Surrogacy after Colorectal Cancer 

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In May 2019, Joanna, age 31, was diagnosed with stage III rectal cancer. This diagnosis, alone, was devastating. What she did not understand at the time was that her journey to motherhood – one riddled with sadness and heartache, while also filled with beauty, growth, and appreciation – would take years to come to fruition and entail a lot of work on the part of many people, especially her best friend from kindergarten, Colleen.

In November 2023, four-and-half years after she heard three life-altering words, Joanna and her husband welcomed their son via their gestational surrogate, Colleen. Joanna shares her surrogacy journey to give others hope. She believes her story highlights how love, friendship, and support can turn dreams of motherhood into reality, even after a devastating colorectal cancer diagnosis and treatment.  

Q: Had you discussed surrogacy as an option with your health care team? What guidance did they provide? 

A: Prior to the start of treatment, my team advised me that radiation would remove the possibility for future pregnancies, due to irreversible damage to my female reproductive organs. I was stunned when I heard this news. I was wholly ill-prepared to hear that I had only two options to motherhood – surrogacy or adoption – and that neither involved my body bringing life into this world. At that time, I knew nothing about surrogacy, and I did not know any success stories. It felt like a far-off possibility and yet another huge hurdle to overcome.

My oncology team initially advised against IVF (in vitro fertilization) because my cancer seemed too advanced to delay treatment. They wanted to focus on my present need for lifesaving treatment, not future family planning. I understood their position. Their job was to cure my body, while eliminating the possibility of stage IV cancer.

After many discussions, however, my health care team gave me their blessing, granting us three weeks to start and finish IVF before radiation started. I must admit, I had no idea if three weeks was enough time because I had no idea what the IVF process entailed. I knew that I wanted the opportunity to have a biological child, so I understood that my husband and I needed to move fast, quickly educate ourselves, and hope that the right people came into our lives to make this dream happen. Insert Dr. Moe. She understood the assignment as we presented to her office for an emergency egg retrieval. We had one shot. 

Everything moved at lightning-fast speed. While preparing for radiation, I simultaneously started medication (pills, shots) for the egg retrieval, which took place a little over a week after starting medication. Although we understood that the egg retrieval had been successful prior to radiation, we had five days to wait for confirmation that the fertilization process resulted in viable embryos. Three days after my egg retrieval, I started radiation. I prepared myself for the worst while praying that Dr. Moe would call with news of multiple, genetically normal embryos. And she did.

Q: How did you reach the decision for surrogacy? 

A: Although we had a successful IVF journey, my husband and I considered adoption as a family-building option. We ultimately decided that we wanted to have a biological child, which led us to pursue surrogacy.

Q: What were the specific concerns or challenges related to colorectal cancer and its treatments that led you to the surrogacy process?

A: People often ask me why I can’t carry. Because of the likely effects of radiation on my uterus, my radiation oncology team advised against any future pregnancies. It would be my decision ultimately, but they were adamant that what my body had gone through likely impaired my ability to carry a pregnancy to full-term.

Sadly, my team had counseled female patients with colorectal cancer, who ignored their advice and had failed pregnancies due to radiation-related effects on their uterus. I wanted to carry – and still wish I could – but the pain of losing a baby, when I know there exists a high likelihood that I could miscarry, is not a risk I am willing to take.

Q: How did you choose or find your surrogate?   

A: I know God opened the door to surrogacy once I was ready, and I think “ready” looks different for everyone. There are a lot of unknowns with surrogacy and pregnancy, in general. For me, feeling ready meant that I started to make meaningful progress to accepting my cancer, the uncertainty that existed with my health, my path to motherhood, and the fact that my body cannot bring life fully into existence.

Colleen enjoys being pregnant and had a desire to be a surrogate for a long time. When she finished building her own family, she asked me if she could carry for us. She felt God calling her to bring life into this world for us. In August 2022, my husband and I finally felt ready to start our surrogacy journey with Colleen and her family.

Q: What are the steps to take for surrogacy?

A: There are two avenues you can take when starting a surrogacy journey. You can work directly with a surrogacy agency or proceed independently. A surrogacy agency has a pool of surrogates who are “cleared” and ready to match with intended parents. What I mean by “cleared” is that agencies have a pool of women who have been deemed medically and physically fit to carry, while also receiving approval that they are mentally and emotionally equipped to handle a surrogate pregnancy. An agency will provide candidate profiles to intended parents, which provide a very in-depth look at the candidate, her family, and her life in general, as well as compensation and whether the surrogate holds surrogate-friendly health insurance (that the woman’s insurance policy covers a surrogate pregnancy without exceptions).

You can expect an agency to present high-quality surrogates, while also providing administrative assistance through the entirety of the pregnancy. Surrogacy agencies charge fees, which typically range, depending on the agency, from $10,000 to $50,000.

Alternatively, an independent journey means that intended parents know the surrogate, so there is no need for a match. Once a known surrogate is identified, the potential surrogate must receive clearance to carry. For Colleen, our clearance process included a detailed medical review, countless blood draws and numerous ultrasounds, three psychological evaluations, and an insurance review to confirm Colleen had surrogate-friendly insurance. An independent journey removes the surrogacy agency fee, often making this option more affordable, although it tends to take longer.

Q: Would you recommend surrogacy? Why or why not?   

A: Yes, absolutely. Lately many news media outlets are highlighting infertility awareness and surrogacy, as they spotlight many celebrities that have chosen this option. For a lot of people, they see this process as exclusionary, and they are not wrong. The financial costs are often too large a barrier. With that said, there are instances of altruist surrogacy, where a friend or family member carries. However, the process is not free because there exists high expense for medical and legal, among others. In addition, I would suggest people explore surrogacy grants and organizations that offer funding (see below) to make surrogacy less financially burdensome.

Q. How has your support network, including family and friends, responded to the idea of surrogacy? 

A: Our support network rallied behind us the minute cancer entered our life. Seeing us prepare for parenthood and then welcoming our little one into this world in November has been a special journey for our family and friends, especially those who have known Collen and I since kindergarten.

It has been, and continues to be, a beautiful time in our lives. The phrase, “it takes a village,” has a whole new meaning to us these days.

Q. What emotional and logistical support did you need during the surrogacy process?  

A. Honestly, surrogacy felt very lonely at times. I was the first person in my family and friendship group to go through surrogacy. It is difficult when you picture your life a certain way and then you are forced to pivot down a path that looks wildly different than you envisioned. I pivoted, but I frequently felt alone.

I really leaned on therapy as a space to mourn this loss and to be unapologetically real, raw, and honest. When I did this, my immense pain started to turn toward acceptance, which was especially helpful once Colleen was pregnant. I so often feared that I would not connect with our son, because I missed out on the first nine months of his life in utero. A lot of women feel this way, even if they do carry their children. As I started to care for my son, this fear dissipated as our connection inevitably grew.

Q: Are there any comments, questions, or hesitations that you had about the surrogacy process that you'd like to share? 

A: Surrogacy requires a football team of people to have a child. It can be really exhausting at times when countless people – fertility doctors, lawyers, embryologists, insurance reviewers – are closely involved in a pregnancy journey that is supposed to be a very intimate process between two people.

I was surprised to learn that more spaces are needed for intended moms and parents to talk about the process, grieve their loss of a traditional path to parenthood, and receive support from those with a common story. More conversation is needed about surrogacy and the emotional pains that many intended parents experience when faced with a nontraditional path to parenthood.

Q: How does your cancer journey play into your surrogacy journey?

A: I know that both journeys have stretched me in unimaginable ways. I felt every feeling during treatment and often experienced inconsolable emotion right before my chemotherapy drip started.

The thought of having a family one day was often the only way I could pull myself together and keep moving forward, especially when giving up seemed really easy at times. As I look at my son, growing and laughing and experiencing the world for the first time, I am beyond proud of myself for continuing to move forward when the road ahead looked really dark and frightening.

Q: How did it feel holding your son for the first time? 

A: Holding my son for the first time is one of the most emotional things I have ever experienced. I could not – and still cannot – believe he is here. All the heartache, longing, and sadness about my journey to motherhood washed away when Colleen delivered him: We heard him cry for the first time, and I held him in my arms.

He is a true miracle.

Q: What are your hopes and dreams for the future? 

A: As my five-year cancer anniversary approaches, I hope to be cancer-free moving forward. I want to watch my son grow into a wonderful human, and I hope to continue expanding our family in the future.

Q: Are there resources available to families looking into surrogacy post-cancer?  

A: There are several programs and resources available for intended parents. Please note that some programs, such as the Expect Miracles Foundation SAMFund Family Building Grant, have a brief window for application submission.  

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