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Baby? How about two?

Published January 25, 2005 1:17 am

With twins, the risk of the pregnancy and cost for the childless couple jump
This is an archived article that was published on sltrib.com in 2005, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.

Parenthood by Proxy: Last in a three-part

series

SPRINGVILLE - Mothers worry. No one understands that better

than an expectant mother, even if the baby isn't destined to be hers.

In October, eight days after undergoing an expensive in vitro

fertilization (IVF) attempt, Crystal Young learned she was pregnant. But

her relief was short-lived, as concerns about the baby's health took hold along

with nausea and exhaustion.

As physician Larry Andrew searches her womb for signs of life

this Nov. 16 morning, the 27-year-old Payson woman muses on the possibility that

the baby is a girl.

"I hope everything turns out OK. I'm feeling sick to my stomach.

But that can be a good sign," Young said. "I wish the parents were here. I feel

guilty they will never know their daughter or son this way."

Kazuo Takahashi, the father whose sperm was combined in a petri

dish with a donor's egg and placed in Young's body a month ago, wishes he were

here, too. So does his wife Kumiko. But the couple live more than 5,000 miles

away in Tokyo and can't afford to fly to Utah for every doctor visit, tummy flutter

and kick.

No doubt, they'll hang on Young's every word when she phones

to tell them: It's twins.

"Twins?" says Crystal, her mouth agape. "No wonder I've been

so sick."

The second fetus, resembling a kidney bean, floats onto the

ultrasound and the exam room is filled with the rushing, thumping sound of its

heart at 152 beats per minute.

Now the real worrying starts. Twins pose heightened risks for

any pregnancy, as well as added costs. But in a pregnancy involving two families,

plus a surrogacy agency serving as intermediary, the risks and costs are magnified.

Despite the best efforts of reputable surrogacy agencies to

psychologically and legally prepare their clients, there is no fool-proof plan

to avoid complications.

The Takahashis will now have to dig deep to afford buying two

of everything on top of the $90,000 to $130,000 they have already spent

on 12 years of unsuccessful fertility treatments.

Twins also bring into clearer focus the risk to Young's life

and livelihood. What if the single mom and accountant is confined to bed in the

final trimester and can't work or care for her 7-year-old son, Jordan? She worries

about missing work and fears the less than $18,000 she is being paid won't

cover her expenses.

And there is the bicoastal Nevada/Tokyo agency that matched

Young with the Takahashis, Aktiv Planning Inc. Director Akio Sasajima has taken

a risk contracting with Young because she lives in a state where paid surrogacy

is illegal. He has a financial stake and a reputation to maintain, as someone

who looks after his surrogates while protecting the rights of his client parents

and their babies.

His solution: abort one fetus through "selective reduction,"

which involves injecting potassium chloride into one amniotic sac at about 9 to

11 weeks gestation.

"Everyone is sort of in a dreamy stage. I'm speaking from my

business experience and heart. What good does it do if they can't afford to raise

this child?" asks Sasajima.

He has seen twin pregnancies result in stillbirths and neonatal

intensive care bills topping $300,000. The Takahashis don't have American

insurance and will have to pay the pediatric bills in cash.

It's still early, so there's a possibility one fetus won't

survive. For this reason, Sasajima advises Young against sending them a copy of

the ultrasound.

But Young calls the Takahashis, confident that's what they

would want.

"I want them to know I have pictures of their babies. If something

happens, OK, it happens. But not to show them?" said Young.

But by the time Young called, Sasajima had already told the

Takahashis.

"[Kumiko] said that the last few days she had a feeling it was

twins. She said that my health is most important, but if I was willing to deliver

two babies, they'd be very happy. I told her that I'd be happy to carry both of

them," said Young.

"I do have to say, though, I woke up this morning somewhat

scared. This is going to be quite the challenge for my body. I hope I can get

these babies here happy and healthy."

Embryos and risks: All gestational surrogacy pregnancies are

treated as high-risk because they involve in vitro fertilization and more than

one-third of IVF births involve multiples. Like many infertile couples, the Takahashis

chose to transfer two embryos to improve their odds of conception.

Twins aren't as risky as triplets, but they still have higher

chances of being stillborn, underweight or suffering from a developmental delay

or cerebral palsy.

Because of this, some European countries mandate single-embryo

transfers. But in America, parents often opt to transfer two embryos to improve

their chances - something surrogacy agencies can't control.

It's hard to measure the scope of the largely unregulated and

highly competitive surrogacy industry.

While adoption agencies report to state licensing bureaus and

seek accreditation from professional organizations, there is no such oversight

over surrogacy agencies.

That worries Adam Pertman, executive director of the Evan B.

Donaldson Adoption Institute in New York City.

"Letting the Wild West rule seldom results in best practices,"

said Pertman. "As it is, there isn't enough training, education, regulation or

monitoring of adoption agencies."

Shirley Zager, owner of a Chicago agency and director of the

Organization of Parents Through Surrogacy - the closest thing to a national organization

- says the industry does a good job of regulating itself. By her count, there

are about 70 agencies in the country, a good half of them in California.

Surrogacy agreements that dissolve into painful lawsuits or

custody battles get media attention but are rare, asserts Zager, who estimates

that nationally about 1,000 babies a year are born through surrogacy.

Zager says agencies have adopted guidelines aimed at averting

situations that might be perceived as immoral or exploitative. "Most of the professionals

do a wonderful job. A few out there are in it for a quick buck," Zager said.

Sasajima subsidizes his surrogacies with a lucrative egg-donation

sideline. He has brokered 65 surrogacies since 1992, some resulting in twins,

bringing the total number of babies to 75. None of his contracts has landed in

court and none of his surrogates has been injured.

Sasajima requires his clients to undergo counseling and handles

all their legal affairs, including drafting the contract that guides them. But

Young's contract is silent on the subject of selective reduction.

"People change their minds," Sasajima said. "All I can do is

get them to think about these things before."

In October over lunch, before the Takahashis had elected to

transfer two embryos, Sasajima attempted just that.

"How do you feel about twins?" he asked Young and the Takahashis,

after ordering an Atkins-friendly burger with chop sticks. Sasajima is the broker,

the travel agent, counselor, advocate and liaison between the two families - in

this case, two cultures - and humor helps.

The Takahashis deferred to Young, who said, "It's their decision.

It's their baby."

But Young's mom, Irene, who had come along for "moral support,"

interjected.

"She'll have them both," said Irene Young, a devout member

of The Church of Jesus Christ of Latter-day Saints and identical twin to her sister,

Ilene. "If it was just Ilene, you wouldn't be here. Remember that, Crystal."

At the time, they all agreed to put the decision off. In December,

Young and the Takahashis met in Hawaii and agreed: They would keep the twins.

Shared lives: Sasajima matched Young and the Takahashis based

on their mutual outlook. Some clients see surrogacy as a business transaction

and prefer to keep a comfortable distance from one another. But Young and the

Takahashis stress their desires to keep in touch after the birth.

The Takahashis have been reading up on Utah and have offered

to have Jordan come live with them for a study-abroad experience. And they plan

to tell their children how they were conceived.

"I will tell them a person named Crystal helped bring you into

this world," said Kumiko.

Through this surrogacy, Young is fulfilling a family tradition.

Her grandmother and great-grandmother bore twins. Both delivered about a month

early, but without bed rest or complications.

"They did it, so I figure I can," said Young, who has been

taking comfort in her grandmother's wisdom and shared stories.

But the strain of a twin pregnancy is already taking its toll

as Young, exhausted after a day's work, heads straight to bed after helping Jordan

with his homework.

She eats cereal for dinner to avoid heartburn and falls asleep

by the time her boyfriend, Ryan Radke, usually arrives. Seeing her curled up on

the bathroom floor with "morning sickness," Young says he tells her, "You're never

going to want to be pregnant again."

Young has no regrets but has decided this second surrogacy

will be her last, because "I may want to have more children myself one day."

The Takahashis will have to go to even greater lengths than

they expected to keep the surrogacy agreement secret.

Because surrogacy is shunned and regulated as if it were illegal

in Japan, Kumiko plans to fake a pregnancy by "wearing baggy clothing" and telling

friends she delivered unexpectedly while on vacation in America - a more challenging

feat with twins.

Not knowing whether Utah lawmakers will legalize paid surrogacy

in coming weeks, both Young and the Takahashis are uncertain where she will deliver.

Her due date is July 2.

The Takahashis began work on the nursery after New Year's and

are looking forward to learning the babies' genders so they can pick out names.

Kumiko keeps copies of the ultrasound photos in her bedroom.

"They're cute little babies," Kumiko said, laughing. "Any baby

and we will be happy."

kstewart@sltrib.com