Warren and Mark, both doctors in their early 50s, have been together for 32 years - ever since their med-school days.
A few years ago, they wanted something more: a child. To make that goal a reality, they decided to pursue surrogacy, and their search led the New Yorkers to Madison.
After working with the Surrogacy Center, located on Madison's west side, the men are the overjoyed parents of three-year-old twins. (For the sake of their children's privacy, Warren and Mark prefer not to use their full names.)
Because surrogacy is illegal in the state of New York, the men had no choice but to look elsewhere. They're not alone: The Surrogacy Center's clients come from all over the world, from Chicago and Boston to Japan and France.
Warren hopped online to research agencies around the country, contacting at least three before picking the one in Madison. Other agencies turned him off for various reasons. The first was reluctant to provide clear information about costs; another didn't screen egg donors and surrogates thoroughly enough for Warren's comfort. Still another didn't have the inclusive feel he was searching for.
Some information he received from other agencies "was very straight-oriented," says Warren. "All the brochure pictures were of men and women. Nothing depicted gay couples."
His contact with the Surrogacy Center left a better impression. Its brochures included pictures of both straight and gay couples (one of the promotional pieces proclaims "Our Two Dads," with a photo of young men in matching sweaters holding infants in matching overalls).
"It wasn't only that they're incredibly nice on the phone, but that they're very open and transparent. The word 'transparent' is overused these days, but it was very clear they wanted to answer all my questions, and I was impressed," Warren says.
Although still relatively uncommon, surrogacy receives quite a bit of media coverage. In spring 2008, Newsweek ran a cover story with the somewhat loaded title "The Curious Lives of Surrogates." It reported that many are the wives of military personnel.
In November 2008, New York Times writer Alex Kuczynski shared her surrogacy experiences in "Her Body, My Baby," the tale of her son's birth via a Pennsylvania woman. The story drew over 400 online comments, many of them harsh, focusing on the disparity between the wealthy Kuczynski and the middle-class woman who bore her child.
Some clearly feel that surrogacy is frivolous or exploitative. Others feel that it, like adoption, is simply another way to build a family - and a valuable, positive option for gay couples or straight couples facing infertility.
Either way, surrogacy is much different today than in the mid-'80s, when the practice first grabbed national attention.
Baby, you've come a long way
If you're 40 or older, your first exposure to surrogacy was probably the Baby M case. In 1987, a trial pitted a surrogate mother against the couple who had hired her to carry a child for them.
After giving birth, Mary Beth Whitehead wanted to keep the baby, who had been conceived using Whitehead's eggs. William and Elizabeth Stern, the intended parents - or IPs, in today's surrogacy lingo - fought back. Ultimately William Stern (the baby girl's other biological parent) was awarded custody, and Whitehead was granted visitation rights.
The bitter case formed many people's opinion of surrogacy as something complicated at best and bizarre at worst. A brave new world of reproduction had arrived, bringing with it legal and ethical questions most had not yet considered.
Now, more than 20 years later, much has changed. While surrogacy still accounts for a small fraction of births, it's become more commonplace. There are no precise numbers, but The New York Times reported earlier this year that the American Society for Reproductive Medicine estimates "400 to 600 births a year from 2003 to 2007 in which a surrogate was implanted with a fertilized egg." Others believe the real number is much higher and will climb.
Technological advances have had a major impact. The Baby M case was emblematic of the problems posed by what's now called "traditional surrogacy," in which the woman carrying the baby is also the child's biological mother. Through in vitro fertilization (IVF), now widely available, embryos can be created that have no genetic link to the surrogate - by using donor eggs, for example. In these situations, the majority of surrogacy arrangements today, the surrogates are known as gestational carriers.
Tabloids are now filled with snapshots of celebrities and the kids they've had through surrogacy. Today's celebrity coverage makes it seem glamorous - and possibly unattainable for regular folks.
The Surrogacy Center was founded in 2002 by three local lawyers: Lynn Bodi, Carol Gapen and Judy Sperling-Newton.
Sperling-Newton represented the first gestational carrier case in Wisconsin in 1995. She was guardian ad litem for the baby, tasked with representing the child's interests in court. As medical technology advanced, Sperling-Newton found both would-be parents and surrogates coming to her seeking legal guidance. The center's founders wanted to provide "a professional, safe and legal arena for these arrangements," says center program director Mary Murphey. It is not a medical facility, but can refer clients to medical providers if desired.
Surrogacy law varies widely by state. In Wisconsin, no law prohibits it, but it's not regulated, either. While the Surrogacy Center voluntarily adheres to guidelines set by the American Society for Reproductive Medicine - and is, in some respects, even more stringent than those rules- it is not required to.
The process is costly; an individual or couple can expect to spend $100,000 or more in the pursuit of a child. That figure encompasses the surrogate's fee, legal fees, medical fees for in vitro fertilization, donor egg costs, travel and other expenses. The center screens surrogates and IPs, matches them with each other, handles the legal aspects of the process, makes referrals to medical providers if needed, and provides emotional and logistical support to both parties during the process. For example, the center can help a potential surrogate figure out what her insurance might cover. While the Surrogacy Center suggests a fee range to gestational carriers ($15,000 to $25,000), ultimately the woman sets her own fee.
For Warren and Mark, parenthood has been the capstone to their lives together. Warren, a pediatrician, says, "It's nothing like I thought it would be like. It's a hundred times better." It's also added a new dimension to Warren's work. "Professionally, it's made me a better pediatrician. I listen to parents more and respect parents more. When parents say something is wrong, I trust them."
Mark is the biological father of one child, and Warren, the other. Technically, the children are half-siblings, since they have the same egg donor.
Although his children are very young, Warren has begun addressing those "Where did I come from?" questions all children ask. Says Warren, "It's the same advice I give to my patients who adopt: Talk about how families are chosen. You can choose, but once you choose, it's forever."
Happiness is a new baby
For straight couples, the road to surrogacy often has a different emotional landscape than for gay couples. For many, surrogacy is a last resort after miscarriages, failed IVF attempts and adoptions that fell through.
New York's Margaret Klein, now married to her second husband, had wanted for years to be a mother, but infertility thwarted that goal. A social worker with a private psychotherapy practice, Klein says, "Fertility issues can wreak havoc in a person's life. I'd say that, indirectly, it was probably the cause of my divorce."
Klein, 50, has now been married for four years to Eric Hoffmaster, 55, who works in tech support. Hoffmaster has a 19-year-old from his first marriage.
While the pair considered adoption, they decided it wasn't right for them. Then Klein "picked up a Newsweek article about surrogacy and thought, do people really do this?"
Her first contact with an agency, like Warren's, was disappointing. The agency had a combined age limit of 100 for the intended parents, deeming Margaret and Eric too old.
Her next move was to call her adoption attorney for surrogacy advice. That lawyer knew Sperling-Newton of the Surrogacy Center, which is how the New York couple wound up using the Madison agency.
From the very beginning, it seemed like the right fit. "I liked the fact that the Surrogacy Center was small and very personalized," says Klein. Only six or seven babies are born each year as the result of the center's efforts. As of late October, 44 babies had been born in its seven-year history.
Margaret also praised program director Murphey's knack for matching intended parents with gestational carriers: "It made me feel like this woman is completely working for us, on our side. It doesn't feel like a business, even though it is."
Murphey connected Margaret and Eric with surrogate Laurie Moyer, 38, who lives near Stevens Point. Moyer delivered their son this past August, two weeks before Margaret's 50th birthday.
The two women have forged a close bond. Klein has extended an open invitation for Moyer to visit. In fact, Laurie's hoping to run the New York Marathon next year and stay with the couple and the little boy she gave birth to.
The relationship between intended parents and surrogates involves a level of trust beyond many other human relationships. While IPs want to know that the pregnant woman is taking good care of herself and the fetus, the danger is that some become overly controlling. Reputable agencies try to manage these sorts of expectations before a pregnancy occurs.
During Moyer's pregnancy, says Klein, "We had warm, friendly, respectful boundaries. We had several nice, long, heart-to-heart chats, but I knew that she's providing us with a service, and she has her own life."
Moyer is the married mother of two girls, ages 6 and 4. Although she is mostly a stay-at-home mom, she does some consulting work as a registered dietitian.
Carrying Margaret and Eric's child was Moyer's first experience with surrogacy. Her motivation was shaped partly by personal experience: "I had two girlfriends who had struggled with infertility. I realized how amazing it would be to help someone out. I had such easy pregnancies, and I enjoyed being pregnant. I thought that if there's anything I could do to make my mark on the world, it would be to help someone else have a child."
Moyer doesn't discount the financial boost to her family, though. "I'd be lying if I said that wasn't a factor, but my main focus was to give someone a baby."
While friends and acquaintances warned her that she'd have a hard time giving the baby up, even though the baby has no genetic link to her, Moyer did not struggle with it. "Going into this, you know it's not yours," she says matter-of-factly. "He was always Margaret and Eric's baby."
Moyer hasn't yet decided if she will be a gestational carrier again. "It's just such a fulfilling feeling to know you've made someone so happy," she says.
'It's a wanted pregnancy, and everyone's happy'
While the experiences of Warren, Klein and Moyer were all positive, they didn't just happen. At the Surrogacy Center, both parties are screened before intended parents are matched with carriers.
Would-be parents and surrogates must undergo a psychological evaluation, typically done by Julianne Zweifel, Ph.D., who is also a clinical assistant professor at the University of Wisconsin's School of Medicine and Public Health. Says Mary Murphey, "It's rare that [a potential surrogate] gets to that point and the psychologist says no, but it's happened."
Potential surrogates must also be willing to provide medical records pertaining to their previous births, to show they've had generally complication-free pregnancies and deliveries. "It's all about her uterus and how healthy it is," says Murphey.
Typically, the surrogates Murphey works with are Wisconsin women from middle-income families, between 25 and 42 years old, and married, although one lesbian in a committed relationship has been a surrogate.
"We have never advertised for surrogates," says Murphey. "They find us, mostly through the Internet, or medical clinics refer them."
Although in theory, the center would be willing to handle a traditional surrogacy, it never has. All its births have been through gestational carriers with no genetic tie to the babies. Traditional surrogacy is discouraged because it's more complicated legally.
As for the clientele, about 70% are heterosexual couples, and the other 30% are gay male couples. "We've had inquiries from single people, but we've only worked with one so far," says Murphey.
Clients are about evenly split between the U.S. and other countries. "I'm working with six or seven couples from France, and about six or seven domestic." Many European countries prohibit surrogacy, including France, Germany, Italy and Spain.
A necessary part of arranging a surrogacy involves discussing morally charged issues like selective reduction and termination of the pregnancy in the case of genetic abnormalities. Down syndrome is a particularly hard call, Murphey notes. If both intended parents and surrogates don't share the same attitude toward this question, a match would not proceed.
While there are those with religious or other objections to surrogacy, Murphey feels that it, like adoption, is a good option for couples who can't bear children of their own.
"There's a lot of joy," she says. "That's what I love about my job. It's a wanted pregnancy, and everyone's happy. If people could walk in my clients' shoes, they might change their minds about surrogacy."