Gay fatherhood via surrogacy: A feminist-health-informed reading of five memoirs

In this essay I review five English-language memoirs of surrogacy by gay men (see also Layne, 2018 for a review of documentary films about gay dads). Considering the memoirs together highlights similarities in the experiences of American and English-speaking European gay men who are becoming fathers via surrogacy, and illuminates shared cultural tropes upon which they draw to narrate their ‘journeys’. The comparison also brings into relief how very different surrogacy can be, even within the relatively small compass of privileged, white, gay men in the early 21st century. These first-person narratives provide an intimate view into a growing socio-medical sector where there is clearly room for improvement. Not only do they provide an ‘experience-near’ perspective of male encounters with reproductive medicine, but, by necessity, they also paint a picture of what it is like for the women who give ‘the most precious gift while literally allowing [them]selves to be sliced open’ (Warner, 2013: 61).

A note on language. The terms used to describe the new reproductive roles entailed by surrogacy are contentious. Critics point to the way ‘egg donor’ attempts to use the moral power of gift-giving to promote a controversial commercial transaction (Almeling, 2011, Pfeffer, 2011). The preferred term within the multi-billion-dollar global surrogacy industry for the pregnant woman is ‘gestational carrier’. Both terms avoid the loaded label of ‘mother’. In striking contrast, the memoirists routinely use ‘mother’ and its many informal derivatives, alone or as part of a compound. In good ethnographic fashion, I use their terms. Likewise, in keeping with the memoirists' narrative style, I refer to the authors by their first names.

The five ‘journeys’

Michael Menichiello's memoir (2006) documents a traditional surrogacy arrangement: that is, the same woman provided the egg, gestated, and then gave birth. Michael was 38 when he and his husband, a gynecologist, became parents. He found their ‘surrogate mom’, Michelle (age 26), by advertising on a web site of potential surrogates (2006: 117). The men flew from New York to Reno to meet her, her husband, and their two children. For the first 2 months, she tried home inseminations with semen Michael sent to her by courier. When that failed, Michael (and his mother) flew to Nevada, so he could provide fresh semen (2006: 35). This time it worked, and a healthy, uneventful pregnancy ensued. Both dads and Michael's mother were present when Lilly was born vaginally at full-term. The memoir ends 2 years later, as they start talking with Michelle about doing it again.

Traditional surrogacy has been largely supplanted by the more expensive, elaborate, and invasive process of gestational surrogacy (Spar, 2006: 82) in which the surrogate is impregnated with an embryo created by IVF using another woman's eggs. Golombok et al. (2015: 166) report that a major reason given by gay men for choosing this type of surrogacy is that it was recommended to them by their surrogacy agency and/or doctor (cf. Warner, 2013: 7).

Jason Warner met his partner and formed a Christian-music duo, ‘Jason & deMarco’, when they were both in their twenties. They were ‘blessed’ when, in their early thirties, their friend, Lexi, a heterosexual, married woman who had just completed her family with the birth of a third child, offered to be their surrogate. Ultimately, she was not able to do so, but instead gave them her eggs. She took hormone injections for 30 days and by the time of the retrieval was so bloated she felt as if she was 3 months pregnant (2013: 11). The men each fertilized about half the 13 harvested eggs and used intracytoplasmic sperm injection (ICSI), whereby a single high-quality sperm cell is selected and injected into each egg (they used credit cards loans to pay the anticipated $15,000–20,000 for this procedure). The resulting embryos were frozen and stored (2013: 10). They were not sure how they would ever find a surrogate as they could not afford to pay an agency $30,000–$100,00 to do so, but ‘trust[ed] that if this were supposed to happen, it would’ (2013: 8). Three years later, it did.

The duo had moved to Texas to work at a megachurch (2000 + members) of a denomination, Unity, founded in the Midwest in 1889, which emphases the power of positive thinking and holds that dreams are a source of divine guidance (Fillmore, 1930). While attending a Unity church conference Jason had organized, a 22-year-old single mother named Katie dreamt she was having the men's child and so she offered to be their surrogate. Katie had become pregnant at fifteen, was raising her seven-year-old on her own and needed money to pay for college. She agreed to accept $10,000, plus pregnancy-related expenses (2013: 19), but legal and logistical problems soon arose, and the plan was abandoned. Meanwhile, Mary, a mother of two who worked with them at the church, also dreamt she was meant to have their children (2013: 18). Jason describes ‘Mother Mary’, their ‘baby mama’, as like a ‘sister’ to him (2013: 13, 17, 29, 31). Mary did not have to synchronize her menstrual cycle with that of an egg donor since the embryos had been readied several years earlier, but because the couple wanted to use a particular doctor (a Christian, gay dad based in Boston), they asked her to take hormones so she would ovulate on a date the doctor would be available. She suffered numerous side effects (2013: 32, 37). When it was time, the dads-to-be used their ‘spiritual principles to visualize the transfer taking place’ on the optimum day and ‘the little zygotes dividing, one of each’ (2013: 33). And so it came to be.

The three other gestational memoirs document transnational surrogacy. Richard Westoby, an Englishman in his 40s, and his American husband, Steven, undertook surrogacy in the USA while living in the UK. The process cost them $191,000, not including private nursing for 11 weeks (Westoby, 2015: 116). Richard chose a doctor they had seen on American television and Richard has since become the European representative for him. Jessica, the American ‘egg donor’ they selected, was young, married, educated and open to on-going contact. They were able to meet Jessica and her husband over dinner the night before egg retrieval at the IVF clinic in Connecticut. Half of the 12 eggs harvested were fertilized by each, since their preferred method of mixing their semen together for the process was no longer legal in the USA.

For their surrogate (‘tummy mummy’, a term they acknowledge may strike readers as either ‘endearing or annoying’) (2015: 17), they hired Angela, a Filipino-American single mother-of-two, from Arizona. Once Angela was successfully impregnated with two embryos, she returned to Arizona and the men returned to London. Richard emailed her every other Thursday, but the separation meant it was ‘very hard to stay connected with the reality of the pregnancy’ (2015: 77). The expectant dads flew to Arizona for her 10- and 20-week scans and Richard moved into a hotel nearby during her 35th week. Steven made it just in time for the birth of Alexander and Liliana at 37 weeks.

Hans Hirschi's ebook is derived from a blog he wrote during the pregnancy. A Swiss/Gypsy immigrant to Sweden, he describes himself as ‘a writer who just so happens to be gay and really angry’. One of the things he is angry about is the fact that he and his Swedish husband, Alex, who is 12 years younger, were unable to adopt because Hans was over 40. They decided to foster instead but the Swedish Child Protective Services cancelled the placement of the 4-year-old boy to whom they had opened their hearts because the biological mother objected when she learned they were gay. Once they reconciled themselves to surrogacy in India, a place they could afford at an expected cost of $40,000 plus travel expenses, they selected a Southeast Asian Hindu woman from the agency's database as the egg donor (‘mother’). Hans never met her, but apparently they were at the clinic the same time. A member of staff pointed her out to him on surveillance-camera footage of the waiting room and he speculates that his future child may be ‘thankful that your mother and I were at least once physically in the same location’ (2013: 828).

For the ‘surrogate mother’, they picked an Indian Muslim married mother-of-three, who had served once previously as a surrogate. Hans met her, along with her husband and youngest daughter, when they signed the contract. Three of the nineteen embryos he ‘fathered’ were inserted into her ‘womb’. Two implanted but one of the twins vanished during the first trimester.

After Hans returned home, he felt very detached from the process. ‘We somehow don't feel pregnant … our child is growing inside a womb 10,000 km away … our pregnancy is just theoretical. Our life continues as always, we live our DINK (‘double income no kid’) lives … Every now and then we think about our little one being “baked” in Mumbai’ (2013: 1661, 1687–88).

The most recent memoir is by James Phillip, a businessman in London. He decided to pursue surrogacy in Thailand because the 4-year-old he co-parents is of mixed Thai/British heritage and his work takes him to Asia frequently. For the egg donor (‘biological mother’), he chose Autumn, a ‘beautiful’ 21-year-old who was willing to stay in contact after the birth. As the surrogate (‘tummy mummy’ and ‘birth mum’), he selected Grace who spoke good English and was a single mother of a 7-year-old. Autumn's 13 eggs resulted in only four embryos that were unsuccessfully implanted in Grace over a 2-month period. James picked a different egg donor, Sophia, a ‘beautiful’ university student, and considered trying a different surrogate as the clinic had another woman who was ‘willing and able to be’ his surrogate because ‘she was in sync with’ his egg donor (2017:40). In the end, he continued with Grace and a pregnancy resulted. James developed a warm relationship with Grace, whom he describes as a ‘friend’ and a ‘sister’. They messaged each other regularly and he was able to be in Thailand for many key moments of the pregnancy. He had started his ‘journey’ as a single man, but during the pregnancy, fell in love with a man who is now a legal parent of Leo and Olivia. James plans to take the twins with him on his next trip to Thailand.

Maternal morbidity in gestational versus traditional surrogacy?

Surrogacy is ‘arguably the most controversial’ (Jadva, 2016) of the assisted reproductive technology routes to parenthood. Ethical debates have focused on payment and structural inequalities. There has also been concern with the health risks to women who ‘donate’ eggs because of overstimulation with hormones to maximize yield, and the memoirs indicate this is still a problem. James insisted that his second donor send a picture of herself injecting the hormones every day. Sophia produced 25 eggs and had to be seen at the hospital a few days later for medical complications as a result (2017: 23).

Interestingly, given the privileging of genetic relatedness in surrogacy, the egg donors play a minor role in these narrative accounts. The interaction between the commissioning fathers and the donor ranges from incidental to none. In contrast, except for the Indian case, there are extensive interactions between the men and their surrogates. As a result, readers get a glimpse at how these women suffered. Despite the well-documented risks that multiple gestations pose for women, twins were conceived in all four of the gestational surrogacies. Curiously, none of the authors discusses their decision-making, but the attraction of a ‘two for the price of one’ logic is widely understood (Westoby, 2017). According to the American high-risk pregnancy obstetrician, and gay dad via surrogacy, whom Richard interviewed, ‘a surrogate pregnant with twins is at increased risk for C-section (over 75% twins in the USA are born via Caesarean)’. Every one of the gestational surrogacies ended in C-section (in three of four cases, an emergency one). In addition, the doctor notes, the pregnant woman ‘is more likely to develop high blood pressure, diabetes, haemorrhage and also death (rare, but it does happen). She is also at greater risk [of hospitalization] for a pregnancy complication – for days or weeks – which can lead to bed rest and the need for additional help with the house/childcare’ (Sylvestre quoted in Westoby, 2017).

The doctor is right. Take for example, Mary, Jason's 40-year-old friend/coworker/surrogate, pregnant with his twins. Mary had placenta previa with bleeding in the first trimester, requiring 3 weeks of complete bed rest over the Christmas holidays. This made for ‘the worst Christmas ever’ for Mary and her family, while Jason entertained family and friends at their cabin in the country (2013: 45). In the third trimester, Mary developed high blood pressure, requiring more bed rest, and her depressed/angry, soon-to-be ex-husband threatened her, then checked himself into a psychiatric hospital. Another ‘angel [was] sent to them’ in the form of a woman who agreed to care for Mary's children during the final 3 weeks of their school year. Mary moved in with the dads, something Jason described as ‘a beautiful experience’ (2013: 50–51). Both babies were breech and a C-section had been planned at 36 weeks, but when Mary was given an epidural her blood pressure dropped dramatically. She lost consciousness and woke up in tears after an emergency delivery (2013: 55).

We don't know the age of Hans' Indian surrogate, but we do know that this was her fifth pregnancy and that she suffered many complications. Like Mary, she suffered placenta previa requiring bed rest, and in addition had to undergo a cerclage procedure to reinforce her cervix in the second trimester, and then also developed gestational diabetes and too much amniotic fluid in the third, resulting in hospitalization from 33 weeks until birth by emergency C-section at 36 weeks.

Nor do we know the age of Grace, the ‘small’ Thai woman who served as James's surrogate. We do know that she had debilitating morning sickness and went into premature labour at 30 weeks. She remained hospitalized for the remainder of the pregnancy and a friend, whom Grace had helped through her own surrogate pregnancy, took care of Grace's 7-year-old daughter for the duration. At 34 weeks, the twins stopped growing and a C-section was scheduled, but Grace went into full labour. The babies were born via an emergency delivery and then spent 10 days in the neonatal intensive care unit (2017: 112).

Richard's surrogate, Angela (age 34), had given birth vaginally to her two children and hoped for another ‘natural birth as it was less intrusive on her body, with a quicker recovery rate’. Alas, her blood pressure started to rise, and the twins were delivered by C-section at 37 weeks (Westoby, 2015: 82, 88). Even though each gestational surrogacy ended with surgery for women who had children of their own at home, Richard is the only one who took responsibility for helping his surrogate during recovery. He hired a nurse to take care of Angela and to help at home during her first week after surgery (2015: 89).

The inequalities between the commissioning men and the reproducing women, especially, but not limited to, surrogacies that take place in the Global South, are hard to overlook: whether it be the American nanny who made sure all the clothes the couple ‘had bought for the babies were washed and ironed … then … got to work being the maternity nurse’ (Westoby, 2015: 95), or the Swedish couple who enjoyed a ‘relaxing arrival massage … [and] lazed by the pool, enjoyed the sun and amazing food’ while their surrogate was in the hospital enduring the final days of her difficult pregnancy (Hirschi, 2015: 2560). These inequalities are not merely about differences in wealth, but also about how much ‘skin in the game’ they have. The physical danger and pain the women bore, the personal hardship of being separated from their own children and home are striking, all the more so, because this may not be necessary. There was significant maternal morbidity in each of the gestational surrogacies and none with the traditional surrogacy. Do these few cases point to a critical but overlooked difference? Are records available that would allow a systematic comparison? If not, why not? Traditional surrogacy, especially if undertaken by younger women, would not only be low cost for the men, but would greatly reduce the risks to the women who are willing to help them achieve their dreams.

Conclusions

Harris-Perry has described the literature on ‘modern families’ as falling within two genres: ‘intellectual … texts that warn against the commercialization of reproduction’ or ‘triumphant personal narratives that pretend personal desire and positive outcomes are sufficient to transform troubling transactional aspects of unconventional family-making into uncontroversial stories of love and destiny’ (2015: xi). The memoirs reviewed here belong to the latter category. Yet, it is possible to read them against the grain, in this instance, as I have done from a women's health perspective. Doing so opens up a middle space between the abstractions of ‘bloodless academic texts’ and the particularities of individual heroic tales and brings to the fore questions that have been overlooked. For example, how might gay men who wish to undertake surrogacy do so in a way that minimizes the risks to the women who are willing to assist them? In all but the Indian case, the authors developed caring relationships with their surrogates. This suggests would-be fathers are open to knowing about the likely consequences of the medical choices they are making for the ‘angels’ who agree to help them, and what the alternatives are. Yet, if they trust the commercial surrogacy industry to advise them, is it any wonder that the most common path is one that gives the commissioning dads the babies they want while most benefiting the industry, despite the clear costs to the women involved?