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