Most Surrogacy Agreements Have Happy Endings for All : Business: Agencies specializing in the arrangements say demand keeps growing. Their services aren’t cheap, but it’s more than worth it to couples longing for a baby.

To celebrate the special bond between them, Nancy Italia of Laguna Niguel this year sent a Valentine’s Day card to Lorena, the woman who carried Italia’s child inside her when Italia could not.

The card contained a picture of T.J., now 6 1/2 months old. On Valentine’s Day, 1992, T.J. was conceived in Lorena’s womb for Nancy Italia and her husband, Terry, through artificial insemination, after the couple tried unsuccessfully for years to have a child naturally.

Entering the surrogacy process required “a leap of faith,” a trust that Lorena would not betray the Italias and claim the child as her own, Nancy Italia acknowledged. But it was a risk the Italias were willing to take.

The women, who were closely united during Lorena’s pregnancy, will remain friends, Italia said, but now lead very separate lives.

“It is a business arrangement of the heart,” Nancy Italia said. “But then there is an end to it.”

Such happy, snag-free endings of surrogate parenting stories are far more common than the legal tug-of-war that culminated in Thursday’s California Supreme Court ruling. In a 6-1 decision, the justices upheld the award of Christopher Calvert to genetic parents Mark and Crispina Calvert and the termination of parenting rights for surrogate Anna M. Johnson.

The favorable odds that the process will go smoothly and the inexorable desire for a family, advocates say, is why childless couples in Southern California still make pilgrimages to agencies specializing in finding surrogate mothers.

Those who run the agencies say that the Anna Johnson case, which has been fought through the California court system for two years, has not dampened couples’ enthusiasm for surrogate arrangements. But it has increased awareness of the need to carefully select prospective surrogate mothers.

Although there are no firm statistics, there have been an an estimated 5,500 surrogate births since 1980, when artificial insemination was developed, said Ralph Fagen, co-director of the Center for Surrogate Parenting in Beverly Hills. Fagen said his statistics are bolstered by another survey.

An estimated 10 to 15 agencies nationwide, including about four in Southern California, specialize in matching surrogates with prospective parents.

The number of hospitals or clinics willing to use surrogates is also limited. In Orange County, only the UCI/Saddleback Center for Reproductive Health in Laguna Hills will implant an embryo in an unrelated woman, the method used in Johnson’s surrogacy.

The cost of a surrogate program to a couple generally averages about $40,000, but can vary depending on which kind of medical technology is used and the number of attempts necessary to achieve pregnancy.

Even at the UCI/Saddleback Center for Reproductive Health, where the embryo at the center of the legal dispute was implanted in Johnson’s womb, doctors say that requests for surrogacy arrangements have been on the rise.

Dr. Jose Balmaceda, the center’s director, said Johnson was one of the earliest surrogate mothers to be part of his program. Since then, he said, evaluations of surrogates have become more sophisticated. He added, however, that no psychological counseling or testing can predict with 100% certainty that a surrogate will not try to keep the child after birth.

“I would say the patients are better informed because of the Anna Johnson case,” added Dr. Jane Frederick, a fertility specialist at the center. “A lot more questions are being asked.”

She said the center refers most patients to agencies that specialize in finding and screening surrogates and referring patients to the few lawyers who are familiar with writing surrogate contracts.

John Tenery, a civil attorney in Laguna Niguel who represents couples entering into contracts with prospective surrogates, said he wishes the state Legislature would give more guidance in the provisions that such contracts should contain. He said he advises couples that the best way to ensure that a contract will be binding is to make it as fair as possible.

“The thing we try to do with the folks I represent is to educate them about the uncertainties and make them understand it is a very unusual kind of contract and has to be fair on both sides,” Tenery said.

Fagen, whose center has been matching prospective parents and surrogates for 13 years, said that fewer than 1% of surrogate births nationwide have resulted in legal challenges.

“The few cases that have had problems have not been professionally managed and were based (on the fact that) the women chosen as surrogates were not appropriate candidates,” Fagen said.

Fagen said that center has arranged for the births of 267 children by surrogate mothers. Business received a boost, he said, about six years ago with the emergence of medical technology that enables a surrogate to give birth to a child formed from the egg and sperm of a couple.

Previously, the only surrogacy technique available was artificial fertilization of the surrogate’s egg with the husband’s sperm, leaving the wife genetically unrelated to her offspring.

Demand for surrogate-assisted births, Fagen said, also has been spurred by a sharply declining fertility rate among American women and by economic changes that prompt women to postpone childbirth until later years, when many have more difficulty conceiving.

But there are barriers to the expansion of surrogacy, Fagen conceded: The considerable expense of the procedure is within reach only of higher-income couples, and the number of potential surrogates with the appropriate background and commitment is limited. The demand for surrogates, he said, is outpacing their availability.

“There definitely is a shortage,” he said, noting that the center has an 11-month waiting list of couples. The center advertises throughout California for surrogates, he said, but rejects 95% of the women who apply.

Agencies like the Center for Surrogate Parenting act as “case managers” for the prospective parents by arranging for psychological, legal and medical services and providing ongoing emotional support and counseling.

For their services, local agencies generally charge between $9,000 and $17,000. Also, prospective parents must pay the surrogate $10,000 to $15,000, plus expenses, such as the cost of maternity clothes and travel and compensation for time off from work.

Then there are the surrogate’s and couple’s medical costs, only some of which may be reimbursed by medical insurance. And generally the couple must also provide medical and life insurance for the surrogate mother if she does not already have such coverage.

All told, Fagen said, couples in the program at the Center for Surrogate Parenting can expect to spend $36,000 to $42,000 to take home a baby created by artificial insemination of a surrogate and between $40,000 and $65,000 for a baby conceived outside the womb and then implanted in the surrogate.

Couples trying to cut costs sometimes find their own surrogates, often friends or relatives, and deal directly with fertility centers, which refer them to lawyers and psychologists.

Critics of surrogacy contend that the process is centered on profit and that surrogates are drawn primarily from the destitute.

For surrogate mothers, “the major motivating factor is the $10,000 to $15,000 that they believe will change their lives. . . . They desperately need the money,” said Richard Gilbert, Johnson’s lawyer.

Few surrogate mothers fight to keep the children they bear because they can’t afford a lawyer, Gilbert contends.

Operators of surrogate agencies strongly dispute Gilbert. They contend that the surrogates they select are well-educated and financially secure. Although the women often can use some extra income, they primarily want to do a good deed, surrogacy proponents say.

Fagen said Johnson would never have passed his agency’s screening because of her history of financial need. “She (had been) on welfare and we don’t accept women on welfare,” he said.

The surrogate agency managers who were interviewed said they require that a surrogate mother already have children of her own, although she may be a single parent. Usually, they said, the surrogates have a great appreciation of motherhood and enjoy the status, attention and even the feeling of being pregnant.

Fagen said that over the years the largest number of acceptable surrogates for his Beverly Hills center have come from Orange County.

Orange County, in fact, has spawned two busy surrogate agencies founded by women who had been surrogate mothers themselves.

Kathy Wyckoff, owner of the Center for Reproductive Alternatives in San Clemente, operates her small business out of her home. But currently, she said, she has about double the workload that she would like, assuming responsibility for 24 couples and their surrogates. She said she believes that using surrogates to build a family is “becoming more socially acceptable.”

One of Wyckoff’s surrogate mothers, Cristie Montgomery, three years ago founded Surrogate Parenting Services at her Laguna Niguel home.

Montgomery, who has seen six children born through her program and said she is working with 19 more couples, acknowledged that when couples enter the program, their biggest fear is that the surrogate mother will back out. But that fear dissolves, she said, when the couples and surrogates meet.

Montgomery recalled that when she was contemplating bearing a child for another couple she worried about a New Jersey judge’s decision in the “Baby M” case. The ruling gave a surrogate mother visitation rights. She said she wondered whether a court might hold her responsible for the care of an infant who was born handicapped.

Montgomery said she was relieved when the prospective parents, whom she “liked straight off,” assured her that they would accept the baby, whatever its condition.

Three and a half years later, Montgomery said, she remains friends with the couple she helped become parents of a healthy baby girl.

Montgomery, whose two daughters are biological half-sisters of the child conceived through artificial insemination, said her family feels good about the role she played. She likes to show an album of joyful pictures taken at the girl’s birth and more current ones of the child she regards as a niece of sorts.

“When I see her, I feel pride,” she said.