Single fathers by choice: Memoirs of getting twins and triplets via transnational gestational surrogacy

1. Introduction

Single fathers by choice (SFC) are a relatively new, quite small but growing addition to the many family forms that have burgeoned in the USA and UK since the 1970s (Golombok, 2015: 160–162). SFC created a Facebook group in 2018 with 137 members, they are getting some press attention, including but not limited to single celebrity dads, and social scientific studies are starting to be undertaken (Carone et al., 2017, Graham and Braverman, 2012). Some single men adopt, but as the 21st century progresses, surrogacy, particularly gestational surrogacy (Blake et al., 2016), is becoming a more frequent route. British law, which had restricted parenthood via surrogacy to couples, was changed in 2019 so as not to discriminate against single parents.

A USA-based nonprofit organisation that helps gay men world-wide use surrogacy sees ‘interest from single men’ as ‘part of a broader surge in gay families' (Scher, 2018). The Pop Luck Club for gay fathers in Los Angeles reported that about a quarter of the 240 families in the group in 2008 were headed by single men (Navarro, 2008).

Some heterosexual single men are also using surrogacy. One US-based agency reports that between 2006 and 2011 they helped nearly as many heterosexual single parents as gay couples (Trimmings and Beaumont, 2013: 471) and the American man who started an SFC hotline says about half of the approximately 30 calls he receives each month are from straight men (Ludden, 2012).

This review examines the two surrogacy memoirs of a British heterosexual man who undertook single fatherhood in 1999 and that of a gay man from California who embarked on surrogacy in 2014. Together they reveal how in the space of these 15 years, at least in some cultural milieus, the ‘reproductive consciousness’ of men changed dramatically. Their first-person narratives augment our understanding of the experience of surrogacy for men who do not intend to parent with a woman. They also offer a glimpse of how painful, life-threatening and life-altering these made-to-order pregnancies can be for surrogate mothers and their families.

2. ‘Britain’s first surrogate father … with no wife to help’ (Daily Mail headline 30 June, 2016)

Ian Mucklejohn became something of a celebrity when in 2001, at age 53, he became the father of triplets via gestational surrogacy (Knight, 2016). He had devoted himself to his business and caring for his elderly parents. When his mother died, and he was left caring for his father, Ian decided he wanted a family of his own. Given his age and responsibilities, he did not feel he had time to develop a romantic relationship and decided to use surrogacy instead.

He settled on an agency in California, the most popular of the states in the USA for surrogacy (Gugucheva, 2010; Smietana, 2017). Vivian, a former surrogate, now surrogacy broker, e-mailed him ‘a selection of delights’ from which to select an egg donor (p. 70). He picked Melissa, age 27, who looked ‘like a model’ and who would use the ‘small payment’ to help pay for graduate school. She produced 19 eggs, eight of which were fertilized with frozen semen Ian had deposited while in Los Angeles.

For the surrogate, he picked Tina, a financially-strapped, 26-year-old who was raising two young boys on her own. Her husband had abandoned them 2 years earlier (2006: 67). Ian asked her if she would get a divorce to simplify custody. She tracked her husband down and discovered he was in jail because of unpaid fines.

Ian hoped Tina would come to the UK for the birth and arranged for her visit him on his country estate (2006: 74). He raised the issue of multiple births and reports that ‘in principle, Tina had no problem with having twins,’ and that neither of them ‘were comfortable with the idea of killing babies’ (2006: 67–68). California has no limit on the number of embryos that can be implanted. Tina was impregnated with four embryos; triplets and a difficult pregnancy ensued. She was put on bedrest almost immediately and lost her job as a result (2006:84). At five months gestation, Tina was hospitalized ‘for the duration’ (2006: 89). Ian is reflective but not remorseful about his adamant position against fetal reduction: ‘We were taking risks with these babies’ lives’ (2006: 82). Indeed, the likelihood of spontaneous abortion and intrauterine fetal demise, neonatal and infant death, cerebral palsy, and congenital birth defects is significantly increased with twins (Ryan et al., 2007), and they are even greater with triplets.

Of course, it was not just the babies’ lives he put at risk, but this single mother’s as well. Tina’s doctor told her that ‘one of the most common problems for multiple pregnancies is that they haemorrhage because the uterus is stretched’ (2006: 85). She told Ian she was ‘afraid of dying. I’m afraid for my sons … if my uterus ruptures’ (2006: 85). This was not an unreasonable fear. In 2015 a surrogate in Idaho carrying twins for a Spanish couple died this way, leaving her own two children behind (Laffey, 2018, Riben, 2015).

In early February, the babies were delivered by Cesarean-section. During the 5 weeks they were in the neonatal intensive care unit (NICU) in California, Ian remained at home in the UK. Tina went to the hospital daily to help with the feeds and one by one, as they were released, she brought them home, setting up cribs in her small living room (2013: 179).

Once Ian brought them back to England, he engaged round-the-clock nannies to care for them until they were 3 years old. Thereafter Ian raised them, using skills he had acquired as a teacher to good effect. Most surrogacy memoirs focus on ‘the journey’ to fatherhood but Ian’s goal is to demonstrate that a man can raise children and so his focus is family life with these three rambunctious boys.

Because his memoirs span so many years, and because of his openness to press coverage, we learn more than is usual about the lives of the egg donor and surrogate after the birth. When the triplets turned 5 years old, Ian and a BBC film crew took them to meet Melissa and Tina in California. They also ‘met’ their four full-siblings – the remaining frozen embryos, pulled out of a thermos of frozen nitrogen resembling ‘an elongated ice lolly’ (2006:300) – and were introduced to two half-siblings, twin boys conceived with Melissa’s eggs and gestated by Vivian for a 79-year-old widower (2013:96).

Ian learned that Tina subsequently carried twins for another single father, presumably because she had lost her job while pregnant for Ian. She had had to have a hysterectomy as a result. Such losses occur often enough that some surrogates consider them ‘work-related injuries’ and put compensation for ‘lost reproductive organs’ into their contracts (Soderstrom-Anttila et al., 2016, Berend, 2016). When the boys were aged 7, Tina wrote asking for more frequent photos. Ian then never heard from her again and ‘assumed she’d simply moved on’ (2013:182-3). In fact, Tina died from a stroke at the age of 45 (Knight, 2016).

3. An American, single gay man’s quest to become a ‘non-traditional, biological father'

At the age of 36, Joe Hahle was distressed. He believed ‘the best time in life to have a child is … between 25 and 35 years of age’ (p. 5). ‘The clock was ticking … time was running out.’ He noticed children ‘Everywhere!’ and wondered ‘Where was mine?!?!? I had to gather my resources, do the work …, and make this happen’ (p. 9, ). This is a striking example of ‘procreative consciousness’ a concept used to explain how gay men construct their procreative identities over the life course (Berkowitz and Marsiglio, 2007, Smietana, 2019). In this instance, the change appears to be generational rather than individual.

Even though Joe lived in California, he decided on Thailand where the price ($40,000) would be about one third of what it would cost in the USA (p. 24). He left it to the agency to pick a woman to gestate his children and showed no interest in learning even the most basic information about her. The egg donor was a different matter. He had a long list of features he wanted, including the ability to tan (2017:20) but could not find an ‘ideal’ donor, and settled for someone who was ‘not perfect.’ Roxanne was ‘very sweet looking with dark flowing black hair and green eyes’ but ‘her family was not very tall or long-lived.’ He blended her picture with his on a website and found the results were ‘astoundingly good’ (2017:35). Her prior donations had ‘yielded a solid 12 + eggs … and two pregnancies' (2017:35). Roxanne flew from her home in South Africa to Bangkok. A total of 20 eggs were harvested and fertilized by intracytoplasmic sperm injection using the semen Joe had had couriered to Thailand.

Joe wanted sons to carry on his family name (pgs. 8, 41; the idea that female children might carry on a family name was not part of his procreative consciousness) and used sex-selection methods to achieve this. His brothers had five daughters between them, two of whom had been adopted from China where girls are available for adoption due to the cultural preference for boys. Joe's need to use sex-selection technology can be seen as a consequence of the preference for sons in China as there is a dearth of boys available for adoption. Joe used sperm sorting and preimplantation genetic testing. Two of the resulting six male embryos were implanted (p. 42). Joe anticipates explaining to his sons that they ‘… are boys. That’s no better than being girls. Yet unlike 99.99999% of people out there, your gender was not accidental.’ He feels it is important for them ‘to know that you were not changed into boys but chosen. Your embryos developed exactly as they naturally were’ (pg. 41). In other words, Joe believes that modifying embryos would be unnatural and morally worrisome (in contrast to those who suggest genetic engineering would be ethically preferable because it would not involve the creation and destruction of ‘wrong gendered' embryos (Liao, 2005). Simply choosing male embryos in lieu of female ones Joe finds to be morally sound and even in some ways superior to leaving it to chance. His sons are special because they were ‘chosen’.

Joe’s parents, retired Christian missionaries in their late 70s, sold their home and moved in with him when they learned he was expecting. The twins were delivered by Cesarean-section at 31 weeks. Five days later, Joe and his parents arrived in Bangkok and met the surrogate at the agency. Together they walked the four blocks to the hospital but to Joe’s annoyance, she was slow as she ‘was still quite sore’ from the surgery (p. 81).

The babies, one of whom had a heart defect, remained in the NICU for a month during which time the Hahles became friendly with a gay couple from Australia who also had male twins in the NICU. The Hahles stayed another month with the babies in the apartment they rented from the agency while Joe got the required paternity test and passports issued.

His memoir ends on a self-congratulatory note when the boys are 2 years old. 'My journey [was] quite a struggle. I’m proud of what I achieved. It was an amazing number of hoops to jump through.’ He credits his accomplishment to ‘his undeniable determination to succeed,’ which resulted in enough earning power to afford surrogacy. This neoliberal stance is part of his procreative consciousness. Not only does he assume he can have children if/when he wants, he sees reproduction as an individual achievement.

4. Conclusions

The idea that reproduction can be an individual achievement is reflected in the titles of these men’s memoirs. Mucklejohn declares himself ‘A Truly Single Father’ despite the utterly essential roles of egg donor, surrogate, and live-in nannies. Hahle claims for himself the heroic role of a ‘Single Man’ who successfully completes his ‘Quest’ and creates ‘Baby Humans.’ Given the fact that Joe is raising his family with two ‘able-bodied, retired grandparents living in the house’ (2017:160), a more accurate description would be ‘extended family,’ but this old-fashioned label runs counter to neoliberal scripts and restricts the opportunity for self-aggrandizement. These dynamics speak to the need for an ‘integrative reproductive labour perspective’ that is cognisant of many forms of waged and unwaged work involved in making and maintaining such families (Vertommen and Barbagallo, unpublished article).

Commercial gestational surrogacy relies on a robust market for cheap, unregulated and unmonitored female labour in the USA and the global south. What is most concerning is the unnecessary harm that gestational surrogates are subjected to. Pregnancies always entail risks, but the pregnancies described in these memoirs are risky by design. They are part of the ‘epidemic of iatrogenic twin and higher-order gestations’ that IVF has wrought (Lee et al., 2016, Sazonova et al., 2013). Multiple pregnancies increase the risk of preeclampsia, gestational diabetes, placenta previa, placental abruption, pre-term delivery, Cesarean section, all of which befell the surrogates featured in these and other gay dad gestational surrogacy memoirs (Layne, 2018). As if that were not bad enough, such complications may have life-long effects. Peripartum hysterectomies like the one Tina had are 24-times more likely with multiple pregnancies (Francois et al., 2005) and women who have pregnancy complications are significantly more likely to die from cardiovascular causes (Neiger, 2017), as Tina did.

Single embryo transfer (SET) has become the norm in most of Europe, but not in the USA (Maheshwari et al., 2011). Triplets like Ian’s are less common now than they were when he had his in 2001, but in the USA the rate of twins born following assisted reproductive technology (ART) treatment has plateaued at about 9% higher than in Europe, resulting in an estimated ‘twenty-six billion dollars of healthcare costs’ annually ‘for iatrogenic preterm deliveries’ (Lee et al., 2016).

A study carried out at a university-based IVF clinic in the USA found that after reading a one-page document that compared the risks to maternal, fetal, and neonatal health of twins versus singletons, a significantly higher number opted for a single embryo transfer than had done so prior to being presented with this information (Ryan et al., 2007). Commissioning fathers like Mucklejohn and Hahle are apparently not being informed adequately about the harms such pregnancies almost inevitably entail for the surrogate, the babies, and their bank balance (e.g., food, lodging and hospital bills that follow premature birth as illustrated by the Hahle’s 2-month stay in Thailand).

Surrogacy is ethically fraught, but it is not a uniform thing. There are options that minimize harm. The organization Men Having Babies (MHB) has proposed guidelines for ‘ethical surrogacy’. The memoirs of men who use gestational surrogates certainly illustrate the need for such an initiative. They also highlight limitations of some of the practices MHB endorses – ‘informed consent’ and ‘medical screening’ so as to select only those women who would ‘likely complete the process with minimal risk to themselves or the child'. As Mucklejohn’s case and other first-person accounts of surrogacy (Westoby, 2015, Berend, 2016) show, the fact that a woman has had complication-free pregnancies and births with her own children is no guarantee that gestational surrogate pregnancies, especially if they involve multiple fetuses, will go well. Gestational surrogacy pregnancies appear to have significantly worse outcomes in terms of maternal morbidity. In contrast, minimally invasive, traditional surrogacy, which much more closely mirrors the kinds of pregnancies surrogates would have had for themselves is safer for all concerned. But it is also much less profitable for the commercial surrogacy industry which plays a major role in steering would-be fathers toward gestational surrogacy (Golombok, 2015: 166). Those interested in developing ethical surrogacy practices should consider this.