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	Family By David Katzive

This is a story about compassion, family values, and sharing that began at Ruder Finn and then unfolded into a tangle of plot twists that brought the protagonists to the brink of an erupting volcano, to the corridors of power in the nation’s capital, to the production studios of a network soap opera, and to a high-end fertility lab in Northern New Jersey. The story also brought them face-to-face with a grisly murder investigation, stolen embryos, a host of medical treatments and, ultimately, a glorious and inspirational gift of life.

Chapter one:We have news

It is December 2002 and my daughter, Natasha, and her husband, David, take my wife and me to dinner in a fancy restaurant and announce: “We have news.” But it’s not quite the news we are expecting. They had been trying for a year to get pregnant and it wasn’t working so they had started going to a fertility clinic. The diagnosis was PCOS (polycystic ovarian syndrome), a condition my daughter explains is fairly common and not a big deal. They have pictures that show clusters of eggs lined up like a string of pearls around her ovaries, but going nowhere. The news sends us to the Internet for second, third, and dozens of other opinions, most of which confirm what we had been told: that IVF (in-vitro fertilization) with PCOS works extremely well as long as the eggs and sperm are healthy. Fertility is not the problem, plumbing is.

Chapter two:

Big needles We learn that the process involves “harvesting” her eggs, then making them fertile in a test tube (the husband basically doing what fish do). They then grow for a few days into the tiniest of embryos, just a few hundred cells, and then, remarkably, they are chilled down and kept in cold storage until the mother is ready to have them placed in her uterus. The first step was drugs. Lots of them. Some taken orally, some injected in the stomach, some in the buttocks: Clomid, Lupron, and Follistin to stimulate the ovaries, and Progesterone, Metformin, Natafort, Medrol, Doxycycl, and Pregnyl. Many doses are administered by my son-in-law in a process that makes him feel like a “mad scientist mixing up chemicals and injecting them into my uncomplaining wife.” He also tells me, “I’ve seen a lot of stories about people who were so desperate and depressed, but for some reason we never felt this way…we felt that one way or another it would work out and we would take it one step at a time.”

The effect of these treatments is spectacular, impressing even the staff at RMA, Reproductive Medicine Associates, the fertility clinic in New Jersey. RMA’s slogan: “The Source for New Beginnings.” My daughter ends up with more than 50 eggs, and the production of a large number of viable embryos is quickly accomplished. All the doctors tell her how lucky she is.

But the most arduous chapter of this story is getting these embryos to attach and grow in my daughter’s womb. Her uterine lining never gets thicker then 5 millimeters. She is diagnosed with endometrium insufficiency.

The clinic recommends drugs intended to stimulate various systems that would cause the uterine lining to thicken to at least nine millimeters. The variety of products includes: Viagra (normally for erectile dysfunction), Prometrium, Femara, and Tamoxifen (both associated with breast cancer treatments) but nothing seems to work and the embryos do not latch on. While the medical staff struggles to explain why these treatments fail, the emotional burden on my daughter, her husband, my wife, Arlene, and all members of our family is getting heavier. Natasha gains weight, gets puffy, loses weight, breaks out in rashes, pimples, and all the time is sore where she sits. She even tries acupuncture and meets with a specialist in eastern medicine. Throughout this process, we never doubt her determination. It makes the inexplicable failure of these treatments even more heart-wrenching.

My daughter says, “For some reason I didn’t respond to any drugs that thicken the lining, and I tried everything and they don’t know why they had so little effect…so they suggested I think about someone else carrying the baby…but I had done so much work…it was already two years of drugs.”

Waiting in the wings throughout this process: the “surrogate.”

Chapter three: Flashback, the Ruder·Finn connection

It is the early 1990s. My son Matthew is an executive trainee at Ruder·Finn, his first professional assignment after graduating from the University of Michigan. He goes on to become a successful communications specialist in Washington, D. C., marries his college sweetheart (Kim, who will hate me for calling her that) and becomes head of public relations for many of the independent channels of Discovery Communications. They have two extraordinary daughters, my grandchildren.

While all this is playing out, my daughter, fresh out of Lehigh University, is accepted for a position as script supervisor for a ten-camera shoot Ruder·Finn is producing in Hawaii for the Jason Project. With lava flowing all around us and tempers growing short, she makes a terrific impression on the director we had hired for the project and he recommends her to the staff at the 70 year-old New York– based soap opera Guiding Light. She joins the staff and meets her future husband (currently the head writer) and thinks they are dating in secret when everyone at this closeknit broadcast family knows very well what is taking shape behind the scenes.

Chapter four: Carrier

With their options rapidly dwindling, Natasha and David start considering the possibility of finding a surrogate to carry their children. The clinic refers them to their counselor for surrogate parenting, Melanie McGuire, whose role is to help them understand the practical, medical, and emotional issues involved. Some of Natasha’s closest friends offer to be “gestational carriers” but the best candidate turns out to be someone they had admired for her skill and warmth as a mother, her intelligent and responsible approach to pregnancy, her physical heartiness and mental focus: my daughter-in-law, married to my son, aka Natasha’s sister-inlaw, Kim. It would keep it all in the family.

Definition: a gestational carrier is someone who holds the embryo (with the parent’s DNA) and brings it to term. A surrogate provides the egg and carries it to term.

My daughter explains they want Kim to do this because “she is family, because she is such a smart capable, wonderful person and I know she will take care of herself and the baby.” Plus, Natasha and David think that my son, Matt, would be especially supportive for Kim during this process. The underlying magic to this story is that Kim and Matt had already thought about this very scenario a year earlier, so when my daughter asks my son if he thought Kim might consider doing this, the decision to go ahead has already been played out in their minds.

Matt: “Kim knew Tash really wanted to be a parent, really wanted to have kids…and she wanted Tash to have the same wonderful experience…and I also told Kim she shouldn’t worry about saying no to doing this…that no one would hold that against her…but if she wanted to do it was certainly a wonderful, amazing thing…” The burden is clearly going to fall most heavily on Kim, but she is willing to take it on because “I thought they’d be really great parents, excuse me if I get a little teary…I love my kids more than anything and to be able to give that to somebody else, then yes I’d do that, and then I thought how super it would be for our family . . . how it will make all our lives richer…it is for the family, for everybody…”

There are some restrictions, the chief being that the pregnancy would have to wait until Matt and Kim’s youngest daughter is at least one year old.

And there are many concerns. Everybody has concerns.

My wife, Arlene, is worried about the unnecessary burden of Kim managing two young children (1 and 3) while pregnant. I am worried that the embryos would not fare well after being thawed out. Natasha and David are concerned about the strain this would place on their relationship with Kim and Matt, and Kim is concerned that she was being entrusted with the care of someone else’s children, a form of extreme babysitting.

The process begins with psychological testing for both sets of parents, physical tests, blood tests, and then legal papers, lots of legal papers.

The gestational advisor, an immensely practical and saucy professional nurse, talks regularly with both Kim and Natasha, answering questions, helping set the stage. Kim and Natasha both enjoy talking to her: “She is so smart and so matter of fact but I guess she has a dark side.”

The first hurdle turns out to be a surprising one: surrogates and gestational carriers are not legal in the District of Columbia. All legal processes and delivery of the children have to happen somewhere else, in this case, Maryland. The legal issues are complex and grimly down to earth, dealing with a wide range of scenarios that can play out during and after a pregnancy.

For Kim and Matt, the next step is needles once again, the same process that Natasha had gone through for years. The injections shut down the gestational carrier’s production of estrogen and then oral medication restores it so that her body is in an optimal mode to receive the implantation. More pain, more ice packs, more testing, more waiting.

Chapter five: Showtime

On Columbus Day, 2004, two embryos are thawed out in New Jersey and implanted in Kim’s carefully prepped uterus. Natasha and David, elated, lightheartedly give them names: Emmy and Emmett. The story line of gestational carriers also shows up in a highly modified fictional form in episodes of Guiding Light. Embryos are stolen by one character and secretly implanted in another as a way to seek revenge on a lost love. But that is another story.

In mid-October Natasha gets a call from Melanie, the nurse/advisor, who tells her “You are so f * * * ing pregnant!!” It is twins. Confirmed. And doing well. As soon as possible, the clinic starts ordering sonograms and at 20 weeks we learn that Emmy and Emmett are indeed a boy and a girl. An instant family.

Kim adds “I was freaked out a lot by the procedures, and with twins, I was really worried I’d be put on bed rest because of my own kids…and there was tension and anxiety and happiness and sadness and exhaustion…but to me it was like anybody would do this…I mean, why wouldn’t you…?”

From the moment we learn that Kim was going to carry the babies, my wife and I can barely contain our amazement and admiration for her courage and generosity. To us, it is a magnificent act of love for our daughter and for our son. Her decision and actions give even more depth and definition to our idea of family, sharing and the joy of children. It’s never too late to be collecting warm and fuzzy feelings that make your spine tingle.

Chapter six: Weird stuff

The tangled tale of gestational carriers on a soap opera pales in comparison to what happens to Kim and Natasha’s nurse. As of this writing, Melanie McGuire is under arrest for allegedly murdering her husband. In a case spread all over the front pages for weeks, her missing husband was found dismembered in several suitcases along with forensic evidence that appears to link Melanie directly to the crime. The story has made the Style section of the New York Times (many wealthy New Yorkers had used and praised her professional services).

Her voice mail says: “Melanie Maguire is out of the office indefinitely.”

My daughter and daughter-in-law now have a new advisor.

Chapter seven: Curtain up

The babies are very carefully monitored, Natasha moves in with Kim and Matt for three weeks before the scheduled delivery date, and as 36 weeks pass, it is clear the babies are at good weights and doing well. A cesarean delivery is discussed.

Natasha: “I helped Kim out with her girls so I got to hang out with my nieces and that was great and that was when Kim and I really bonded, going shopping, getting coffee, going to the movies…”

Tests show Kim is carrying about 14 pounds of baby and a C-section is scheduled. The names are kept secret from us.

Kim and Matt explain to their two children (Caroline, now 4 years old, and Anna, 2) that they are “helping Aunt Natasha get some babies.” No details provided. Inexplicably they don’t seem to ask about how Kim has changed, except Anna notices it is hard to “stay on mommy’s lap.”

June 17 is picked as a date for the delivery. I come back early from Switzerland, and three sets of parents show up at the hospital: Kim’s parents, Matt and Natasha’s parents (us), and David’s parents. They only allow one person in the delivery room and Kim chooses Natasha.

Kim: “I was really really afraid of the cesarean going in, and I wanted Matt to be there…and you are thinking I did this to myself, but then I decided that Natasha has to be there for the birth of her own children.

Natasha: “Not that I hadn’t realized it before, but at that moment I really understood the enormity of what we had asked her to do and we were both really scared.”

While Kim and Natasha are in the OR, all the grandparents wait in the cafeteria and Matt and David are in an empty patient’s room nearby.

David: “I said to Matt that I am sitting here reading the paper like it’s any day and in about ten minutes somebody’s going to come in here and tell me I have kids…”

And then the babies are delivered in 6 minutes. Dashiell first at 7 pounds 14 ounces and, one minute later, Fiona at 6 pounds 7 ounces.

Natasha: “He came out really quiet and she came out screaming and all the nurses were so excited and amazed by Kim and this whole process… She gave us our family, that’s the most amazing gift anyone can ever give.” There are 13 adults and two infants crying. All of Kim’s doctors are amazed that she made it to over 38 weeks and wasn’t even dilated, had no bed rest, never complained, and, for twins, the babies were huge. Natasha gets a note from her doctor (she is crying as she reads it to me) that includes these words: “Dear Natasha, I am thrilled beyond words to hear about the birth of your twins…after all your hard work and perseverance… I am so proud of you… Your children will always know how much they were wanted.”

Chapter eight: Scene one

Now we have four grandchildren and they are quite a noisy bunch. To everyone’s surprise, our two very young granddaughters are extremely attentive, gentle and almost maternal to their infant cousins. They even entertain them and make toys for them.

David: “Every now and then we still have that moment where we say we can’t believe that Kim was willing to make this sacrifice and now that they are here and all those things that everybody says about being a parent are true…and all the love you feel and the fact that we’ve been given this astounding gift…”

Matt: “After navigating all these currents and cross-currents for three years, the most exciting thing now is to see how Dashiell and Fiona turn into little people.” Natasha: “It is such a miracle, the science is so spectacular, and we’ll always be incredibly grateful to Kim and Matt.”

Kim: “I grapple with ways to be involved in their lives that is meaningful and not weird…and not because of obligation…what I mostly want out of it is a sense that they are well loved…they are the product of an incredible amount of love…that they do well by their lives… I don’t want them to take their family for granted…that they understand that they’re so loved, they were wanted so badly and not to turn their backs on that and always recognize that...your family is all you have in life.”

My wife adds: “Dashiell and Fiona have an extraordinary aunt who doesn’t give herself enough credit for what she did.”

As for me, now four times the grandfather, it is hard to fully grasp the magnitude of this gift. But just seeing them all together is a pretty good start.