuts. Some of the time you have matched until you have a transfer is probably five to six months. People want it to be faster. It's the dang lawyers that take up all the time. Okay? So they take a long time to do their stuff. So all in right now, I'd say that without the cost of IVF, because remember that changes from every different clinic has their own price range. But if you're gonna do agency fees, secret compensation insurance,'cause you have to have insurance, it costs a lot of money. Legal, psych, medication, travel, all that. You're talking probably somewhere between, I'd say 105, 110,000 to 130,000, depending on if you need more than one transfer of embryo. So the first time doesn't work. You're not starting all over again. She's coming back. But you're gonna make payments, she's gonna get paid for the transfer, the clinic will get paid. So that's what we call, so when you throw in the IVF portion, you're asking another 25,000 or so. If you throw in donor egg. can see that cost. So you would say if a donor egg surrogacy pregnancy for say two same sex. Same sex couple, you're looking at 160, 175,000.

Judith Mueller 34:39

And would you often see that a donor egg could also be the surrogacy?

Mary 34:44

Nope.

Judith Mueller 34:45

That would always be different.

Mary 34:47

Yeah. We don't do what they, we don't do that girl, we don't do you're the egg donor. Caveat is we have worked with people who used a cousin, a sister or whatever and that's different, okay.'cause they do have a genetic connection. Okay? So that has a lot of legal paperwork. So you're, instead of having the eggs come out, fertilizing going to another person, you are just gonna do with the clinic. We only will work with a legal IVF clinic with all the in place. Okay? So that is, where you're the carrier and the egg donor. Most of the time I've seen it, and I get it maybe every two years or three years, is with a sister. So I actually did, the last one I did was twins. So the sisters, they were not identical twins, they were fraternal twins, but one sister was the surrogate and she get donated her egg.

Judith Mueller 35:35

So who is A actually brings me on to my next question. Who is a typical surrogate?

Mary 35:41

They're all over the board. I think there's this myth that they are, down on their luck, women doing this. No, they can't be. So in the United States, you can't be on any kind of government assistance. So you can't have government subsidized healthcare or you can't be on aid families of dependent children, and you can't have, food stamps. You can't do that. You have to be able to pass a background check, which you have to be employed or your partner has to be employed. I don't do well. People go I don't work and I'm not married. are you doing that? I'd say the most part, they're middle class women. I do get some teachers, which are really good. They wanted like another kid, but they didn't wanna have another kid. And they do it so that they have the baby. In the summer, I get NICU nurses. So neonatal intensive care nurses they have been good because they've seen what happens when there's tragedies. I get a lot of people, I'd say preschool teachers sometimes they're stay at home moms and their husband works and this is a way to give them a step up. Lot of these are women in their twenties, maybe early thirties. This gives them a step up. Most of them want to use the money for a down payment on a house.'cause as we all know, globally, the whole housing thing is awful. And so having 50,$60,000 in cash that you can then use on a house really can change their family's.

Judith Mueller 36:59

Interesting. And you mentioned, they might want the kits for the summer. Does that mean they would normally have some sort of connection to the kit later on?

Mary 37:08

Most of them have what I'd call an acquaintance type relationship. Now that's, maybe 10, 15% actually have a, and it's usually with the same sex guys. They tend to have a closer relationship with their surrogate, but there's not a woman that's having a loss. And I think that if I try to educate the surrogates about when you are stepping into her role of gestating her baby, whether it's with her own eggs or with a donor egg, she's lost. She doesn't feel part of it. Okay? So it's understandable that she wants that part of her life to go away, and now she is a mom and dah. So don't be upset if she doesn't want to talk to you once a week. So that's why most of the surrogates I see really gravitate towards same sex couples.'cause they're like, I'm gonna be, and they do. And it's not bad. I just tell, think it's very important to educate not only the intended parents that are of opposite sex, but also the surrogate sex, but is the dynamics. So we offer, so like our surrogates have a a social work visit before they get approved and they talk about all these things. And then during the course of the pregnancy, they have three opportunities to meet with a psychologist. Just to talk about this.'cause I think sometimes the intended parents get real anxiety ridden, is she doing drugs? No, she's eating, organic food. And so I think it's hard for them to say what would make somebody want to do this? Be glad someone wants to do it. And they've been thoroughly vetted,

Judith Mueller 38:33

I think it's.

Mary 38:34

a surrogate.

Judith Mueller 38:35

When you look at the incentives in a way, obviously there's the money, but I think otherwise there, there's probably quite an emotional, I think trauma's not the word because, you went into this knowingly in a way, but I don't know if most people, most surrogates actually know the emotional impact that's gonna have on them.'cause you do have the hormones and everything right.

Mary 38:54

I will say, because we get really close to our surrogates and I'd say probably 60, 70% come back to do a second journey, which is astonishing. But the difference is maybe they had two or three kids and they had them over six or seven years. So they had'em pretty close together. Okay. So they go and they remember the exhaustion that happens when you bring home the baby. Okay? And I just think about it now. And I had twins and they were 27 years ago. Oh my God. I was tired all the time. So they don't do that. They go home and if they're not going to pump, they, quit leaking breast milk in a week or so. It's painful.'cause having it dry up is painful. But then they get back, literally two, three weeks later, they're back at the gym or they're back to walking or whatever, and they bounce back and they're not taking care of a baby. So when you don't have a baby to take care of, all of a sudden it's I'm not living on no sleep or whatever. Most of them wanna go home within 24 hours. Now, the US healthcare system is a whole nother discussion, but they wanna go the moment that they can get outta the hospital. They wanna leave. Okay they don't wanna sit around and lay around and postpartum. They want to go home to their family,

Judith Mueller 39:58

It's potentially, when you look at it that way, it's potentially really neat way of co-parenting

Mary 40:05

maybe.

Judith Mueller 40:06

in the sense.

Mary 40:07

I think that most, and then the surrogates, because most of the time they don't live in the same city. No matter how much we try to match people in the same location. don't. Okay, so then you could live in Houston and you're serving your B in Austin and that is a three hour drive. Okay. So you're not gonna have opportunities to go run into them. Most of the time the relationship lasts for about a year as far as, they send pictures or whatever after that. It seems to be Christmas or holidays and the birthday. And but with the same sex couples, it tends to be a little bit more vibrant and last longer. Like they'll invite her to their baby shower. Okay. Heterosexual couples. You're not seeing them invite the surrogate to the baby shower?

Judith Mueller 40:51

Interesting. It's, I think one question of getting my head around is what can you actually stipulate? So I'm guessing every situation is different because my question is do you move in together? Do you, for example, my thing would be I definitely want her to eat organic. I definitely want X, Y, Z. I'm like, she still has a life, right?

Mary 41:08

The reason that we have these three sessions. the psychologist and it's offered to the intended parents also, is to get around this, you have to let down your control. Okay? So people will write in their contracts that they want the circuit to have organic food, no cheeses, blah, blah. The thing is, then they have to pay for it. So then, okay, so you have to go to Whole Foods, which is the organic food place, and it costs more money. So show your receipt, you get reimbursed for that more money, which means your whole family has to eat that way because you can't just go make your little strawberries that are organic and let the family eat the pesticide ones. That's in it. I'd say that a, my attorney colleagues do a very good job of educating everyone about the limits of the legal system when it comes to surrogacy. Okay? Because bottom line, the only thing that they can actually change is they can't keep the baby. Okay. They can't, no way they can keep the baby because they've done a pre-birth order before the baby is born. The baby is not genetically related to them. I'm talking about the usual ones. And so hence when they go to the hospital, they have this paper that says, is Sue and Sam's baby. And when the baby comes out, Sue and Sam take the baby and they put the little ba bracelets on them that said, this is your baby. And all the little gadgets they do. So the baby doesn't walk off the the baby doesn't crawl off the unit and it's not the surrogates. Okay? So most of the time when they stay in the hospital, she doesn't even go to the postpartum floor. She goes to a DYN floor or something like that. So she's not around the babies or whatever. And the intended parents get a room, okay? They get a room and they room in with their baby. It always makes me think of you, you the British kinds, like when I went to Sterling Castle with Mary Queen of Scot's, and they showed the room where she was born and that everybody was around the room watching the baby be born. And I'm sitting here thinking I wouldn't really want 50 people watching me deliver a baby, but okay. And it's so that there was no bait and switch. Okay. So then you think now with surrogacy, there's literally a bait and switch.

Judith Mueller 43:12

Yeah.

Mary 43:12

baby comes out of this person and then Sue and Sam walk out the door and go look at our baby. I

Judith Mueller 43:17

Interesting concept.

Mary 43:18

go.

Judith Mueller 43:18

Interesting. So in terms of, are you seeing a lot of cross border surrogacy? Is that unusual?

Mary 43:26

What I'm seeing now, which is a new phenomenon, is people come to the United States and they want this US egg donor because there's so many, there's thousands of egg donors. Okay? So there's so many choices. And then they're shipping their embryos to Mexico, Guatemala, Argentina, because the cost of surrogacy is literally a third. Okay? So they can go and spend their money on getting the best egg donor for them without having to spend$175,000. Okay? So they'll spend half that and they'll go and they have some, and then they have some excellent clinics in Mexico, Columbia, I don't know about, but I do know that Argentina has some excellent clinics. And so hence. It's a win-win. And I'm wondering when the American IVF cleanser and go, wait a minute, what are y'all doing? Because they're gonna start siphoning off that population,

Judith Mueller 44:22

Interesting. And it's all business at the end of the day, so there's a incentive. So once again,

Mary 44:27

right?

Judith Mueller 44:28

in terms of when you do see cross-border couples, what are complications in terms of, citizenship, birth certificates, exit permits? What else do you need? You exporting a baby, what do you do?

Mary 44:40

The worst thing, seriously, say you're an English couple, okay? And you've come over and you go to a New York City IVF clinic, and it's your eggs and your husband's sperm. Okay? So we're all good. So we don't have any genetic weird stuff, but there's no, you can't get insurance without paying about$28,000 for the baby. Okay, so when the baby is born, because remember, you've already severed your parental, right? The surrogate's already severed or parental rights. So when the baby comes out, the moment the umbilical cord is cut, it's those people's baby. if there's any complications from then on, or the baby needs to go to the nicu, they have to pay for it. So you have to get insurance policies, right? And you can't get one'cause you're not a citizen or a legal resident, okay? So hence you have to go through a third party, which is Lloyd's of London, and they charge a$28,000 deductible.

Judith Mueller 45:36

So when you say deductible, that's not the premium, that's the risk of what you pay if something happens.

Mary 45:41

is that's your premium, okay? Pay$28,000. And the the policy doesn't start paying until you have accrued$28,000 worth of care. So at$29,000, it will start paying, okay? So when people from overseas say they want twins, I'm like, no, I don't out, because no one will insure you for choices. They will, it'll just cost you,$50,000 they don't want, so healthcare in the United States is so massively expensive when it shouldn't be that you can't just go I'll just pay. Because the clinics are like no, you have to pay. So I have seen before, right at COVID, before COVID hit, we would do a lot of Asian couples and they would, did not wanna pay these outrageous prices, but then they would have$150,000 bill and they'd skip out on it. But the good news was they couldn't put the bill on the surrogate, because remember, she's not the.

Judith Mueller 46:38

So the 28,000, that's the deductible. How much would the premium be out of interest? How much are you paying upfront?

Mary 46:44

It's the same. So the premium is 28,000 the deductible. It's all in one. So you pay 28,000. Now, let's say that you had a normal vaginal delivery. Okay? Normal vaginal delivery. The baby comes out, it's eight pounds, it's crying, it's gonna be able to go home in 24 hours. bill, if you were gonna pay cash, would probably be less than$5,000.'cause they didn't do anything. Okay? The baby sat in a bassinet and they checked it a couple of times. Okay? You've just paid$28,000

Judith Mueller 47:14

Just in case.

Mary 47:15

hours stay.

Judith Mueller 47:16

Wow.

Mary 47:17

So that's where, I see both sides. You don't, as a hospital, they don't wanna be stuck with this massive bill because the baby was in the NICU for four months. The other hand, it's not fair to the intended parents.'cause now they're paying, all this money

Judith Mueller 47:31

And you have to take out the insurance if you do in the us

Mary 47:34

If you don't, then you have to have some sort of, here's my credit card that has$50,000 on it

Judith Mueller 47:40

Yeah. Okay. He's five credit cards to have whatever might be. Okay. You've mentioned previously to me when we were chatting, there's a rise in affluent single men commissioning Surrogacy with Donor X. Tell me about that.

Mary 47:52

So one of the things that's really struck me is, especially in today's world where there was dating apps and this, and now those are falling off in favor. We're seeing, and I'm saying in the last maybe 18 months, an increase in single men over 50. Really wanting to have a baby with a surrogate and an egg donor. And they're real cagey. They don't wanna talk about why. I've had two that would talk about it. One said he'd seen his brother go through a horrible divorce and lose custody of his kids, and he didn't want that. So he was just gonna have baby on his own. And then another one basically said, I haven't found the right woman, and it's time is ticking and I wanna have a baby. So my question is, I find it weird, but on the other hand, none of us bat an eyelash if a single woman wants to have a baby with an egg donor and she's 45. Okay? So we're all like, oh, okay. But I think it's different because she can actually gest state the baby. And there's not, but this is I'm outsourcing, a partner. I'm outsourcing someone who I'm gonna love and cherish and we're gonna have a baby together. I don't know, I guess I'm old school. It just grosses me out.

Judith Mueller 49:05

There's also a question who's raising it, right? If you're the birth mother, whether it's your own ex or otherwise you, the hormones are different. The society expectation is different. There's a lot of the chance of you actually taking care of the babies. Probably higher then if you don't have that again, I dunno what the situation is, but, okay. Very interesting point.

Mary 49:22

it's, it goes back to my whole child versus family theory.

Judith Mueller 49:26

Yeah.

Mary 49:27

this? Because, and one of the things I've found is everybody's picky. Everybody's picky. These people are the pickiest of the picky. Okay? So they want the five 11, huge tall girl who's also model worthy, who went to a top 20 school who majored in a hard subject. They don't want somebody who majored in psychology. They want somebody who majored in chemistry. Okay? They want all those things in this girl and it's like really? You want a baby or is this a science project?

Judith Mueller 49:58

It helps to have the major in chemistry anyway. Speaking of, let's look at genetic testing and embryo screening, particularly around promise versus overreach. There's a couple of terms. There's P-G-T-A-P, G-T-M-P-G-T-P. What are these?

Mary 50:14

Okay. So they're all pre-implantation genetic testing. It's just a matter of what you're testing. So and they keep changing names. I'm telling you that every three weeks they're going, now we have PGDQ, and it's what is that? The bottom line is PGT is pre-implantation genetic testing. It's looking for chromosomal abnormalities in the embryo and or genetics. Now remember, everyone's already had their genetics tested, but there's outliers. So some people may say, my husband and I both have. Cystic fibrosis in our family. So it means that we have a one in four chance of having a child that is cystic fibrosis or could be a carrier. So what they're gonna do is they're gonna do a single gene look. They're gonna look at the chromosomes and they're gonna go, okay, so here's a single gene. We're gonna do a probe, and then we find out that three of your embryos have cystic fibrosis, and so we're gonna discard those and then you can rest assured that you can c create a baby without that. Now, when we start getting into this other stuff, I read this fascinating article on the airplane today. Yeah. Two days ago that was about these new companies that are coming out with this. We can find out that embryo with the most athletic ability, whatever, and what they're doing is, and I'm simplifying it like my progesterone simplification, is they've run algorithms that say, here's all these people's DNA, and this is the people that were five 11 who went to a top 20 school that majored in chemistry and are Olympic level athlete. Okay. There's three of them. Okay. But nonetheless, we now have this algorithm that shows their DNA looks like this. So when you've made this embryo, now we're gonna go and look and see which ones match that. So a lot of controversy about it. This was in MIT quarterly. I thought I was like crazy person buying this at the airport, MIT quarterly. I look so smart sitting on the airplane, but I did it because it was all about this and then I'm reading it and my favorite scapegoat is deeply embedded in this, which is private equity. And so I see it as this whole thing where I had these people who go, she has to be five 11, da. Now they can just go, that's great. We're just gonna go we'll pick this donor and then we're gonna pick the embryo. That's the best. Everybody wants the best for their child. When I first got into this business, and there would be people that I would say were just normal looking, maybe even a little bit on the homely side, they would pick the most gorgeous egg donor. And I remember doctors going, why are those people picking that girl? They don't look anything like her. And I thought to myself, know what? If you're driving a Toyota. You really wanna drive A BMW, you know what I'm saying? It's like you want the BMW, you want the best. So I don't blame'em. They want the best for their kid. Maybe they didn't like being homely. Maybe they want a pretty child.

Judith Mueller 53:04

Okay, so let's move on to the ethics questions. Actually. You previously mentioned about telling the kids. What's your opinion on that and why?

Mary 53:13

I think that secrets are bad about your genetic origins. And I think that people there's so many children that have been born through donor egg, through surrogacy now, donor sperm. We all know what happened with the donor sperm thing. Okay? At least we should. People that were conceived with donor sperm, say in the last. I don't know, maybe 40 years ago, 30 years ago. They have hundreds of siblings. Okay. And I think that's very discombobulating for people. It's one thing to say I have all these relatives out there that are my fourth cousin. No, these are your half siblings. Okay. That's a whole different ballgame. And so by not telling people all this bad stuff could happen, and I think people get real caught up in the cons, guity, oh my God, my kid will have two heads because I, they accidentally married their half, brother not really. You'd have to have, it had to be like Egypt and they had to keep doing that for, a millennia before you'd start getting the two-headed baby. But on the other hand, I do believe that people need, it's ethical to tell them their origins. And I believe that's what I mean, we preach it to everybody. Start early and often with your child. That doesn't mean secrecy, it means privacy. Privacy means this is our family story, not the kindergarten story. And it's a little bit easier to teach kids about that. There's books out there and you start very early with, one of my favorites has rabbits in it,'cause they proliferate, have a lot of rabbits. And there's this, and a friend of mine wrote the book and it's so cute. And it's Mr. And Mrs. Rabbit, one of the baby and this lovely other rabbit handed them this, little Connie. And they took it home and they gestated it, and then they had their own little baby. Okay, so you start out with that. Okay, somebody gave us a gift by the time they get 10 or 11, 12 years old, then you can really dig into why we did this and what happened. There's a a woman who I'm to complete groupie of, and she's English. Her name is Elizabeth Gba, and she works at Cambridge or Oxford, one of those. And and she does all these studies on donor conceived children, surrogacy conceived children, and she's very much like the kids that have no issues about this or the ones that knew from the very beginning with people. Wait till they're 16, you've opened up Pandora's box.

Judith Mueller 55:27

Identity. I think there's also in this day and age where we are going more into genetic tests and I'm actually doing quite a bit of work in the Middle East, which is genetically an interesting as we've mentioned genetically an interesting place. It's actually quite helpful, your family history. So obviously if you do have a 26 pace questionnaire on this is my genetic mother, father, whatever it might be, that's actually quite helpful down the line. Okay. And what both with egg donors and surrogacy, what are the patterns of regret and relief that you're seeing?

Mary 56:01

With egg donation. The biggest regret I see. I don't see it with donors. I really, I, I don't, and I've actually had donors, I've been doing this for so long, that those donors that I knew years ago are now in their forties. Okay. Mid forties. I've had probably 10 or so come back to me after, in their forties and they got married and now they need an egg donor. And I knew them. when I first started out I was smaller and I knew every single donor really well and they don't really have any regrets.'cause they said, my DNA's out there in the world somewhere, so I'm good. But I wish I hadn't waited so long. And it wasn't because they were an egg donor, it was because they were 43 and now they're trying to have a baby. We get a lot of girls who say they never want a baby and then they show up. Like we have one, one of my favorite donors about two years ago, she was like in her mid thirties and she did a donor six times and she was a fabulous donor and she couldn't get pregnant. And we're, I'm like, oh honey, I thought she didn't want a baby. And she goes, oh, I met this guy now I want a baby, blah, blah. And so we helped her navigate it. We helped her get to the right doctor and this and that and the other. We found her free medication because we wanted to help. We thought you helped. So many people have their dream. So when she had her baby shower, we sent her a stroller, we went all out. We bought her a stroller, a buggy or whatever you call it, a pram. And she was like, oh my God, it's the biggest gift I got. We were so happy for you that you had this baby. I actually even had an egg donor who ended up going through IVF'cause her husband had mail issue and she ended up with all these extra embryos and she donated them to us and said, can you find somebody? We found somebody that we knew that had run outta options and they, so we, it was like, oh my gosh, this is so wonderful. This is the reason we do this. So she donated her leftover embryos to somebody who had gone through everything and now was out of time, money and effort. And she got to have a baby and be pregnant and have her own baby. And they actually know each other and they have communicated, I wouldn't say they're best friends, but they're, they are talking to each other so that there's not a lot of regret on the donor side. The regret on the intended mother side. I'm gonna talk about, heterosexual couples is that they waited so long that they dilly ded going, should I do it? Should we do another IVF cycle? And the fact that they were at 42, 43 or getting one embryo. Look, I could have spent this time being a mother on the surrogate side. I don't see the surrogate intended parents ever having regrets. surrogates end up having some regrets about the people they chose to carry for. I think they think this is magical experience. Everyone calls it a journey in the parlance of fertility, and I think they think it's this magical journey. egg donors are given a lot of information because they're, it's a big procedure, not that having, carrying a baby in, but it's a little different with egg donors. So they really walk in prepared, I know it's gonna do this. The surrogates think it's all gonna be, Disneyland and it's not. Sometimes the intended parents are not very communicative. Sometimes they are too demanding. Sometimes they just ghost them. So that's the whole ball and wax. But I don't see regret on the side of intended parents. At least I haven't seen it myself.

Judith Mueller 59:04

Interesting. I'm getting goosebumps, actually. Some very interesting anecdotes. Any last words of wisdom? Anything that you think other practitioners if other practitioners or people who are entering this space should know and could benefit from your 25 years of experience?

Mary 59:23

I'd say if I could limit it to one, I would say that when people are going to pursue third party parenting, and I'm gonna say egg donation, okay.'cause it's much bigger than surrogacy is, not get caught up in the nuances of every little thing about the donor. I had a patient one time who told me, but her ear lobes are not attached, and I'm like, what are attached ear lobes? What? What is that? And they're like, oh. Oh, okay. So I think that people need to go, someone's giving me a gift if this person, because remember you have her picture, lots of her pictures. If I could put this person in a family portrait like at Christmas time where people go, oh my God, who's that? Or they go, no big deal. Okay, she just fits in. That's it. Remember, you are growing the baby. You nurtured the baby. You are the one that will teach it. How to go potty, okay? You'll be potty training this baby. So don't think that, this donor has over influence on, it's not, the donor is not gonna influence your child's life. She influenced it at the moment of conception and from then on, she's a donor and you are the mom.

Judith Mueller 1:00:33

Do you think it's easier to have an egg donor and carry the baby yourself from a woman's point of view, or to use your own eggs and have someone else carry it? Or like even have donor eggs, have someone else carry it and then be a mom?

Mary 1:00:48

Okay, so there's actually a study done in the late, I guess I'd say maybe 40 years ago, right? When they started doing donor egg and they asked women, it was from the University of Iowa, car and country, right? And it was just a, the questionnaire was you had your choice. You could carry the baby with an egg donor baby, or someone else could carry your genetics, and it ended up being almost equal so people were divided, The interesting thing was women who'd had a baby. In other words, so they'd had a baby on their own, right? They were just, these were not fertility patients, they were just random OB, GYN patients. who had a baby said, oh, a hundred percent. I always wanna carry the baby. People who didn't have a baby were all like, oh no. I'm good with that. I just wanna make sure it has my DNA. So I do think there's something to be said for the process of pregnancy that makes you have a connection to that child no matter what. And one of the things in surrogacy is that they have to sever that connection, but they've thought of it the whole time. This is not like you're pregnant, you think you're gonna go home with a baby, and then somebody snatches it away from you. You've known going into this, that this is, you're babysitting. So that's it. That's what I see.

Judith Mueller 1:02:03

This is interesting. How are you seeing fathers getting more or less attached, say in natural pregnancies? So they've been there for gestation, it is their DNA versus, the various different options of who donated what to whom, et cetera. But they're still there for the gestation versus the whole thing is surrogacy again, could be their DNA, could be someone else's, DNA, obviously that's a lot of different cases.

Mary 1:02:27

I would say that okay. With the surrogates, their partners are not very involved. They're just there. Okay. You don't, they're there as a helper. They come, they'll be at the delivery, they'll do this, but they're just there. Sometimes they've, I've seen them, the four of'em have a relationship, like the two guys will talk football or whatever, but that's not it. Where I see the biggest disconnect, which always makes me the saddest, is when I call it the male partner is driving the mus. Okay. So he's the one that makes the first call and he's the one that says, no, we don't like this egg donor. And the worst is when people have an egg donor and a surrogate. The woman basically feels like I'm sitting in the backseat and no one cares about me. Yet I'm supposed to jump up when this baby is born and suddenly morph into a mother. And so that doesn't happen real often, but we, in my office, we all know who it is. It's if the guy calls first, we know that okay, it's gonna be one of those. And I think it's because sometimes the women, and it's okay, it's usually people who are under second marriage. So the woman might have already had two kids, the man never had any kids, and now they're together and she's had a hysterectomy. So she has to have a surrogate. And maybe her eggs don't work by now. Okay. So she's tuned out, she's already raised kids. She's And so then that's what they want. So that's the deal.

Judith Mueller 1:03:41

That was a really beautiful episode. Thank you for that.

Mary 1:03:45

Okay. I enjoyed talking about all of all this cool stuff, and I will say the United States is out there sometimes, but I do the fact that we believe in reproductive autonomy, at least for the nanosecond until it goes away. But right now we have reproductive autonomy. So you can pretty much do what you want. You can have a baby, you can not have a baby, you can use a donor, you can use a surrogate. You just have to be in the right state. But we don't have legislation nationally that says you can't do that.

Judith Mueller 1:04:14

Thanks, Mary.

Mary 1:04:16

Okay. It was fun. Fabulous.

1:04:24

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