This is the 40th installment of Barren Advice. You can ask questions that are fertility or non-fertility related.

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Dear Mel:

I am desperate for some advice! My husband and I are infertile due to an emergency partial hysterectomy to save my life during a bad labor and delivery of our daughter Vivienne, who subsequently was diagnosed with brain cancer and passed away at nine months old. We are beginning the process of looking into expanding our family with either a traditional or gestational surrogate mother.

In light of different things I've read, for example that surrogacy agencies are not licensed or monitored in any way, and the recent fraud and theft of IP's funds at SurroGenesis, USA, I am looking for: (1) Recommendations of good agencies. We live in Pennsylvania but due to the unfavorable legal status of surrogacy in the state, will likely use an out-of-state surrogate, and/or (2) Some pointers on how to evaluate agencies and what questions to ask, and/or (3) Any advice or suggestions on compassionate community fund-raising to help us supplement our savings and what we take in loans, to finance the surrogacy process. I've been researching these items online, and haven't found any or many great answers! Thank you so very much!!

--Mary

The question sort of has two major parts: doing it right and how to get help. The doing it right part is easier to manage, insofar as bad reputations usually remain attached to agencies that fail to provide good customer service. What constitutes good customer service when it comes to a surrogacy agency or lawyer? Well, unfortunately, the happy ending of a healthy child is not necessarily the deciding factor. They cannot control child birth any more than any of us can control child birth. But some agencies do a better job of protecting your heart on the items that are within their control.

I went to Kym from I'm a Smart One, an infertility blogger AND successful surrogate, who used her own experience needing assistance conceiving to help other people build their families. She tackled this question thoroughly and passes along this advice on choosing a surrogate.

The website is often the first window into the quality of an agency. Anyone can throw up a website and call themselves an "agency," and many people often do. However, established, well-maintained agencies will have a depth of information that helps give credence to their effectiveness as an agency. The more information provided, the better. Things to look out for on agency websites:

*About Us/Who We Are -- This page should give some details about who the agency is run by and how did the agency come to be. Was it established by former intended parents and/or surrogates or by an attorney well-versed in surrogacy? Quality agencies will also have support personnel who are either an integral part of the staff or are independent, adjunct professionals. Such support staff includes: surrogate and intended parent coordinators, licensed social workers, counselors, and/or psychologists, attorneys, bookkeepers, and receptionists. The About Us pages should do exactly that - help potential clients to know about them and provide background information on educational levels, their roles within the agency, and contact information. Be wary of agencies who give little to no information about themselves.

*Financial Information -- Surrogacy websites should offer explicit information as to the type of financial investment intended parents can expect to make by working with them. Outlined should be specific dollar amounts, to where the associated fees are going, when portions of the money is due, and whether or not any paid funds are reimbursed if you choose to part ways prior to achieving a pregnancy with a surrogate. All agencies require that majority of the funds for the surrogacy journey are placed into escrow. Escrow funds should be held by a cooperating third party and *not* by the agency itself.

Examine the agency's fees and what services they include. Some agencies offer varied fees depending on what level of involvement you want them to have in your surrogacy journey. For example, a couple may prefer to use an agency for matching services only and then independently manage all other aspects of their journey (arranging medical appointments, etc). Other IPs may want full-service involvement, from the initial matching straight through to the delivery. The more involved the agency, the greater the fees paid will be. Still, fees range greatly from agency to agency. When comparing agency costs, IPs should pay close attention to the breakdown of the fees, paying close attention to the amount being paid directly to the agency itself (as opposed to the surrogate, psychological and medical fees, etc). On websites, this is usually referred to as the "Agency" or "Professional" fee. Agencies vary greatly among well-established, reputable agencies. Some of the more well-known agencies may charge upwards of $25,000, while smaller, but no less reputable agencies charge around $10K-15K for their services.

*Explanations of the Surrogacy Process (from both the IP and Surrogate perspectives) -- While they generally follow the same chronology, specifics in the process can vary slightly from agency to agency. Important things to note are whether or not an agency's surrogates are pre-screened. Most agencies have surrogates who have already been accepted into their programs and will also find surrogates by posting classified ads (online) on behalf of the intended parents. Surrogates who are found after intended parents have contracted with the agency will still have to be screened medically. This section of the website should explain how the matching process is handled. Will both IPs and surrogates receive each others' profiles, or will the IPs receive the surrogate's profile to review and decide whether to proceed to the next step. Will the agency facilitate a three-way phone conference? At what point is personal information exchanged between the surrogate and intended parents? How will the agency continue to support both the IPs and the surrogate once pregnancy has been achieved?

*News/Media Coverage/Testimonials/Affiliations -- What do other people have to say about this agency? Quality agencies will have reputations that speak for themselves, but also have other people want to speak for and associate with them.

When seeking information about surrogacy agencies, don't underestimate the power of word of mouth. Do thorough information searches online to learn of others' experiences with these agencies. A great place to start are online surrogacy message boards. Surrogate Mothers Online has an extensive system of searchable forums where you can easily access pages of agency client's experiences. Information can also be found on All About Surrogacy. AAS requires registering to be able to search the forums while SMO does not.

Once IPs have examined websites and have narrowed down two or three agencies to contact, questions they should definitely ask (if not already answered on the website) are:

1. Knowing that the ultimate financial investment has many variables, how close is the estimate presented to what most intended parents actually end up paying?

2. Has the agency ever been sued by any surrogates or intended parents and if so, for what and what was the outcome?

3. If a surrogate does not already have an insurance policy which which will cover the pregnancy (as some have exclusions against surrogacy), how will the agency help acquire a policy and what are the approximate costs?

4. How long have they been in business?

Above all, one mistake that some intended parents make is falling under the misunderstanding that by working with an agency, it completely frees them from becoming fully educated about the surrogacy process prior to embarking on a journey. Agencies are there to help guide both intended parents and surrogates through the process, but both IPs and surrogates have many things to consider before seeking a match, whether with the help of an agency or independently.

To help ensure a smoother start to their surrogacy journey (whether independently or with an agency), IPs have many other things to consider. How much (or how little) will you feel comfortable asking for/paying in compensation and fees? How much contact do you want to have with the surrogate before, during, and after the birth of the child/ren? How do you feel about selective reduction, and in which circumstances would you (or would you not) reduce or terminate? There are no right or wrong answers to these questions, but to have a good match, it is imperative that you know where you stand on these issues, and on which you have room for flexibility or none at all.

The key to finding a good match is finding someone who shares the same mindset on as many issues as possible. Matching with someone who has polar opposite views on some of the heavier issues could potentially be a recipe for disaster. Thankfully, agencies are there to help facilitate matches so that the intended parents' focus of a journey can remain where it should - on having a baby through the supportive partnership with their surrogate.

Remember - good agencies may be the experts with what they do, but don't forget that they are working for you. Once contracted with an agency, be sure that your (and your surrogate's) needs are being met in a timely manner and do not hesitate to press if you feel that you are not getting the service for which you've paid. Agencies should be warm, welcoming, and accommodating, there to guide and support.

Okay, so that incredibly thorough answer (thank you, Kym!) should get you started on separating the wheat from the chaff. But what about the other part of your question--raising funds to make surrogacy possible.

People seem to fall into two categories with the soliciting for donations, especially asking for money outside of family and close friends. With your family and friends, you are personalizing the request. They know you and you probably know their financial situation. It is completely reasonable to turn to a parent or sibling and ask for help. Sometimes we ask for a person's time or a person's expertise. Other times, we ask for money. And while it is not the easiest conversation to have, many people have found that by laying out the facts (we need help in order to build our family) and explaining how the money will be used and if/when it would be paid back if it were a loan rather than a gift, that they can gather help in financing their family building efforts. The worst thing that happens is that the person turns you down and as long as you can accept that their lack of money does not translate into a lack of love for you or for your future child, you have nothing to lose by asking.

So those aforementioned two categories come up when soliciting donations from a community. Most people are indifferent or unaffected. If they have money, if they get something out of it themselves (for instance, a raffle), or if they have an emotional connection to the situation/person, they are unoffended by being asked for a donation. They either act or they allow their eye to pass over the virtual donation plate on the person's sidebar. A smaller group finds the request for donations off-putting, explaining that everyone has personal needs--most of which require money--and choose to not read blogs that ask such requests (and therefore, you lose the emotional support). It's a hard decision to make whether or not to solicit within a community.

A better place to start is with people who know you or are connected via a local network such as a social group or religious institution. Friends of Journey to Parenthood have been holding a series of fundraisers to cover missing income after Ben was diagnosed with cancer and Kari became pregnant with quadruplets. The most creative was the "flocking," but they've also had a softball tournement and a dance. The combined fundraisers have raised thousands of dollars, with everyone giving a small bit to bring the couple a lot of help.

I asked Angie Best-Boss her thoughts, as the author of the book Budgeting for Infertility. If you don't know this book, you should. It costs $12 and a few hours to read it, but it will save you hundreds if not thousands. Truly, there isn't a more helpful source for navigating the funding of treatments, third party reproduction, or adoption. Especially the advice on dealing with insurance claims...

She said:

Funding surrogacy is tricky. As you know, most of the creative loopholes you might find for either adoption or IVF aren’t available for surrogacy. But, that doesn’t mean you are out of luck, either.

Out of the country surrogacy options are less expensive, but have their own issues. One of the best ways to save money on surrogacy is to work with an experienced surrogacy attorney. He or she may be able to facilitate the entire process without having to use an agency. Surrogacy agencies can be wonderful, but they can also be very expensive.

In terms of raising money, here are a few ideas to get you started. For most of these, you need somebody in the community to help. For example, you might need a church or other group with a non-profit status to do some of these fundraisers (though contributors won’t get a tax write-off) or someone with a large space.

* Crop till you drop. Find a local scrapbook consultant and host a $20 crop for 4-5 hours one night. The consultant can demonstrate techniques and you can collect cash.
* One of my favorite ideas is a Texas Hold ‘Em poker night.
* Current has great cards, wrapping paper and gift items and their fundraising programs offers 50% back.
* Host a big garage sale and ask for donations from family and friends.
* Make and sell things over at etsy.com
* If you or someone you know is an artist, start a Café Press store to sell imprinted mugs, shirts, bags, etc with a great piece of art.

It's a good starting place and certainly read the other blogs in the surrogacy categories on the blogroll, from both the IP and surrogate point-of-views because often, tucked inside a post where you least expect it, are the nuggets of advice that help you the most on your journey.

No really, the beauty of a blog advice column is that you get to weigh in with your two cents too. Let the questioner know if you support the advice, add to the response, or dispute it completely.

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