As all other avenues fail, Israeli would-be mothers turn to surrogacy as a way to realize their dreams.
By MATTHEW WAGNERfertility feat 1 88 298(photo credit: Illustrative photo)
'I can't sleep. I find myself once again writing to my virtual support group at a crazy hour. I take comfort in the knowledge that I am not alone in my tremendous need to be a mother. I try not to need it too much. But I can't help myself."
It's 1:31 a.m. and a woman with the online name "Realizing a Dream" is filing an entry on Tapuz's Internet forum devoted to surrogate motherhood.
"I sniff babies," the entry continues. "I am addicted to the talcum, the shampoo, the lotion, the fresh baby skin smell. If fantasies, dreams and longings could bring a baby into the world, we would be the parents of a large family by now. But they don't. Still, I can't help myself. I call out to my child-to-be to remind him/her/them that we are waiting."
In an interview with The Jerusalem Post, this distraught would-be mother says she is vehemently envious of women who get pregnant easily.
"One thing that drives me crazy is when women say things like 'I get pregnant just from the smell of him,'" she says.
"It is difficult for me to meet young people with children," she says. "You see them with one child then another and another while you keep on trying with no results.
"I admit it. I am jealous."
"Realizing a Dream" - who overcame cancer but lost her fertility in the fight - is just one of thousands of women who feel betrayed by their own bodies. Motherhood, which seems to come so maddeningly easy to most women, has eluded them.
But despite their physical limitations, these women refuse to give up. The drive to nurture is too strong and they want a genetic child. If their own body refuses to cooperate, they will borrow the womb of another woman for the nine-month haul.
Some say the strong need to be a mother is a Jewish-Israeli phenomenon - which explains Israel's high fertility rate (2.7 among Jews). Others claim it is a reaction to the Holocaust, or the fulfillment of a Zionist-nationalist ideal to win the demographic race against the Palestinians, or a cornerstone of Jewish culture, or it is something too deep and primordial to be fathomed. Whatever the reason, as Israeli fertility rates are the highest in the Western world, childbearing is obviously a value that resonates deeply.
Surrogacy 101
Called surrogate motherhood ("pundaka'ut" in Hebrew), arrangements in which a fertile woman carries a baby for another have been governed by law in Israel since 1996. Israeli surrogacy legislation, which is heavily influenced by Halacha (Jewish law) and cultural sensibilities (see box), restricts surrogacy arrangements to gestational surrogacy. Unlike full surrogacy (illegal in Israel), in which the surrogate's own egg is fertilized with the father's sperm using insemination technology, gestational surrogacy is accomplished via in-vitro fertilization (IVF).
In most cases the surrogate is implanted with an embryo created from the egg and sperm of a married couple (the "designated couple").
The surrogacy process is long and grueling. Women with a history of fertility problems often turn to surrogacy after years of failed treatments. These women are generally older and have suffered through numerous cycles of difficult hormone treatments, which often involve adverse side effects such as bloated stomach and weight gain which are sometimes painfully mistaken for pregnancy.
But even women who have not undergone years of fertility treatments face a gauntlet of obstacles. There are medical committees, legal arrangements, psychological evaluations, medical examinations and the financial burden.
If the prospective mother is providing her own eggs, she must undergo additional hormonal treatments, as well as surgery to have her eggs removed so they can be fertilized by her partner.
But in cases when the female of the designated couple does not have her own ova (see box), the egg is received from an anonymous donor and is fertilized using the husband's sperm.
Egg donors are often non-Jews from Romania, Ukraine or Cyprus. Although the law allows Israelis to donate ova, very few do. Only women receiving infertility treatment are allowed to have their ova removed and these women feel they need their eggs for their own fertility treatments.
Sagit, who at 24 suffered from early menopause, used an egg donor from Romania and a surrogate from Israel to have daughter Rachel. Her husband, who provided the sperm, is the only parent with any genetic connection to Rachel. Nevertheless, Sagit feels like Rachel's mother in every way.
"For me, nurture is everything and nature is insignificant," says Sagit, who was wary of being interviewed. Like many mothers who use egg donors, Sagit plans on keeping the egg donation a secret - even to Rachel. Friends and family think Sagit donated the egg.
"It's simply not a big deal," says Sagit of her decision to keep the donation a secret. "It's about as important as what I ate for lunch."
Sagit says that since Rachel's birth, relations with her husband have improved incredibly.
"Things were tense between us for about three years before Rachel was born," says Sagit. "Having Rachel was our life project. Now it is behind us. Now we have our entire future ahead of us."
The Surrogacy Process
The infertile couple's first stop on the way to surrogacy is the Health Ministry's Surrogacy Approvals Committee that consists of two gynecologists, an internist, a clinical psychologist, a lawyer, a social worker and a rabbi (if the couple is Jewish). The committee's job is to determine whether the couple is eligible for surrogacy.
The couple must prove to the committee that they have exhausted all other options for childbearing and that surrogacy is their last chance for genetic offspring. They also must prove their psychological health. The process involves exposing some of their most intimate medical and psychological details.
Next, the couple must locate a surrogate that is likely to be approved by the Health Ministry committee. The going price in Israel for a surrogate is about $25,000. There is an extra charge for twins, which is common since surrogates are implanted with at least two embryos simultaneously to improve the chances of pregnancy. There is also an extra charge for a delivery by C-section. The couple is obligated to provide the surrogate with psychological treatment during pregnancy and after the birth.
Doron, the happy new father of twins - a boy and a girl - born to a surrogate six weeks ago, says that by the time he was through with all the expenses, which included taxis for the surrogate to get to and from medical examinations and a babysitter for the surrogate's children while their mother was away, the surrogacy arrangement cost at least $40,000.
"In our relationship with the surrogate, my job was to take care of the financial stuff while my wife took care of the intimate stuff." "Intimate stuff" included being in almost daily contact with the surrogate to make sure she was feeling well, accompanying her to all medical exams, feeling the movements of the twins in her stomach and even singing to them.
Doron and his wife Leah, who was born without a womb, were lucky. They found a surrogate quickly. And she got pregnant from the first IVF treatment.
Sometimes things don't go so smoothly. In the case of "Realizing a Dream," her first surrogate had sudden misgivings and backed out at the last moment, which brought her back to the beginning of the process.
This negative experience convinced "Realizing a Dream" and her husband to hook up with the larger of two surrogacy agencies in Israel. Called Pundaka'ut Hoveket ("Embracing Surrogacy"), the agency guarantees a surrogate within six months and gives legal, medical, psychological and practical advice throughout the entire process. The other agency is called Mercaz Lehorut Be'emtzaut Pundaka'ut ("The Center for Parenthood Through Surrogacy"). Using an agency costs $8,000 to $12,000 more than doing surrogacy on one's own.
But even after the couple has passed these hurdles, they have no guarantee that the surrogacy will succeed. According to data supplied by Embracing Surrogacy, over the last decade since the surrogacy law was passed, about 400 couples have filed a request with the surrogacy approvals committee and 320 have been approved. But only about half of the couples have ended up with children - about 40 couples had twins.
Motivating Factors
Why are "Realizing a Dream" and others like her willing to travel the difficult route of surrogacy to attain motherhood? Why don't they simply resign themselves to their fate? Or adopt?
Susan Kahn, author of Reproducing Jews: A Cultural Account of Assisted Conception in Israel and Harvard University's Associate Director of the Center for Middle Eastern Studies, points to what she calls Israeli-Jewish pronatalism which she says "is grounded in perceived demographic concerns about maintaining parity with Palestinian and Arab birthrates," in a Jewish version of Yasser Arafat's famous declaration in the 1980's that "The womb of the Palestinian woman will defeat the Zionists."
The trauma of the Holocaust is another factor, adds Kahn. "For some, having children is a direct response to the loss of six million Jews and reflects a desire to 'replace' those who were killed."
Hebrew University anthropologist Dr. Elly Teman calls this an example of German philosopher Rabbi Emil Fackenheim's 614th commandment, the injunction to continue Jewish life after the Shoah and deny Hitler a posthumous victory.
For other Israeli women, it is a very essential, religiously rooted desire. Rabbi Yuval Cherlow, a member of the Health Ministry's surrogacy committee, cites the Book of Genesis as proof that motherhood is a very Jewish need.
"Rachel equated barrenness with death," says Cherlow, quoting from Genesis (30:1): "And when Rachel saw that she bore Jacob no children, Rachel envied her sister and said [to Jacob]: 'Give me children, or else I die.'"
Nahmanides, a medieval biblical commentator, explains that Rachel was actually threatening to commit suicide. Her inability to provide Jacob with children, especially in the face of her sister Leah's astounding fertility, was that devastating.
In perhaps the most prototypical surrogacy story, the matriarch Sarah encouraged her husband Abraham to have a child with Hagar, their maidservant, even though the child would not have her genes.
"And Sarai said to Abram: 'Behold now the Lord has restrained me from bearing. I pray thee go in to my maid; it may be that I will obtain children by her' and when she [Hagar] saw that she had conceived, her mistress [Sarai] was despised in her eyes." (Genesis 15:2, 4).
For Sarah living a childless life was a source of degradation and for Rachel it was worse than death.
Religious opposition
But even with these biblical precedents, Halacha, which is seen by Orthodox Jews as a revelation of God's will on earth, does not obligate an infertile couple to resort to surrogacy.
"The Torah commands us to be fruitful and multiply," says Rabbi Binyamin David, of the Puah Institute, which provides pro bono counseling to Orthodox couples with fertility problems.
"But we are not expected to exceed accepted and natural endeavors to have children," said David.
According to the rabbis who oppose surrogacy, what is a childless couple supposed to do? In theory, after 10 years of marriage without children the husband is expected to divorce his wife. But in practice this rarely happens.
In fact, many leading rabbis remained married and childless their entire lives. Rabbi Avraham Yeshayahu Karelitz, known as the Hazon Ish (1878-1953), Rabbi Zvi Yehuda Kook (1891-1982), and Rabbi Menachem Mendel Schneerson, the Lubavitcher Rebbe (1902-1994), all died childless and never divorced.
The Book of Samuel offers advice to the childless couple. Elkanah's response to his barren wife Hannah's crying is: 'Why are you crying? Why won't you eat and why is your heart bitter? Am I not better to you than 10 children?" (1 Samuel 1:8).
Rabbi Bachya ibn Pakuda in the fourth chapter of his book Hovot Halevavot (circa 1040), argues that there is a moral obligation to thank God for freedom from children.
"He should notice the absence of the heavy burdens and obligations [that accompany a spouse and children], and consider it one of the Creator's benefits to him. If he wants to pursue worldly things and needs, his hard work will be much easier without a wife and children, and their loss is his gain and comfort. If he is concerned with the next world, his mind will undoubtedly be clearer and freer because he's alone."
Nevertheless, many religious and even haredi couples turn to surrogacy. According to Merav Levi, founder and director of Embracing Surrogacy, about 15% of the couples that come to her to find a surrogate are religious or haredi, which matches their percentage in the general population.
Still, surrogacy is taboo in insular haredi communities. One haredi couple that was forced to turn to surrogacy is hiding it from their neighbors. The genetic mother is play-acting pregnancy with a pillow tucked into her shirt. The couple has arranged for an ambulance to arrive with a stretcher to take the mother away when the time comes for the surrogate to give birth. The couple apparently fears the stigma attached to a child born via surrogacy.
But the desire to have a genetic child is stronger than any social pressures. Judith is a haredi woman with Mayer-Rokitansky-K ster-Hauser syndrome (see box) who is in the process of choosing a surrogate. Because of her condition, Judith had a difficult time finding a husband. In the haredi world of matchmaking, she was obligated to notify men of her condition. Singles refused to meet her. She ended up marrying a widower with five children.
Judith says that her desire to have children has nothing to do with religion.
"The mitzva is on the husband," says Judith. "My husband has already fulfilled the commandment. I'd call my strong desire to have a genetic child of my own a personal, psychological need."
And Judith is not alone in her personal motivation for having a genetic child, according to a 2005 Jewish fertility survey sponsored by the Jewish Agency's Demographic Initiative.
The survey, which found that the average Israeli Jew of reproductive age would ideally like a family of three or four children, revealed that the impetus for having children often has nothing to do with religious, nationalist or historical factors.
Dr. Sergio DellaPergola, chairman of population studies at the Hebrew University of Jerusalem, who conducted the survey together with Dr. Mina Tzemah and Dr. Rimona Wiesel, was surprised by the reasons respondents gave for wanting to have big families.
"We expected people to give religious or nationalistic imperatives for wanting to have a lot of children," says DellaPergola.
"However, we discovered that usually the reasons were very personal. For instance, people mentioned the positive impact of a child on a couple's relationship or the importance of growing up with brothers and sisters. Sometimes they gave vague explanations such as 'that's what a family is supposed to look like.'"
Motherhood without Pregnancy?
Women who have given birth in the traditional way tell how the experience tied them to their children. Many would say that pregnancy is what differentiates between a father and a mother, so how motherly a relationship can a woman have with a child that was never in her womb?
Anthropologist Teman, who has personally interviewed over 50 couples and surrogates as part of her recently completed doctoral dissertation on surrogacy in Israel, rejects the idea that pregnancy and the birthing experience are what create a bond between mother and child.
"The whole idea that there is such a thing as a 'maternal instinct' is a big myth," says Teman. "Bonding is the result of a conscious choice made by the mother. None of the surrogate mothers I have met bonded with the babies they carried. They go into the arrangement with the firm understanding that this baby is not theirs. The only bond that they develop is with the intended mother."
Orly, a surrogate mother at the end of her ninth month, says that money is what motivated her.
"I never would have volunteered to go through all this," says Orly, sitting on the edge of a chair, her huge belly protruding above her spread-apart knees.
"The first three months were horrible because I was allergic to the hormone shots they gave me in my butt."
Sometimes Orly regrets ever having gotten herself involved in surrogacy.
"One day I threw the idea out and it just kind of snowballed. Now I look like a big ball." Orly has two children of her own, a five-year-old and a six-year-old, who she says, "couldn't care less" about the baby she is carrying.
"The only thing that interests them is the envelope at the end," says Orly, referring to the payment. "I promised them a plane flight as a present. Nothing expensive. Something local."
But Orly later admits that the surrogacy did have a negative impact on one of her children.
"My younger one started wetting his bed again months after being potty trained. But I'll make it up to them when this is all over."
Orly says she has no emotional feelings for the baby she is carrying.
"Obviously, I take care of myself so that nothing, God forbid, happens to him. But this baby belongs to David and Aliza."
Teman cites research by anthropologist Dr. Tzipy Ivry of the University of Haifa's Anthropology Department to prove that the bond between a mother and a child is not dependent on pregnancy. Ivry showed that the Israeli mothers she interviewed did not begin to bond with their children during pregnancy because they feared that genetic testing might force them to abort or that they might miscarry.
"Ivry found that the fetus is a suspect that needs to be investigated. Women are suspicious of it and do not accept it fully until after birth," says Teman.
Another study cited by Teman that was conducted by controversial Berkeley anthropologist Meira Weiss found that before ultrasound provided prenatal screening, 68% of babies with external defects such as Down's syndrome or even cleft lip were abandoned by Israeli mothers, higher than in any other Western country.
"Weiss's work suggests that there is no universal, biological maternal instinct," said Teman. "If the baby was not to the mother's liking, she chose not to take it home. Today, with improved prenatal diagnosis, women are simply not having those babies."
THREE NEW births were announced on Tapuz's surrogacy Internet forum in the past two months. "Realizing a Dream" has mixed emotions about the births.
"Obviously, I was so happy for those women. But I also feel that my own [baby] is so far away."
Through Embracing Surrogacy, "Realizing a Dream" has found another surrogate to replace the one that backed out. The Surrogacy Approvals Committee was supposed to authorize all the legal and medical arrangements last week, but due to a mix-up the documents never reached the committee.
But this woman with a dream has learned to have patience.
"Eventually, we will get our chance to become parents," she says.
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