My Surrogacy Experience with Dr. Malpani Part II: Finances and the aftermath

Dr. Malpani claimed that his fee schedule is very clear. Judge for yourself; see the original table below. For me, the repetition of the sections in red font created initial confusion. 

Anyway, the original schedule is the only thing I received from him before starting this process, and being utterly stupid and trusting of him at that point, I gave it no thought and barely spared it a glance. All I wanted at that point was a baby, and I did not stop to think and ask the right questions about these practical and monetary considerations. Had I done so, I may have spotted the red flags I saw later, and I may honestly have looked elsewhere at that very point.

Note that while knowing that I am an Indian citizen living in India at the time of treatment, he decided to charge me in USD based on my sojourn in America. He also did not fix the dollar rate: During the first part of my treatment, the rupee was stronger against the dollar, and I paid at Rs. 55 to a dollar. Then the rupee went on a crazy downward slide, and he then charged me at Rs. 60 to a dollar.

This struck me as rather unfair, especially since the service did not change, but the perceived value did. I honestly did not pay that much attention to the fact that he was charging me in dollars in the start since I never dreamed that the exchange rate he was giving me would change. When it did, and the unfairness (in my opinion) became blatant, I was stuck, because we were already well into the process. It was a pretty bad place to be in then, honestly.

Later, when I was talking to the people at Surrogacy India, I ask them what they do about this specific point, because I was not at all happy how this was handled by Dr. Malpani: They are apparently very scrupulous about charging Indians (with Indian passports) living in India in rupees, and if they do a rupee to dollar conversion, they have fixed it at Rs. 50 to a dollar. Kudos to them. 

How are the monies spent by Dr. Malpani? As I spent more and more time actually considering each sum he charged and each of his practices, I started to have serious issues with the way things were being done. I repeatedly asked him for detailed invoices or breakdown of the amount charged, and he adamantly refused at each point. In all fairness, that is his prerogative upto a point (we will discuss this later). 

So I paid because I had idiotically agreed to this, but it is also my right to try to analyze it retrospectively. 

To try to give you all an idea of his overheads, let me tell you all about how much blood work/ultrasounds in India cost. I got these figures from a local lab, NM Medicals, by calling them and asking them how much specific tests cost.

Note that he does use this laboratory for his bloodwork and also used them for ultrasound testing.

Full STD panel (HIV/Syphilis etc): Rs. 1700 ($28)

Prolactin: Rs. 500 ($8.34)

Beta-HCG: Rs. 600 ($10)

Routine Ultrasounds: Rs. 2000 ($33.34)

2nd trimester NT screen: Rs. 2000 ($33.34)

Triple marker screen: Rs. 2000 ($33.34)

PIO injection (taken from the Hiranandani Bill): Rs. 159 ($2.65)

(Exchange rate used for above calculations: Rs. 60 = 1 USD)

Given how laughably cheap all this is, I would not expect full prenatal screening and management (progesterone, other pregnancy hormone tests, Beta HCG tests, ultrasounds, etc) in India, from the first beta-HCG to the point of hospitalization at the end of the pregnancy, to exceed Rs. 40,000 (~$666), and this to me seems to be a *very* generous estimation.

So here are my explanations about the steps of the process- how much I paid, how much the surrogate got, and how much the medical care may have come to:

I have asked him multiple times where the money goes, and I get answers like "prenatal care costs a lot," (had to laugh at this one) or "we need to charge for coordinating services," etc. This last answer was when I asked him what he was doing with the balance that Hiranandani had repaid him.

How can monies charged for "antenatal care, ultrasound scans, hospital birth, etc" and "additional compensation of LSCS (c-section)" be reasonably diverted for "coordinating services?" when his fee schedule already includes sections such as “Registration fee” and “Surrogate Handler fee?”

He had no answers for this, and just said that he owed me no explanations. Uh, you do if you are asking me to cover hospital bills while waving a refund they gave you in my face!

At this point, I was planning to have my embryos and 2 vials of donor sperm transferred to another clinic, just in case I wanted to have another baby. I put in the request to have my biological materials transferred. He then refused my request to have my embryos and sperm transferred till I had paid him for the initial hospitalization (!!!!).

In this case, the amount he asked me to pay was utterly unwarranted, given I had paid all the stipulated fees and there was a large unexplained balance left over, in addition to the surplus he had retained from the amount supposed to go to the surrogate. 

Nonetheless, I don’t know what the situation would be if a patient defaulted on the bills they should have been paying, but I doubt it would involve the clinic deciding to hold their biological materials hostage: this is not the Wild Wild West after all; I would have thought that the SOP for a clinic then is to transfer the materials to the patient and send the unpaid dues to a collection agency or settle the matter via legal venues, but the biological materials would logically not be dragged into this process.

Nonetheless, such avenues apparently cannot be considered by Dr. Malpani, who thinks it is okay to release a patient’s private blog to a newspaper reporter without getting consent from that patient, or hold embryos (which may be her future progeny!) hostage to money. Amazingly, when I used the word “hostage” in an email and he agreed to it, and told me that I gave him no choice!

When all this happened and this man decided to hold my embryos/donor sperm samples hostage, he then demanded I pay storage fees that he had not informed me of in the past to keep the embryos that I wanted transferred with him, or he would destroy them due to “lack of space.” He was refusing to transfer my embryos while telling me he would destroy them because he had no room to store them! I looked at my options then. We went to see a lawyer, who advised me to go to the police to get my property freed, and then advised me to sue him in both consumer and criminal courts. The lawyer practically rubbed his hands together with glee at all this, because everything about these financial dealings was documented. We had the legal notice all drawn up to make him release my embryos, and maybe also go for punitive damages.

 My mother (who is herself a physician) asked me when this man has behaved so unprofessionally/vindictively (our opinions), and has clearly shown his willingness to make life as difficult for me as possible (again, no more than our opinion), would I trust that the embryos and sperm in his care would have been handled ethically and correctly, even if I forced him by legal means to transfer them? Would I want to pursue expensive fertility treatments using said embryos and/or sperm, when I had no guarantee that they had not been damaged while being in his care? My father also voiced the same concerns. My answer was I did not know, but anything was possible, given his behavior, which I would never thought he would be capable of, given our initial interactions.

Even if I gave up on my embryos and sperm (my parents make valid points, I think)---he keeps refusing to transfer them and keeps sending me emails that he will destroy them due to “lack of storage space” unless I pay up---I could sue him for monetary damages---these are 50% of my embryos from my second IVF cycle, and the donor sperm that I have paid through the nose for. This man, has, in writing, refused to transfer them, while citing limited storage space as a reason for destroying them (!!!) The mind truly boggles.

I could also sue him (in lawyerspeak) for the mental agony I suffered: I was insanely stressed out in the final month of Gauri’s gestation due to this man’s behavior and her discharge against medical advice. I was actually terrified for my baby’s safety and wanted him/her to be out of this man’s control as soon as was humanly possible. Then there is the fact that, after my surrogate went home with a clear vaginal swab against my wishes, she came back with a greenish discharge indicative of an STD, and the fact that my poor baby was born with what looked like a respiratory infection acquired in utero and required IV antibiotics for one whole week!

But I had an epiphany. One day, late at night, I was up with Gauri, I saw an email from him asking for money to store my embryos and sperm samples after refusing to transfer them. He was asking me to pay storage fees that I can never remember him mentioning before (I went through the emails to check). I was instantly taken to such an angry, stressed-out place. It is that place that I have gone to so often with him. This man has disturbed so much of my life….should I still let him be in it, making me angry for the next few years when our legal cases in multiple courts may drag out? The lawyer assured me that I would not have to do a thing and the case would be fought while requiring no input from me, but even then. Even if it was settled quickly out of court (I suspect it would be), I want to move on. My dad initially wanted me to sue because he does not believe in taking such behavior lying down. My mom has always been against it. She wants to avoid the ugliness this battle will bring, and she is a big believer in karmic retribution.

 A man who keeps part of the fees that he states is for the surrogate: what is your opinion of that? Compare his input and her input into this pregnancy: she, having puked her way through 9 months and doing the tremendous service of growing and carrying a child at the expense of her future health, gets only Rs. 250,000 from the nearly 10,00,000 I paid him, and not even all the money he had taken from me in her name. Is it fair?

Yet, I have my daughter, not because of him but rather despite him, in my opinion. Money comes and goes, but peace of mind is far more important. So letting go is what I am going to do now, for my own peace of mind. Of course, if he vexes me any further, there is always a legal process available to initiate.

When I write all this out, it seems like a bad dream. It scarcely seems possible that the person I met in late 2010 could have behaved in this way, but he has. His behavior with me aside, which most certainly is out of character for him in my opinion, there are several issues (financial and logistical) with the way this man runs his surrogacy program. Most IVF doctors in Mumbai are not running their own programs, they actually outsource it to an agency who have the bandwidth to discharge their duties properly, and I applaud every doctor who takes this responsible step. If you want to pursue surrogacy in India, I would strongly recommend going to one of them. I will next be writing a separate review about the Malpani Clinic for IVF, and it is definitely more favorable than this, but even there, there are issues. I will be giving alternatives there, in that final post.

And as for me....I think I will have to end up getting donor sperm over from the US again, and doing a fresh IVF cycle if I want to try (at a much later point) for baby # 2. 

I just had to put all of this out there, so people going for surrogacy will not make the same uneducated, ill-informed choices that I did.

I also wanted to use my experience to say this: more of the money paid by the biological parents should go to a surrogate, with trusts being set up by the surrogacy agencies to distribute the money in installments (for example, educational trusts for her children).This is an important and constructive safeguard, because the husbands of such women may often use up all the money at one go, leaving these women destitute a short while later, forcing them to surrogacy again for another round. If you go for surrogacy in India, consider speaking to your agency and see if they can do this.

On jinxes and attachment parenting

Every time I praise or discuss my daughter (Oooh her cheeks are getting  nice and chubby, Yikes she drank 38 oz of formula today, etc.), I literally have everybody jump down my throat, because apparently, Indian culture dictates that if you praise your baby or discuss a specific aspect of his/her progress, you will JINX WHATEVER IS POSITIVE. Apparently, praise/focus from us moms is the most deadly thing for a baby. Meh. My response, as you could imagine, was always an eyeroll.

But then, I came here and boasted about how well she was getting over her vaccine, and wham. Day 3 post-vaccination, my mostly Jekyll-esque baby was replaced by Hyde. She was uncharacteristically fractious, and wanted to be comforted/held all day. Two days in a row. The third day (yesterday) she seemed mostly back to normal, but now I am a little more respectful of the jinx than before. The scientific side of me says that it may have been a delayed reaction to the rotavirus vaccine which is a live vaccine, and one of its side effects is irritability...it only surprises me that it was delayed by three bloody whole days. Did any of you experience this (irritability, delayed or otherwise) after the rotavirus vaccine? How long did it last?

The day after Gauri was born, in my bleary haze, I downloaded my first (and only, I think) parenting book: The Baby Book, by Dr. Sears. It basically lay mostly unopened in my phone for a while: I did read the chapter on attachment parenting and went Oh crap, she is in the NICU so I cannot bond with her, she has no knowledge of me since I did not carry her, and I can't breastfeed. Thankfully at that point I was too exhausted to add one more thing to the list of things I worried about, and I was confident that I'd be able to bond with her eventually, BF or not.

And indeed, even though I could not do many of those things, I still get to practice attachment parenting and I love the concept. Overall, I love how sensible that book is, though I have trouble believing that the "cry-it-out" style, if used in moderation, is deleterious. I love the fact that he tells you to parent how people have parented for millenia (including cosleeping, though you have to be uber careful/sensible in how you set things up), with no concept of a strict schedule for feeding or sleeping, no crying it out, and comforting your baby when they ask for it, no matter where he/she is on the "needs" spectrum. All of this seems sensible to me. Yet, I recognize and totally respect the fact parents the world over just do not have the bandwidth to parent like that, given the fact that there are only two (or only one) of them with jobs and limited help from others. Even if there are other people like grandparents, I've seen too many cases where interfamilial friction gets in the way. Fulltime attachment parenting in these circumstances would require herculean effort.

Gauri is low maintenance most of the while and plays by herself a lot, but occasionally requires extra cuddling and holding/attention. She mimics a "high needs" baby in that if you don't give her what she wants, she will open her mouth and make the concrete roof shake. Even her relatively limited requirements would have been difficult to fulfill had I been on my own in the States, exhausted from doing everything myself. In India, there is the concept of the joint family, where parents and grandparents and sometimes great grandparents live under the same roof. To be able to give her to multiple somebodies I trust is priceless. Living in a large family has multiple drawbacks and can lead to a lot of friction, but here is its one shiny, ginormous advantage. If your child is raised by the village, life is awesome  for everybody, most importantly the baby itself, and attachment parenting is possible. The situation now makes the past 1.5 years I spent in India with no life (no dating, an utterly staid social life, limited freedom, lots of nuisances) Totally.Worth.It.

As a side note, I was a little bummed that there was so little response by way of comments to my post on enhancing immune responses: parents, I request you to read and respond as to whether you do or do not do any of those things, and whether your pediatrician recommends any of those things, and if it has made any difference. I'm asking for this because I think an interactive dialogue would be useful.

Tales of my gourmet barracuda, and post up on the other blog

The American Association of Pediatrics apparently has cutesy nicknames for different types of  nursing/feeding behaviors: After extrapolating this to bottle feeding, my darling appears to be a "barracuda." She is currently wolfing around 38-40 oz a day! The "gourmet" title is earned because she still turns up her nose at the milk if it gets too cold. But yeah, mostly "barracuda." I'm so proud. And also afraid, because if we delay bringing that bottle to her by even 3 minutes, she opens her mouth to unleash the hounds of hell on us, and sobs so robustly that her breath catches. Then, when we frantically shove that nipple in her mouth...immediate, blessed silence. It is like flipping a magical mute switch.

Overall, two months in, she is doing wonderfully. No spit up, no colic, great growth, focusing and interacting beautifully, utterly sweet smiles of which I am increasingly a recipient, pooping like a breast-fed baby, and sleeping 7-8 hours a night! I kid you not on the last one. For a  painful 4-5 days, she had decided that between 1 am and 6 am was the time to stay up, demand cuddling, poop a couple of times, and drink about 12 ounces of milk spread out over 3 bottles. Sleep deprivation was me...there were nights I was afraid I would literally fall asleep on her. I figured she had day-night confusion, and decided to try to expose her to really bright sunlight during the day and do whatever we could in our very limited capacity to keep her from sleeping too much....it may have worked, or she may have simply "drifted" into a new pattern, because her "cluster feeding" shifted to the period between 9 pm-12 am, and when she goes to sleep after tanking up on about 12-13 ounces of my goat milk formula, she sleeps around 7-8 hours. This pattern has been in play for about ten days now, and I would totally commit murder to keep it from going away. It is really interesting that after consuming 10 oz of formula, she actually gets super excited and frantic while consuming that last bottle: the "tanking up" instinct definitely seems neurological. This cluster feeding occurs only once during the day; the rest of the time, she takes 5 ounces every 3-4 hours.

She also had the first of the "scary" vaccinations, getting the rotavirus drops and the DTP shot on the same day. Unfortunately, when we went in the acellular verison of the DTP vaccine (which is less efficacious but has fewer side effects) was out of stock and we had to get the whole cell version, which causes a more severe reaction, generally. Her response to that was a very mild fever and induration/redness at the site of injection and general crankiness, but thankfully, her appetite never suffered and she was as alert as ever after, so I heaved a giant sigh of relief, and she was entirely back to normal within 36 hours.  In about 30-45 days, we will go in for the Hib and the pneumococcus shots, or I may split those up. As I had first stated, I wanted to delay these shots till she was a little older (till about 3-4 months), but the guilt/pressure (external as well as internal), even when you want to delay vaccinations just a little is immense. Each vaccine decision is a war: I refused to get her the BCG shot at birth, and gave it only after she crossed the one month mark. Ditto the polio drops. In India, the oral polio vaccine is given at birth, and in very, very rare instances, can cause polio in itself. I hence refused the drops and got her the shot instead at 6 weeks. I had to have arguments with so many people, and also myself just to get these small but significant delays; blargh.

Finally, I have the a blogpost up on the the other blog. I had mentioned that there are some easy ways to ensure that your infant/child's immune system is at its fighting best, and I've addressed that in this first blogpost.

Updates

• I have finally started that other blog with my real name....bookmark it/follow it if you like the subject matter. I would also request you to share it (on Facebook and stuff) if you feel so inclined.  It is at http://decodingscience.wordpress.com The introductory post gives a pretty good overview of what the blog will be about. I eventually will move a lot of the science stuff from this blog there, once it gets a bit more search engine optimized. Next up will be a blogpost on  the benefits of a specific probiotic supplement in infants: I got really excited about it when I first found out about it, and I've been meaning to write this post forever, but I do not call myself the queen of all procrastinators for nothing. I will write it within the next week, I promise.

• I have also started detailing the first few weeks/months for Gauri to come find as she gets older, and have made it a sticky page. I'm still trying to decide the privacy level of this one.

• I have also updated the goat milk formula recipe post with a how-to on making the formula and some other tweaks/notes. Something interesting to share: I started adding 1/8th tsp homemade clarified butter (ghee) to 8 oz of formula to supply additional fats, and to my very pleasant surprise, it increased the frequency of her bowel movements from 1 per day to 2 per day (further investigation revealed that ghee IS used to treat constipation in adults). I know formula-fed babies have some serious issues with constipation, and I saw some of that when I was on Nestle Nan, but they have all gone away using this formula, and her pooping patterns now resemble that of a breast milk-fed baby. I feel pretty good about that.   

Will be updating this post and the sticky page with pictures soon. 

One month old!

It is going to be a little difficult composing blogposts now, because instead of one or two centralized topics to talk about, I have many little things to say, and I'm still struggling to find a format to fit that.

First up, I'm going to continue to talk about science, but in a new blog, using my real name. YAY! it is time to step out of the closet, so to speak. So exciting! The past 4 years, this blog was anonymous only because this journey was secret. Now that it is out in the open, I'm fighting the temptation to share this blog with people I know IRL. The only reason I'm holding back is because many of the posts on this blog are about personal struggles I would not want everybody reading.

But a blog only about science...that I would be happy sharing. First up on the new blog will be a post on probiotics and the ones out there that are a bit more useful. Next, I'm planning a writeup summarizing all the newest research on autism (there are some new rather exciting discoveries). Both these posts will require extensive research, and I need to get off my procrastinating ass to do that.

But.....coming to the nitty gritty of parenting:

• Gauri is an utter JOY to feed. In the breaks between sucking sessions, she looks so utterly pleased with life and makes lip-smacking noises and turns her head frantically to find that nipple. It makes you feel 10 feet tall.  I wish I had given my mom this very simple pleasure...I was a horrible, disinterested eater, to the point of it almost seeming like a neurological issue (in my defense, I was supposed to have been an excellent baby in all other ways though). But still, people still shudder when they describe their experiences in trying to feed me.
• She, on the other hand, is running through like 26 ounces in like 15 hours, which makes me wonder if there is an upper safe limit, and whether she is the one that gets to decide it. Anyway, she produces a lot of wet diapers a day and is gaining a little over an ounce a day, so I'm thinking I should leave this alone...right?
• Thumbs up for the goat milk formula: other than the fact that she loves the taste even when it has fish oil in it (our little highness does a taste test before graciously accepting it), the other great thing is convenience. I use an electric kettle to boil the water (best invention ever...why do formula websites still talk about boiling water on the stovetop?) and make up 28 oz at one go using a 16-oz pyrex measuring jar, which I split into multiple bottles (LOVE my Pura Kiki bottles; planning to write reviews about baby paraphernalia soon). I also love that I know exactly what is going in my baby's food, and can control it. Her constipation is less once we started the goat's milk; she also had really bad diaper rash in the first few days of life, and it is entirely gone now. I don't know what has fixed it (the diaper rash cream I use, the different brand of diapers, or the change in food). It is possible that the cow's milk contributed to the rash, and it was fixed by a change to goat's milk, but it is hard to say.She is a bit gassy once we started the goat'ls milk, and this could be because of the milk protein OR the lactose. Need to figure out what to do here. I can try changing the carbohydrate source.
• I've been trying to cloth diaper, but this kid really hates the feel of wet cloth (even the thick microfiber inserts) against her, and wakes up from sleep. The problem is she seems to pee every 30 minutes, and changing her while she is sleeping wakes her up. Are there CD inserts where the top stays dry like a disposable diaper? Right now, I'm using the Naty brand of disposable diapers, and they ROCK. It would take a really good CD to be as comfortable (for her) and user-friendly for me as this one.  
• Thank you Shannon, for your recommendation of The Piano Guys. She loves their songs (as do I!).
• This kid will be giving me grey hair very soon: As soon as she came home from the hospital,she was already using her feet to push off against people's torso's and thighs, depending on how we were positioning her. All these acrobatics are a little scary considering the fact that she can't support her neck. She is already trying hard to turn over too. at this rate, she is likely to be mobile a little ahead of schedule. I live in a house with really hard marble stairs, and it will be a year before the bones in her skull fuse....YIKES. If anybody has babyproofing ideas for the stairs (other than the gates), please let me know. Just FYI, Carpet in India would  be a really awful idea in the monsoons, where it rains so hard that the waterproofed concrete house starts to leak.
• Going to leave you all with a picture of the munchkin that has many many people wrapped around her little finger.
  

Parenting: the first days

I was tempted to title this post "Snot Factory," because that about sums up my general state for the past two weeks. I can't remember the last time I had the common cold, but I've had a relentless two weeks of symptoms now, and I'm beyond sick of it. At the height of things, where I was coughing every 10 mins, I stayed away from Gauri entirely. Since then, my symptoms have improved, but have not gone away fully.

Then my mom got sick, and we have two people (three including my father) coughing all over the place. A few days ago, it looked like Gauri had finally gotten this nasty infection, but thankfully, today, she seems to be mostly symptom-free, and her feeding (frantically knock on wood) has remained okay throughout.

I have a TON of help (an amazing (albeit slightly bossy) live-in nanny, a cousin who came and stayed a couple of days when everybody was sick, my parents, and my brother). The entire family is hands-on about taking care of her, which has literally saved my life. This is the amazing part of being here, and it is so lovely to see how much my family dotes on her. With my infection, I have not been able to fully bond the way I've wanted to with her, and sometimes, I literally elbowed out of the way by grandma and the grandpa and the uncle and even the nanny. Sigh....everybody wants their time with this little girl.

I went public on Facebook few days after the birth, and the response has been gratifyingly and very surprisingly overwhelmingly positive. It is quite amazing, but many really conservative family members have given me and my parents no grief and only offer congratulations and some even talk about how brave and intrepid I am, which just makes me blink in astonishment: I really did not see this coming, but I am so grateful (for my parents sake) that this response has been so positive.

As a technical note, I started the goat milk formula after ten days of being on Nestle Nan Pro 1 (which has soybean oil, yuck, I detest unfermented soy-based products). She tolerated the change very well, and her poop has become softer and the mild constipation she had on Nestle Nan has gone away.
From the formula I listed here, I increased the goat milk powder (to 1 tbsp per 8 oz), slightly decreased the lactose, halved the coconut oil, and threw out the blackstrap molasses as it appeared to be giving her too much iron (green poop the second day).  The only downside we could see with this formula is that she seems to get hungry a little more often, but her weight gain has been good (8.5 ounces/week). 

Understanding my infertility: four years in retrospect

When I had my first miscarriage and then my second in rapid succession, I had no idea what was going on, and I made truly valiant efforts to understand. I went off on a lot of tangents, and some of them (the Vitamin D deficiency, understanding the connection between Vitamin D and AMH, the thyroid autoantibody issue) yielded a lot of valuable information. There were some indicators that all of these (the vitamin D deficiency combined with the TPO antibodies, often seen in women with PCOS) may be indicative of a very low level of autoimmunity that may have interfered maybe oh-so-slightly with the progress of a pregnancy, but at the end of the day, I think these things were not my central problem.

There are two aspects to egg quality, both of which decline with maternal age. One is the state of the egg cytoplasm, which has all the mitochondria and the nutrients required to survive, divide, and thrive for the first 8 days of life by itself. The second is the chromosomes itself, and this is governed by the meiotic division process where your 46 chromosomes are divided into two sets of 23 chromosomes each. I talk about how one or both of these may be affected in the "Science of Infertility" section.

What was my problem? My cytoplasm quality was, by all accounts, really gosh darned good. It may be that I have an issue with the meiotic chromosomal division process, as a result of which a high number of my eggs are aneuploid, and I may have come into this problem (which is usually seen in women in their 40s) ten years or so too early. Compounding the problem may have been my "superfertility," which may have caused my rather stupid uterus to implant embryos that a "normal" person's uterus may have rejected. I have come to these conclusions based on the following statistics:

• My pregnancy rate was 75% (3 out of 4 unmedicated cycles), which is FAR higher than the figure (20%) reported in "normal" women. Two of my three embryos were shown to be aneuploid, and one of these aneuplodies was a Trisomy 4, which is extremely rare because embryos with a trisomy of this ginormous chromosome almost always fail to make it to the blastocyst stage, or after, fail to implant or grow. 
• Normally, the implantation rate for high-grade blastocysts is around 40-50% (i.e., 1 out of 2 blasts is likely to implant). The implantation rate for my high-grade blasts in women with "normal" fertility (the two surrogates) was far lower (1 out of 5 blasts, from 3 transfers).  

This suggests that most of my embryos were abnormal, and I kept implanting them anyway. This pregnancy may have come about because J's uterus could perform the selection that mine could not.

Had I not the "superfertility" issue, I may have just taken much longer to get pregnant, but may have stayed pregnant when I finally got knocked up. That would have been so much better, but as I gaze at my baby girl, I'm still fine with this version of events.

Now WHY I had the meiotic division problem is really the gzillion dollar question, that remains completely unknown. There appear to be no biomarkers or tests to indicate this. One has to wonder if the common problems seen in infertile women (The MTHFR mutation, the PAI variant, various autoantibodies) are biomarkers (indicators) for this issue, or are linked to it in some way, but nobody has ever looked at these particular questions, I think.

The other thing I wonder if there is a "cross talk" between my embryos and uterus that was messed up, and a developmental "brake" that malfunctioned in my embryos. Each time I ever got pregnant, it was an ovulation from my left ovary. The one time I failed to get pregnant was a right ovary ovulation, and honestly, I fail to see how that embryo could have been more messed up than the left ovary-derived Trisomy 4 embryo that implanted in my next attempt.

During IVF, I asked the embryologist to culture the eggs from my right and left ovaries separately, and the results were interesting. Normally, around 40% of fertilized eggs become blasts, and I saw this in my right ovary eggs. In contrast, over 70% of the fertilized eggs from my left ovary became blasts, which is far higher than normal. My daughter (feels SO amazing to say that), came from a right ovary egg. All this makes me wonder if the fault (for the messed up crosstalk between the uterus and the embryos) is a problem that is a problem specifically in the eggs of my left ovary. Of course, this last bit is wild speculation (even more so than the first bits, which are a lot more likely). 

There...the last 3 paragraphs will probably give everybody a headache, but I had to put down my thoughts for posterity. There is a part of me that wants to go back and do research on this issue, because I feel so passionately about it. I've actually been thinking about whether there are openings at RMA-NJ (because they are such a research-oriented fertility group).

Anyway...all is well that ends well, and I hope this recounting will be of use to somebody someday.

Gauri

She escaped the NICU on Monday (after spending 4 days in there), came to my hospital room on Monday, and we were discharged on Wednesday! We're home and are slowly settling in. The discharge day was especially rough...Hiranandani may be a nice hospital and the nursing staff is amazing and the doctors are pretty good, but they really don't pay any attention to infection control by keeping sick babies away from healthy babies: I was ordered to take her down from my nice clean hospital room to the OPD where we were surrounded by wailing children. I finally got to see the doctor, and when I was in the room with him, in came a baby with the viral flu! And all the doctor did down there was weigh her and pronounce her perfectly healthy.

The good news is that she is perfectly fine. The sucky bit is that I'm mildly ill, as is my father, but with different infections. I usually *never* fall ill, but given the stress of the first few days and the sleep deprivation (I also had horrible insomnia while being bone tired), I developed up a throat infection that has been slowly progressing. I was talking care of her while wearing a mask and suppressing my dry cough, but now that I'm bringing up phlegm every 15 mins, I've been barred from taking care of her.

She looks serene in the above shot (deleted), but this munchkin has a really mobile face...when she is awake she goes through a range of expressions that are amazingly comical. She smiles a lot in her sleep and while awake too...my favorite is the smile she gives just before she opens her mouth (like a shark) to attack that nipple.

I can't wait to get better, so I can be the one spending all day and night with her again, sans masks or worry.

Update

Sorry, this post is from my phone as well, so no pix. It kept telling me to download google plus, and I did, and it is still not working. Blaargh.

About my little miracle:At first, everbody thought that the respiratory issues stemmed from the c-section. However, soon after birth, it became increasingly apparent that Gauri had a infection, which, from the timeline, looks more like it was acquired in utero (the pediatrician says he sees this sometimes in babies born of surrogates--that is why he started antibiotics so very soon, which turned out to be the right call to make). It responded to antibiotics, and her respiration stabilized within 36 hours, letting them start feeding her.

She is now up to full feeds (she seems to be a good eater, knock on wood) and will be discharged to my hospital room tomorrow, where her antibiotics will have to be continued. Poor baby has been stuck with an iv in three different spots already, and I'm so sorry for that, and for the fact that she had this infection to start with.

Can't wait to get out of the hospital and go home! They are taking good care of us though, and NICU staff are awesome...I'm pretty impressed.

It is a girl!

Gauri was born yesterday evening: 5.5 pounds and a miracle all in all. Great apgars. J came through the c-section fine.

Will post about how things went down soon: she is doing well, but there are mild respiratory issues (mild to moderate transient tachapnea and maybe the beginnings of a lung infection) that are keeping her in the NICU.

The poor little thing has only saline so far: they will start feeds only when the respiratory rate stabilizes, and I'm praying that happens by tomorrow: she was started on antibiotics by the neonatologist within 12 hours of birth. The mildly high respiratory rate has not worsened, but it has not improved significantly either.

But she is beautiful, fiesty, alert, and fairly stoic about all the indignities we are subjecting her to.

Pics, more details, updates coming soon: this is posted from my phone.

To all my readers who have helped me cope and survive though this winding road to this beautiful destination, from the bottom of my heart, thank you.