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The Gift


Posted on November 7

Photography by Roy Wilcox

In a dim examining room, Sally Bounds lies on her back, naked from the waist down, her feet in stirrups. There’s a blanket over her knees, disposable booties on her feet and a papery shower cap covering her dark brown hair. Sally’s husband, James, and her friend Celeste Kett stand beside the bed, wearing paper booties and caps, holding surgical masks. 

A medical assistant, also capped and bootied, picks up an ultrasound transducer, splurts some gel onto Sally’s flat belly and presses the instrument against her abdomen. “See there?” she says, pointing to the screen. “The doctor will go in through your cervix and straight to the back of your uterus.”

No one speaks. The medical assistant adjusts the table so that Sally’s head is lower than her feet. James wipes away sudden tears.

Janice Andreyko, M.D., enters the room. Brisk and efficient, she smiles quickly, glances around the room and asks if everybody’s here and ready. Everyone says yes, and Celeste explains why her husband, Mike, hasn’t joined them. “He’s got the flu, so he doesn’t want to get close to Sally. Also, he didn’t want to see Sally . . . like this.”

“He doesn’t want to see me half naked,” Sally remarks.

Andreyko nods and says, “Let’s go. Everybody, put your masks on, please.”

Sally and Celeste have been well-prepared for what comes next; two weeks ago, doctors put Sally through a dry run to make sure everything would go smoothly when the real moment came. Celeste has personal knowledge: One year ago, she underwent the same procedure and found out on her 36th birthday that it had failed. As she slips her mask over her nose and mouth, her eyes fill with tears and she blinks quickly.

Sally lies still as Andreyko picks up a syringe filled with pink solution and gets to work, first washing Sally’s cervix. Then she gestures to the assistant, who picks up the phone and speaks: “Please bring the embryos for Celeste and Mike Kett to be transferred to Sally Bounds.”

Seconds later, a man in medical greens enters the room, a syringelike device in hand, and says, “Two embryos for Celeste and Mike Kett to be transferred to Sally Bounds.”

Andreyko takes the device—called a coaxial catheter—and the assistant says, “Two embryos for Celeste and Mike Kett are being transferred to Sally Bounds.”

Working quickly, Andreyko uses a stylus, or small wand, to open Sally’s cervix. Then, guided by ultrasound, she begins threading the catheter through Sally’s cervix. On screen, the catheter appears as a thin line creeping into Sally’s uterus. As Andreyko releases the embryos against the back of Sally’s womb, a bright spot appears on screen, then dissipates.

No one speaks as Andreyko withdraws the catheter and hands it to the man in greens, the embryologist, who leaves the room. In a moment, he phones to say the transfer was successful: No embryos remain in the catheter.

A sigh of relief is heard around the room, and a single tear runs from Sally’s left eye into her cap. Celeste grips the bed rails, her eyes closed, her pale face both peaceful and pleading. Then she opens her eyes and says, “It’s in God’s hands now.”

It’s Dec. 11, 2002. By Dec. 23, Celeste’s 37th birthday, they’ll all know if Sally is pregnant.

 

**********

Sally Parrish and Celeste Dingman met at The Buckhorn Steak & Roadhouse in Winters eight years ago. On a date with James Bounds, whom she’d been seeing for seven years, Sally spotted James’ best friend, Mike Kett, across the room. “He’s hard to miss,” Sally says, laughing, describing Mike: 6 feet 7 inches tall, a huge man. “His nickname is Moose.” 

James and Mike had grown up together in Dixon, and still lived within walking distance of each other. They were Big and Little—Mike, the gentle giant, looked out for James. “James was the little annoying guy, always getting himself in trouble,” says Sally, “and Mike was the big guy who would fight his battles.”
That night at The Buckhorn, Mike and Celeste were on their first date; James and Sally stopped by their table to say hello. Sally and Celeste made small talk that night, and by the time Mike and Celeste became engaged in late 1997, the women had become close friends.

After dating for 10 years, Sally and James were married in January 1998. It was the second marriage for each. Sally, then 32, and James, 42, brought three children to the marriage: Sally’s 17-year-old daughter, Vanessa; and James’ sons, “Little” James, 16, and Jason, 13. They didn’t plan to have any more children.
“We had already raised our kids together, ” says Sally, now the executive assistant at Sacramento Magazines Corporation. James is a customer service representative for a mobile hydraulic equipment distributor. “We didn’t see any reason to have any more kids,” she says.

Mike and Celeste, however, both from large families, planned to have children immediately after marriage. They had been actively pursuing their careers—Celeste working at CalPERS; Mike building his business, Dixon Tractor & Gravel. Married on Dec. 12, 1998, they hoped to have their first child right away. “The joke was, we’d start trying on Dec. 13,” says Celeste. “We were older; I was almost 33, he was 38, so we were anxious to get started.”

Every month, Celeste waited hopefully to discover she was pregnant. “It just wasn’t happening,” Celeste says.

When she saw her gynecologist, Elizabeth McClure, M.D., for her annual exam, McClure advised her that insurance required her to wait at least a year before it would cover any fertility testing. She told Celeste to watch her cycles carefully, to make sure she and Mike were having intercourse at the most fertile time. So Celeste and Mike kept trying, their hopes turning increasingly desperate as the months went by.

In early 2001, McClure ordered a hysterosalpingo-graphy (X-ray of uterus and fallopian tubes) and performed a laparoscopy on Celeste to see what might be impeding fertility. She also recommended that Mike see his doctor for a sperm assessment.

Mike’s semen analysis looked fine, but Celeste’s tests suggested a problem. Her right tube was completely blocked, which would prevent conception from occurring if she ovulated from her right ovary. “It probably had been like that from birth,” Celeste says, “just a defective tube. The ovary was very healthy, and the other ovary and tube were completely clear and healthy.”

Celeste accepted McClure’s referral to the Northern California Fertility Medical Clinic in Roseville, where Andreyko, John Gililland, M.D., and Carlos E. Soto-Albors, M.D., are partners.

In June 2001, the Ketts saw Gililland for a consultation. After assessing the Ketts’ case and performing a number of tests—including a scope of Celeste’s uterus (hysteroscopy) and another semen analysis for Mike—Gililland prescribed Celeste Clomid (clomiphene citrate), a medication that induces ovulation from both ovaries and increases egg output. During each Clomid cycle, doctors performed ultrasounds shortly before Celeste was likely to ovulate each month. Because her right tube was blocked, they hoped to see more eggs on her left ovary. “It was very discouraging if I went in and they said, ‘Oh, there are 12 eggs on the right side and two on the left side,” Celeste recalls.

No matter how many eggs matured on her left ovary, the doctor injected Celeste with a hormone to promote final egg maturation and ovulation, then sent her home to “have intercourse as many times as you can in the next 72 hours,” says Celeste.

The emotional toll was high; the medications created hormone surges that affected her moods, which further fed her obsession with becoming pregnant. “You’re anxious all the time,” says Celeste. “You’re constantly not worrying about life; you’re worrying about your cycle, fixated on the monthly calendar. And talk about destroying a relationship! There’s nothing romantic about having to plan [intercourse] like that. ‘What do you mean you’re not going to be home?’ There was a lot of conflict.”

Furthermore, the financial impact hit hard. Each cycle of medication and monitoring cost the Ketts about $900, very little of which was covered by insurance. Celeste did four rounds of Clomid therapy, and each month, she and Mike hoped. Then, as she sensed her body preparing for menstruation, they grieved. “I’d start to spot. And those days . . .” she says, her voice quaking. “Those were tough days.”

After four months, Celeste and Mike again consulted with Gililland, who broached the subject of in vitro fertilization. “[Seeing] one blocked tube, one has to be suspicious that the ‘open’ tube may not be functioning normally,” says Gililland. “Tubal damage is rarely confined to one side, though one side can be more affected than the other. A woman with blocked tubes needs IVF.”

Carrying an approximate 50 percent success rate among clinic patients ages 35 to 37, IVF offered hope, but promised to be an all-consuming process for the Ketts. Celeste would need to inject medications daily at home and make numerous trips from Dixon to Roseville for blood tests and monitoring. The biggest hurdle involved finances. “They bring out a book and it’s like six different game plans,” Celeste says, adding that their insurance, like most, wouldn’t cover IVF. “Here you are trying to have a baby naturally, then you’re talking about spending all this money. And there’s no guarantee.”

At the clinic, the least expensive IVF option for a couple in the Ketts’ situation is the Refund Plan, which costs $12,000 up front for one “treatment cycle,” and promises a 60 to 80 percent refund, depending on several factors, if pregnancy does not occur.

Gililland says that when a couple comes to him desperate to have a child, he must weigh their probable success against their deepest wishes. “When I think it’s inappropriate or very unlikely that a couple is going to be successful, I’m very honest with them,” he says. “I don’t like to see couples spend a lot of money, time and emotion only to fail. Sometimes, though, their potential to conceive isn’t so clear and I’m still unable to predict the future at this point.”

Mike and Celeste took the leap and signed on for one treatment cycle of IVF.

**********


First successful in 1978 with the birth of “test tube baby” Louise Brown in England, in vitro fertilization literally means “fertilization in glass.” Eggs and sperm are placed together in a dish in the laboratory and, a few days later, resulting embryos are transferred into the woman’s uterus. About a week later, the woman has a blood test to determine if any of the embryos have implanted.

“The success rate depends on the number and quality of embryos available for transfer,” says Gililland. For the woman, this means a complex system of medication and monitoring rules the monthly calendar—injections of Lupron (leuprolide), a pituitary suppressor that prevents ovulation from occurring too soon, and injections of gonadotropin medications to stimulate the ovaries into maturing numerous eggs.

When eggs are mature, the doctor runs an aspiration needle through the vaginal wall to harvest eggs from both ovaries.

 

**********

If Celeste found treatment with Clomid a rough ride, she discovered it was smooth compared to complete pharmaceutical manipulation of her cycle. That fall, Mike gave her injections every day for three weeks. Her emotions dipped and soared, she felt puffy and queasy, she gained a tremendous amount of weight. “Between the stress and the medication,” she says, “I gained 75 pounds.”

But all that paled next to the hope she felt. When a whopping 14 eggs were harvested from her ovaries on Dec. 10, 2001, it all seemed worth it.
 
**********

 

In the lab, the eggs are placed in a culture media inside an incubator. Meanwhile, the man’s fresh semen specimen is spun in a centrifuge until a population of active sperm is isolated. A few hours after egg retrieval, sperm are placed around the eggs.

About 18 hours following insemination, the eggs are examined under the microscope to see how many have been fertilized. They are inspected daily; cell division is recorded. Three days following egg retrieval, embryos containing six to 10 cells can be transferred. In many cases, though, the embryos are cultured for an additional two or three days to a developmental stage called blastocyst. With 60 to 100 cells, these embryos have the highest potential for establishing a pregnancy. Because some embryos do not continue to develop to blastocyst stage, waiting the additional couple of days helps determine which embryos are likely to continue developing. “This way, fewer embryos may be transferred without lowering the chances for conception,” explains Gililland. “This helps diminish the rate of multiple pregnancies.”

Multiple gestation is one of the most controversial aspects of assisted fertility procedures. While it makes sense to transfer as many embryos as possible in hopes of having one implant in the uterus, if too many implant, a woman’s chances of miscarrying them all goes up; also, a multiple gestation can create serious health risks for the babies and the woman. If the number of embryos exceeds the number that can be transferred, couples may opt either to have them frozen and preserved in liquid nitrogen for later use, donate them for research or have them discarded. 
    

**********

 

Ten of Celeste’s eggs fertilized. Four reached blastocyst—two to be transferred and two to be frozen for possible later use. After the transfer, Celeste was sent home with orders to rest for a couple of days. She was told to lie still, read, watch television, and get up only to eat or go to the bathroom.

“We’re very conservative,” says Andreyko. “There’s no reason not to be. Although ultimately, once the embryos are transferred, whether or not they grow is out of anyone’s control.”

Knowing she had to wait about a week before she could have a pregnancy test, Celeste went through the next week assessing herself for signs. Did she feel any different? Was this bloated feeling from the meds, or could it mean she was pregnant? “I was imagining things because I wanted it so bad,” Celeste says.

On Sunday Dec. 23, her birthday, Celeste drove to the clinic to have blood drawn for her pregnancy test. With her hopes high, Celeste went to her family birthday celebration later that day. There, Mike’s cell phone rang and they got the news that her pregnancy test was negative.

Celeste and Mike were devastated. More than a year later, when Celeste is asked about this particular birthday, she can hardly talk about it. “It was awful,” is all she says.

After that, the Ketts’ path to parenthood took them in several directions. In January 2002, they agreed to undergo a frozen-embryo transfer, using one of the embryos from their previous IVF cycle. Celeste’s hopes were low going into it. “I didn’t feel good about it from the beginning,” she says, citing statistics that show the clinic’s success rates with frozen/thawed embryo IVF in 2001 were 27 percent. “I didn’t really want to put myself through the emotional trauma anymore.” But the embryos were there, so they signed on for a February transfer. Again, it failed.

Emotionally spent, the Ketts tabled the subject, focusing on work, reconnecting with each other, “getting back on an even keel,” Celeste says. Then, slowly, they began researching adoption, gathering information and making inquiries about private, Sacramento county, and international programs. Each adoption option, they discovered, presented them with significant challenges. Their discouragement grew.

**********

 

One Friday in April 2002, the Ketts met the Boundses and a few other people for dinner at Chevys in Dixon. The conversation turned to children and the Kett’s struggle with infertility. “I could tell Celeste was bummed,” Sally recalls. “She was upset, and said she knew she’d never be able to have a baby. I asked, ‘What about a surrogate?’ and Celeste said that it’d be great except you have to worry about some psycho taking your baby, not to mention it would cost more money.” Celeste also said she’d never do it unless the surrogate were someone she deeply trusted.

At home that night, Sally couldn’t sleep. “I was hit with this thought that I could be a surrogate for Celeste and Mike,” Sally says. “I tossed and turned all night.” The next morning, she got up and cleaned the house, her mind whirling with the possibility. “I couldn’t get it out of my head.”

She set aside the vacuum cleaner and hauled out the family Bible, searching for some passage that would suggest surrogacy was morally wrong. She couldn’t find anything.

James had been out helping Mike on a job that day. When he got home, Sally said, “James, I have to tell you something. Just sit down and hear me out and do not interrupt me.”

James, terrified that something was very wrong, sat down. When Sally said she wanted to be a surrogate for Mike and Celeste, James was surprised and touched. He hugged Sally, said it would be an incredible gift and pledged his complete support. As a nondenominational Christian and a volunteer chaplain for Solano County, he applauded her forethought to consult the Bible, and right then, he called their church pastor to inquire about surrogacy. The pastor assured him it was fine.

Next, James called Mike and asked him to come over. “We knew Celeste would be OK with it, but we felt we needed to talk to Mike first,” Sally says. “Mike came right over. Same thing, ‘is something wrong?’ We told him, he started crying, hugged me and said, ‘God, yes.’”

That evening, the four were scheduled to attend the annual Lions Club fund-raiser in Dixon. Before the event, Celeste came home from an all-day trip to Sacramento, and Mike told her about Sally’s offer. Celeste was flabbergasted. “I said, ‘This is the most unselfish thing I’ve ever heard of! Does she know what she’s getting herself into?’” The thought of all that surrogacy would entail brought to mind the emotional ups and downs they’d experienced during the past two years of fertility treatments. As grateful as she was for Sally’s offer, Celeste wasn’t sure she could endure the turmoil. “And the finances,” she says, quoting the clinic’s cost of $13,800 up front for surrogacy treatment. “Did we want to spend this money that perhaps we could be putting toward adoption?”

At the charity dinner, there wasn’t a good time for Sally and Celeste to talk, so finally Celeste pulled Sally aside and said Mike had told her about the offer. “You really want to do this?” Celeste asked incredulously. Sally said yes, definitely, and Celeste hugged her tightly.

“Sally said it would be easy,” recalls Celeste. “She was so persistent. She was so excited, and with her being excited, I got excited again. And it just started building.”

In mid-June 2002, Celeste, Mike, Sally and James consulted with Gililland, who described the surrogacy process in detail, including several layers of assessment that must occur before Sally’s treatment could begin. Sally needed to be suitable from a medical, psychological and legal standpoint. Legally, James had to sign on. “I also think it is very important to have [the surrogate’s husband] on board so that their relationship doesn’t fall apart as a result,” says Gililland.

He arranged for Sally to have blood tests, cervical cultures and a hysteroscopy; James would have blood screenings for AIDS and other sexually transmitted diseases. Gililland also informed the group that they’d need to see a social worker, who would schedule them separately and in pairs, and referred them to an attorney who would draw up a legal agreement.

**********

Surrogacy earned notoriety with the widely publicized Baby M case, in which a New Jersey woman signed a contract in 1985 to be a surrogate for an infertile couple, then refused to give up the baby. That case involved a “classic surrogacy”—the woman was inseminated with the intended father’s sperm and thus the egg was her own. Classic surrogacy is rarely offered anymore because of the ethical and legal dilemmas that arise because the surrogate is the genetic parent of the child. Instead, most fertility programs employ IVF surrogacy: “It involves the transfer of one or more embryos resulting from egg and sperm of both members of the infertile couple to the uterus of a third party—the surrogate,” says Gililland. “The surrogate provides a host womb for the embryos and does not contribute any genetic material.”

Still, surrogacy, with its complex medical and ethical issues, can be a legal minefield. Before any treatment is begun regarding the surrogacy, all involved parties must sign a very detailed contract. The document covers all the potential sticking points, including who has legal rights to raise the child, who can make decisions about terminating the pregnancy in the event of birth defects or a life-threatening medical condition, and who will raise the child if the intended parents die. The agreement also covers the surrogate’s lifestyle restrictions, payment of her pregnancy-related expenses—including lost wages—and her compensation for pain, suffering and inconvenience. According to one attorney who handles many Northern California surrogacy contracts, surrogates are paid $18,000 to $35,000, solely for carrying the pregnancy to term.


**********

That summer, the Ketts and Boundses agreed that the Ketts would pay all of Sally’s medical and legal bills, buy her maternity clothes and cover lost wages if the pregnancy disrupted her work schedule. Otherwise, Sally refused to be compensated. “They’re my friends,” Sally says, shrugging. “And these are two people who deserve a baby more than anybody.”

The counseling sessions with Davis-based social worker Barrie Lamonte helped further illuminate Sally’s motives: She welcomed the idea of having a “happy pregnancy.” Her pregnancy with Vanessa 20 years before had been frightening and negative because she had been a teenager, terrified to tell her parents, scared by all the physical changes in her body and the prospect of raising a child. The pregnancy for Mike and Celeste—if it occurred—would be treasured and surrounded by hope. Lamonte also pushed Sally to discuss her feelings about carrying a baby who she’d then relinquish. “That really didn’t bother me. I’m not looking to be a mom again,” says Sally, who is helping raise her grandson, Seth, who was born in August 2000.

“Seth has filled any need I might’ve had to be a mom again.” 

Significant counseling time focused on selective reduction, because IVF carries the risk of multiple gestation. “When Celeste and I were first talking about it, I said I’d be thrilled to do one, maybe two, but I would not do a litter,” says Sally.

All four agreed that it would be best if Sally didn’t carry septuplets, but no one felt very comfortable with the idea of aborting any embryos. “There was a big mix of feelings, trying to decide what would be best for the babies and everyone involved,” Celeste recalls. “We’d go to dinner after every one of these appointments, and we had to quit eating out at restaurants. I don’t think people in Dixon even wanted to wait on us. We would be laughing one minute, next minute we were crying, we were yelling. We had the gamut of emotions.”

“At one point,” Sally says, “I was thinking what a tremendous irony it is that we’re talking about a reduction when these people cannot even have one baby. So I decided if I can carry one baby or two or four, if I’m OK and the babies are OK, what the heck? We’ll let the doctor make the decision.”

The doctors did make the decision. Upon reviewing Sally’s medical history, they determined Sally should not have more than one embryo—two at the most—transferred. It had been 20 years since her last pregnancy, and she had delivered Vanessa two months early—perhaps only because she’d been so young, but Gililland and his partners didn’t want to take any chances. With these drawbacks, Sally was considered a suitable, but not ideal, candidate to be a surrogate.

Celeste and Sally heard the doctors’ concerns, but brushed them aside. “[The medical drawbacks] didn’t make a difference,” Celeste says. “Sally is what was given to us.”

Both women felt that Sally’s decision to be a surrogate came from outside themselves, and that nothing from within themselves would stand in the way of success. “God spoke to me,” Sally says. Adds Celeste emphatically, “Sally is a gift from God. She was handed to me.”

So they proceeded. Celeste and Mike wrote the clinic another check, and Sally, Celeste and James attended a weekend “injection clinic,” where James learned how to push hormone medications into Sally’s backside. And, as part of the 14-page, 34-paragraph surrogacy contract, Sally agreed to give up her favorite drink, caffeinated Coke; her favorite food, shellfish; and she and James agreed to abstain from sexual intercourse until after the birth of the baby, or upon termination of the contract. “Out of all these, shellfish is going to be the hardest,” she joked.

Once all the details were finalized, they aimed for a December 2002 embryo transfer.    

**********

After an appropriate month is selected to begin treatment, the surrogate begins taking birth control pills to align her cycle with that of the intended mother/egg donor. The surrogate’s cycle must be completely governed by medication, so that she doesn’t ovulate and so her uterine lining is optimally thick when the transfer occurs. Therefore, Lupron is administered daily for approximately three weeks; once the intended mother/egg donor begins gonadotropins to increase egg output, the surrogate begins receiving injections of estradiol valerate (to induce the lining to thicken) twice a week. As the day of the egg retrieval nears, the surrogate goes to the clinic often to be monitored. The day before the egg retrieval, the surrogate begins daily progesterone injections or suppositories—progesterone will support the uterine lining and pregnancy. On the day of retrieval, the intended father/sperm donor produces the semen specimen that will be processed for use in the IVF.

The surrogate is on call, knowing that when the embryos have grown for three days or five, depending on how they look, she will go to the clinic for the transfer. 
 
 
**********

In early December, after the egg retrieval and insemination, Celeste and Mike and Sally and James were on pins and needles, waiting for the embryos to develop. In the lab, 10 eggs were surrounded by processed sperm, and by the next day, seven eggs had fertilized and begun to divide. By the third day, three embryos had divided into eight cells, and the decision was made to “go to blast.”

Two days later, on Dec. 11, the Ketts and Boundses gathered in Andreyko’s office before the transfer. All four were required to sign one last bit of paperwork; Mike, suffering from the flu, sat as far from Sally as possible, and announced his intention to leave before the transfer procedure. Before Andreyko entered the office, the four joked about Sally’s battle scars. “James is brutal with the needle,” Sally accused. “I’ve got bruises all over my butt from the shots.”

They all joked back and forth, blowing off nervous energy while they waited for Andreyko, who came in with a smile, asking, “Everybody ready?”

She showed Mike and Celeste a photo of two blastocysts that had reached approximately 60-cell size. She said she could put one or two blastocysts into Sally’s uterus. “The highest likelihood is just one will take,” said Andreyko. “You have two beautiful embryos. This is the best there is in terms of [achieving] pregnancy.”

Celeste said they’d agreed to transfer both embryos. All four signed a release.

Celeste asked for Kleenex and dabbed at tears. “I’m a baby,” she said apologetically.

“No, this is very important,” said Andreyko. “How does everybody feel?”

“Optimistic,” said Sally.

“We’re excited,” said Celeste.

“Just worried,” said Mike, as Celeste rubbed his leg.

“Pray,” said James.

The day after the transfer, Sally came down with a nasty cold, so lying around for the mandatory few days wasn’t tough. As the week went by, just as Celeste had a year ago, Sally tried to interpret any signs her body gave her. Celeste called several times a day, just to ask how she was feeling.

The attitude among the four varied. Sally felt confident and eager. James, too, already could visualize a boy or a girl. Mike approached it very cautiously, careful not to sound too hopeful. “They’d had so much disappointment,” Sally says. “He and Celeste were concerned about putting the cart before the horse. Celeste was really excited, but she was afraid to be excited, too.”

**********

After the transfer, the surrogate continues taking injections of estradiol, along with progesterone. In about 10 days, she’ll have a pregnancy test. If it is positive, she’ll continue hormone support for an additional eight weeks; in a month she’ll have an ultrasound to confirm the pregnancy. At the three-month point, she will stop the injections and her care will transfer to a general obstetrician.

If the pregnancy test is negative, all hormone support stops and within three to 10 days, the surrogate will start her period.


**********

On Dec. 19, Sally drove to the clinic for her blood pregnancy test with butterflies in her stomach, knowing that the clinic would phone Celeste with the results between 2 and 4 that afternoon.

Just before lunch, Celeste was in a meeting at work when her cell phone rang. It was the clinic, with the best news. Celeste, sobbing in the hallway at work, called Mike, who said, “Really?” and wept. Then Celeste called Sally and, putting on her best poker voice, asked, “So how do you feel about doing those shots?”

Sally, figuring Celeste was just killing time, settled in for a nonchalant conversation. “I dunno, they’re OK,” she replied lazily. “Good,” said Celeste, “because you’re going to be doing them for awhile longer. You’re pregnant!”

Now that Sally was pregnant, the reality of the situation set in. She had a huge responsibility. Standing near a stepladder at work one day in early January 2003, she eyed a space on the wall where she planned to hang a framed magazine cover. “Are you supposed to be doing that?” a co-worker asked. Climbing ladders, although not specifically prohibited by contract, would probably make Celeste nervous, so Sally walked away. The stakes were too high to make careless decisions. She’d given up sex, Coke and crab, she reasoned, so why tempt fate with one stepladder?

A few days later, Sally woke up in the middle of the night and discovered she was bleeding. Her heart in her throat, she called Celeste and the clinic first thing in the morning. The nurse asked some questions, determined it wasn’t heavy bleeding, just spotting, and told Sally to lie quietly until it stopped. Sally had an ultrasound scheduled for the following Monday; she and Celeste were anxious to see that everything was all right. They also eagerly awaited this ultrasound because they would learn whether one or two embryos had implanted.

Laurie Lovely, M.D., performed Sally’s ultrasound. As the images on the screen rolled and jumped, Lovely pointed out what she saw. “It’s twins,” she said, showing them “yolk sac A” and “yolk sac B,” which was a bit smaller. Both showed heartbeats.

“I had a feeling!” Celeste exclaimed happily. “Now Mike’s going to have to do that remodel.” Lovely congratulated Sally and Celeste, told them the due date was Aug. 29, and requested they come back in two weeks for another ultrasound. As Sally dressed, Celeste said, “Let’s go call the guys.”

Mike, who was thrilled with the twin pregnancy, remained reluctant to participate in doctor’s appointments where he might see Sally disrobed. He worried about making Sally uncomfortable. But before the next ultrasound, Sally harangued him about it. “Don’t you want to see your kids?” she nagged. Mike didn’t have a job lined up that morning, and he did want to see the embryos, so he came along.

While they waited, Sally talked about Seth and his cousin, Jonah, and how they’d been running around her house one night recently. “I thought of calling you,” she said to Celeste, “and telling you to come over and see what you’re getting into.”

Celeste said she was nervous. She’d had a dream that when they did the ultrasound, they couldn’t find the babies. “[In the dream,] the babies are gone,” she told Sally in the waiting room. “I think it’s because you aren’t having any symptoms. You just feel normal.”

In the examining room, Celeste whipped out a VHS tape. “To get our first pictures,” she said, as Andreyko slid it into the ultrasound machine. As Andreyko began the ultrasound, she scrolled around quickly; again, images on the screen rolled and leaped.

“Looks like we’ve got just one,” Andreyko said. “This one’s not viable.”

“What?” Celeste asked, dumbfounded.

Andreyko explained that one sac was much larger than it had been two weeks before; the other hadn’t grown at all. “But let’s check the large one,” she said. One large blob monopolized the monitor, and Andreyko began click-clicking the machine, taking measurements. She announced the heart rate was 169. “A good, strong heartbeat,” she said.

Mike just stared at the screen, his face sad and solemn.

After Andreyko took the measurements, she scrolled to a smaller dark spot. “Uh-huh,” she said. “This is not viable.”

“You mean there’s just one baby?” Celeste asked, her voice flat.

“Yes,” said Andreyko, still looking at the screen. “I’m not able to get a heartbeat; it hasn’t grown. We’ll watch it. Can you come back next week?”

“Yeah, sure,” Sally said.

Andreyko wiped off the transducer and looked over her monitor at Celeste. “I know you’re disappointed,” she said, “but one is a healthy pregnancy. This is common; we call it the disappearing-twin syndrome.” She suggested that Sally’s spotting had indicated the miscarriage of the twin.

Andreyko left; so did Mike and Celeste. As Sally got off the table, she expressed frustration that if this is so common, they should’ve been warned. “For two weeks, they’ve had twins,” she said helplessly, her voice breaking.

In the hallway, Celeste was waiting to pay one of Sally’s bills. “I know I should be happy about the one,” she sobbed, clutching the videotape. “It’s just so hard.”

Outside the clinic, Mike, looking miserable, waited for the women. When they came out, Sally called James; Celeste called her sister, then the three of them, still shocked, headed to nearby Carrow’s for lunch. Celeste recalls that she and Sally sat there, lunch practically untouched, crying. “Mike said to us, ‘Maybe it wasn’t strong enough; maybe this is how it was meant to be. We went into this knowing there were possibilities this wouldn’t work at all. We still have one really healthy baby.’”

Celeste slugged him halfheartedly and told him to quit being so reasonable. “But I knew in my heart he was right, even though my heart was breaking,” she says. “One really healthy baby is the best, for Sally, for the baby’s health.”

Researchers have speculated that 50 to 80 percent of twin conceptions end in the birth of a single child due to one embryo vanishing very early in pregnancy. It is commonly documented in IVF conception. “We monitor pregnancy so early, we see things that would be missed otherwise,” says Gililland. “Though it is true that twins occur more commonly in IVF, I don’t know of any evidence that says one twin is lost any more often than if twins were conceived naturally.”

Andreyko performed the follow-up ultrasound on Sally the next week, confirmed the single embryo and announced that all looked good. It was Sally’s last appointment at Northern California Fertility Medical Clinic. In a few weeks, she would stop all her injections; her care would transfer to Celeste’s chosen Ob/Gyn, Elizabeth McClure. At that point, Sally’s medical insurance would cover her maternity care, just as with a typical pregnancy.

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Sally continued to feel good; she had few uncomfortable symptoms of pregnancy. Her clothes began to feel tight before she was four months along. She and Celeste shopped for maternity clothes together. When she first felt the baby kick, she called Celeste, who came over to place her hand over Sally’s belly. “I couldn’t feel anything,” Celeste moaned. “This baby stops kicking whenever I come around.”

Celeste was pleased with her level of involvement in the pregnancy. “If it couldn’t be me [being pregnant], I couldn’t imagine feeling closer to this,” Celeste said, when Sally was almost five months along. “Sally calls and tells me when things happen. We talk or e-mail every day. I’m very connected.”

 The men were involved, too. Sally, Celeste and the guys got together several times a week for dinner. James and Sally got hooked on The Learning Channel’s “Maternity Ward,” which details stories of labor and delivery, and includes graphic Caesarean-section coverage. “Delivery will go just fine,” Sally insisted, “as long as I don’t have to have a c-section. I really don’t want a c-section.”

In early April, when Sally was 20 weeks pregnant, the Ketts hired Ken Bushey of Insight Images to perform a 3-D ultrasound. The 3-D ultrasound is not a routine medical test, and not widely available, but James had a connection: He’s friends with Bushey’s brother. Bushey would be able to see whether the baby was a boy or a girl. Mike didn’t want to know the baby’s gender, but Celeste, Sally and James did. Mike could have left the room, but he opted to stay, arguing that the others weren’t allowed to know something he didn’t. So they all crowded together over the monitor and found out at once: a girl.

“The 3-D was just amazing,” said Celeste. “We’ve seen her toes, we’ve seen her fingers. She loves to suck her thumb. I imagine her being a little blonde.”

Mike chose the baby’s name: Megan Nicole. Celeste began rearranging a few items around the house, but couldn’t bring herself to really start preparing for Megan’s arrival. “We still have a long way to go,” she said in May. “I’m still being kind of cautious. Once you’ve been through fertility [treatment], for self-preservation, you’ve got to get to what you feel is a safe point.”

For Celeste, that was June 1. “I told Mike to make sure the cash flow’s there.” She began tearing apart the bedroom they’d designated as the baby’s. She ordered furniture: a crib, a dresser and a hutch; hung shutters and crown moulding; painted; applied a Winnie the Pooh wallpaper border. “I have a feeling she’s going to be pretty spoiled,” Celeste said.

The baby showers confirmed that. Celeste’s work friends threw one, and about 50 people attended, including Sally, of course. Family members held another one, an all-day event that drew 80 women. “We had people come up and ask to be invited,” Celeste said. “There was one woman whose name I didn’t even know. I had met her once, and Mike and I had a fight over what her name was.”

The surrogacy seemed to amass goodwill. “Part of it could be that we are well-known around [Dixon], but everybody wants to be involved,” said Celeste. “They’ve been so much a part of my not getting pregnant and Sally getting pregnant. Everybody feels a part of it.”

The four of them enjoyed their notoriety, engaging waiters and waitresses and other strangers at their dinners out. They liked telling their story, giving people goosebumps. “Except James just likes to tell everyone, ‘Yeah, my wife is pregnant and it’s not my kid,’” said Sally.

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Sally grew bigger, the weather heated up and her feet began to swell. Monthly doctor’s appointments turned to semimonthly, then to weekly as she neared her delivery date. She reduced her work hours to part time—mornings only, so she could rest in the afternoons. Celeste began training someone to replace her during her four-month maternity leave from work. She and Mike finished up the baby’s room, and James completed the handcrafted rocking moose he’d been working on. James also organized all the baby’s clothes, folding them neatly and organizing them in the dresser drawers according to size. “He’s such a woman,” scoffed Sally affectionately.

Mike and Celeste finalized the legal paperwork to assume parenthood of Megan. In most states, intended parents must formally adopt a child born to a surrogate, but in California, partway through the surrogate’s pregnancy, they file a Petition To Establish Parental Relationship, terminating the potential parental rights of the surrogate and her husband. “This also directs the hospital to place the names of the intended parents on the birth certificate,” says Shelley M. Tarnoff, the Bay Area-based attorney who takes on many Northern California surrogacy cases and handled the Ketts’ legal matters.

Sally and Celeste took a Lamaze class, joking that people probably thought they were a lesbian couple. “It’s always the two of us, women, showing up for these appointments,” Sally said. She and James took a tour of Sutter Memorial Hospital’s maternity operation, although Mike and Celeste also planned to be present for Megan’s delivery. “Only two people could go, and the hospital wouldn’t budge,” said Celeste. “We figured it was most important that Sally and James knew where they were going.”

The couples found their lives increasingly entwined. “We’d always been friends,” Sally said, “but [the pregnancy] took it to a whole new level. We were in and out of each other’s personal lives in a way we never had been before. It really brought us closer.”

The four continued to gather often for dinner. “I get apprehensive sometimes,” said Celeste in early August. “I feel better if I see [Sally] because I can tell by looking at her how she’s feeling. She’s still trying to work, she’s got the kids, she’s got her grandson. That concerns me because I don’t want this to be a hardship on her at all.”

Sally didn’t view the pregnancy as a hardship. “It’s been a lot easier than I thought it would be,” she said. “I figured I’d have morning sickness or at least some pregnancy complication, but I have been fine. Tired lately, but otherwise great.”

Three weeks before Megan’s due date, Celeste breathed a sigh of relief. “She’s 37 weeks, not premature, and that was a real big deal to me.”

Sally agreed, remembering that the fertility physicians had said she wasn’t an ideal candidate to be a surrogate because of the risk of preterm labor. “It’s nice to sit here, huge, and be able to say, ‘You were wrong. Full term. Ha, ha, I’m here.’”

As the final weeks passed, however, they all began to wish Megan would arrive a little early. According to her weekly exams, Sally’s cervix softened, Megan’s head dropped. Sally’s feet swelled terribly, dark spots on her face deepened, she was tired. Doctors began making estimations of the baby’s weight: 7 pounds, then 8 pounds. They began wondering if the baby would get too large for Sally to deliver vaginally. “I do not want a c-section,” said Sally, “so I’m going to start doing everything that causes labor.”

On Aug. 19, one of McClure’s fellow physicians, Heather Beatty, M.D., suggested Sally and James have sexual intercourse—it’s known as a natural method to induce labor because the prostaglandins in semen can cause uterine contractions. Sally told Celeste, “It’s medical advice, so it’s not a violation of the contract.”

Celeste said go for it, so Sally headed home to James. “We were like a nervous high-school couple,” said Sally. “It had been since last October.”

It didn’t work. On Aug. 25, she and Celeste saw Darcy Ketchum, M.D., who examined Sally, listened to her concerns about the size of the baby, and said they could induce anytime. “How about right now?” Sally asked. Ketchum explained that they schedule inductions for the morning. “How about tomorrow?” asked Sally. Ketchum checked, and there were no beds available. When labor was scheduled to be induced at 7 a.m. on Wednesday, Aug. 27, Sally and Celeste high-fived.

Preparing for Megan’s birth, Sally worked late to finish up some projects; Celeste punched out and was enjoying lunch with her niece by 11:30 on Aug. 26. “I just hope for a very fast, easy labor for Sally,” Celeste said, excitement lilting her voice. “She’s done such a wonderful job. She deserves to be done.”


Sally, too, was ready. She had no qualms about delivering the baby to Mike and Celeste. “The highlight is going to be when they get to hold their baby the first time. That will give me a lot of satisfaction,” said Sally, admitting that she could not be a surrogate in a less personal situation. “I can’t imagine ever doing this in a professional capacity, where you have a baby and then don’t know what happened to it. We’re going to be very involved with this baby. We’ll be godparents. She’ll refer to us as aunt and uncle. I’m always going to be part of her life. There’s no doubt I’ll be bonded to her.”

At 5:35 a.m. on Aug. 27, the Ketts picked up the Boundses. They stopped for breakfast at Baker’s Square in West Sacramento—“where of course we told the waitress our whole story,” says Celeste. After breakfast, where everyone was too nervous to eat much, they headed for Sutter Memorial. “But first we had to stop at Manhattan Bagel,” recalls Sally. “James wanted to butter everybody up. He’s such a politician. His theory is if you bring in a bunch of stuff for the nursing staff, you’ll get better care.”

At the hospital, James doled out the bagels, and the four got settled in room 263. “We were all joking around and saying that if they could all make this happen by noon, we’d buy everyone lunch,” recalls Celeste, saying that she thought the hospital staff was “getting kind of sick of us.” Sally was prepped and hooked up to intravenous fluids and Pitocin, which stimulates the uterus to contract. It didn’t begin working right away. Sally and James curled up together in Sally’s bed; Mike and Celeste cuddled in a chair, and they all fell asleep.

By 10 a.m., they were awake and Sally felt big contractions. She dilated to 5 centimeters in about two hours, and had an epidural for pain. She dilated from 5 to 8 centimeters in less than two hours. Then it all slowed down. “I lost all track of time,” says Sally, “but it was slow, getting from 8 to 9. A couple hours, at least.”

McClure says that it took two hours for Sally to dilate from 8 to 9, and then labor stalled at 9 for another two hours. “Sally developed a low-grade fever and was started on antibiotics,” says McClure, who had been in and out of Sally’s room all day; on one early visit she had broken Sally’s water. “Because of potential for infection and long hours of no change, we needed to think about a c-section.”

She told Sally she’d give her one more hour to dilate to 10 centimeters, and if by 9 p.m. she was still at 9 centimeters, she would need to perform a c-section.

“You could’ve knocked me over with a feather,” says Sally. “That hadn’t even occurred to me. The whole reason I was there being induced was to avoid a c-section.”

Sally’s labor didn’t progress, and at 9 p.m., McClure indeed said a c-section must be performed. “We knew the baby was occiput posterior,” says McClure, explaining that this position means the baby is looking at the ceiling rather than the floor when the woman is lying on her back. “Sunny side up,” is the popular term. “It presents the widest part of the skull coming out first,” she explains. “Two-thirds of women with occiput posterior babies end up with c-sections. The position is not dangerous, but it makes it very, very difficult to get the baby out.”

McClure surmises that the baby’s position was the reason Sally didn’t dilate past 9. “Sally’s really tiny,” she says. “She wouldn’t have gotten the baby out. She needed a c-section.”

Celeste recalls the moment McClure said Sally must have surgery. “The look on Sally’s face was utter disbelief,” she says. “I felt so bad. I thought, here she is, giving us this gift, and the one thing that she really, truly didn’t want to happen . . . is happening. She’s given us so much; here we are asking for one more thing.”

Sally wept, but rebounded quickly. “I have a lot of confidence in the doctors,” she says. “When [McClure] said this is what we need to do, I wasn’t going to ask to wait. I just said, ‘OK, let’s do it.’”

From that point on, things went quickly. McClure bent hospital rules to allow one additional person into the operating room—typically only one person can go in. “James would go in with Sally, of course,” Celeste says, “so the decision was whether Mike or I should go in.”

They decided it would be Mike, who had been designated to cut the umbilical cord. But the hospital didn’t have scrubs in his size, so Celeste suited up. “Things in the operating room went pretty fast,” says Celeste. “When they got to Megan, she came out with her hands wide open and her eyes wide open.”

Knowing the umbilical cord plans, McClure cut Megan’s cord low, nearer to Sally, left it long, and had her assistant carry Megan over to the door. Mike was waiting on the other side of the door, in a sterile room. The assistant opened the door, and Mike got to see his baby and cut the cord at the traditional spot, a few inches from Megan’s navel. “I thought this was so great,” says Sally. “Everybody really worked with us as a group and were so respectful that this wasn’t business as usual.”

McClure, whose practice handles five or six surrogacy pregnancies a year, recalls the warmth of the experience as well. “Their friendship was really special,” she says, noting that most of the surrogacy arrangements she’s handled involve people who had no established relationship prior to their pregnancies.

Once Megan was weighed and measured—6 pounds, 10 ounces, 19 and a half inches long—her foot was dipped in ink and her footprint was imprinted on Mike’s, James’s and Celeste’s forearms. (Sally was busy getting stitched up.) Mike held Megan first, then Celeste, then James. Finally, she was given to Sally, who held her as they rolled out of the operating room into recovery.

“It was very emotional,” says Celeste. “Everybody was crying. Here’s this perfect little girl . . . At one point, I looked at everyone around me and said, ‘Is she not just beautiful?’”

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Megan Nicole Kett is now 5 months old, a plump and smiley strawberry-blonde. Sally and James see her regularly—“Now it’s the five of us for dinner,” says Sally, who recovered from surgery with no complications and was back to work within two weeks. She reports that the most difficult aspect of the birth was physical. “I felt like I was being torn apart when they moved me the day after the surgery,” she says. Also, she had decided early on that she wouldn’t breastfeed Mike and Celeste’s baby, so she was  uncomfortable for a few days as she waited for her milk to dry up.

She says people continue to ask her how she felt relinquishing the baby she’d carried for nine months. “It wasn’t hard at all,” she says. “It’s funny. The first time I held [grandson] Seth, I felt so connected to him. Maybe what makes it different with Megan is that in my mind I knew all along that she wasn’t my baby. I love her, but I feel like I’m holding my friend’s baby. Maybe it’s because I went through counseling, but it’s just exactly the way I thought it was going to be.”

The Ketts feel as though they can never repay Sally. Even though Sally refused compensation, they insisted on buying her two things she’d been wanting: LASIK surgery, so she could quit wearing contact lenses; and a Mexican vacation for her and James.

“People who can have children just don’t understand,” says Celeste, emotion heavy in her voice. “They do not understand how desperate you can be. That Sally did this for us . . . . It means the world.”

When asked if she’d do it again, Sally says no. “Not that it wasn’t wonderful,” she says. “It’s just that it’s a once-in-a-lifetime experience.”

Now that it’s over, she’s sometimes overwhelmed by the enormity of her experience. “I never did it for the glory,” she says, cuddling Megan as she sits in the Ketts’ living room. “But there was a lot of glory. And so much satisfaction. I mean, what could be bigger than this?”                                                        

SNAPSHOTS

Angels for Hearts When I Grow Up

Angels for Hearts When I Grow Up

Published: Monday, September 29, 2014