How Surrogacy and Egg Donation Agency Owners Fail: 8 Tips to Avoid Isolating Yourself

What does this ‘isolating yourself’ possibly mean? We have the Internet and phone(s) what else is there? Believe me I get this reaction all the time when I‘m consulting would-be surrogacy and egg donation agency owners. It’s understandable that the Internet, which reaches almost every corner of our world, seems to be more than enough to run a business especially coupled with our cell phone! Not so my friends. In the world of surrogacy and donation being a one man alone show will not work. Soon you will find yourself lost in the ever shifting field of infertility, uneducated and uninformed. (Behind the times!) 

I am not saying that you can’t run an agency by yourself. That is being done at this very moment by several reputable agencies a crossed the USA. What I am saying is that you need to connect with other agency owners, physicians, clinical staff, reproductive attorneys and mental health professionals. Being an island all unto yourself will not work in the long run. 

I know that getting out of your home office is may cost you money and time. Visit clinics? Talk with attorneys? Attend a conference? Why do you need to do that when you can use the phone and internet? The answer is because people tend to trust those whom they meet in person and I don’t mean just once but over and over. It’s human nature. Plus the things you pick up about others when you meet THEM in person is invaluable!

Here are 8 tips to get you out of the isolation rut:

1) Making a few clinic/office visits a couple of times a year in your area will really help your business grow. (You don’t need to bring lunch…brochures and cards are just fine…cookies are good too!)

2) Attending a conference, seminar or workshop at least twice a year and networking while there (My suggestions: START ART, SEEDS and ASRM)

3) Meet with your clients, donors and surrogates in person whenever possible

4) Meet with hospital staff whenever there is a birth local to you

5) Bring brochures and business cards with you to your own personal appointments

6) Practice your ‘elevator speech’ for the next time someone asks you “What do YOU do?” Get use to talking about YOU!

7) Join a business group like the Rotary Club or Ladies Who Launch, (I belong to STARS: Seattle Tacoma Area Reproductive Society, which is local to me) and attend meetings frequently (Even though some of these clubs are not within the infertility field you can network with other business owners and pick up some general marketing tips and make unexpected connections)

8) Join online listservs, Linked IN and Facebook groups and then attend the face to face get together 

You will find that once people see you out and about and connect with your charming personality your network and contacts will continue to grow. Someone who can’t help their client out might just send them to you. Others may want to work with you on a project or invite you to join a board. The more involved you become the more exposure you will get. Trust me…it’s all good! 

How Surrogacy and Egg Donation Agency Owners Fail: Unethical Behaviors

If you go down the wrong path you will lose clients, your reputation, your staff and finally your business. If that’s not stating the obvious then I don’t know what is! But lets remember that I am talking about Surrogacy/ Egg donation Agency owners/staff who are dealing with clients who come to them already vulnerable and needing a guiding hand through this family building process. Add to that hopeful women who are excited to help your clients become the parents they have always dreamed of being. The temptation to engage in behaviors listed below can be quite strong. But you must RESIST!

What does unethical behavior look like? Below is a snap shot:

*Anything illegal (This is a no brainer but it has to be on the list and I believe we can think of a recent case or two of baby selling/human trafficking....)

*My personal current pet peeve, using state or federal insurance for a surrogate pregnancy (this is illegal in some states and a huge gray area in others and it seems that most people do not want their tax dollars going toward a surrogacy pregnancy)

*Misleading Intended Parents (“Yes, we have several surrogates waiting to be matched” when you really have 2 and you have 5 IP’s in line)

*Misleading donors and surrogates about how many recipients or IP’s are waiting to be matched

*Misleading donors or surrogates about how long the wait may be to be matched and how long it will be before they get any sort of payment

*Telling donors that the agency have bought insurance for them when really they have not

*Misinforming surrogates or donors about the potential risks or procedures (Shots anyone? Bloating? Weight gain? No sex? Hmmmm)

*Telling Intended Parents that the surrogate has maternity insurance when the reality is there is a surrogacy exclusion on her policy and you are just praying that no one finds out

*”Fixing up” donor profiles by removing family history of cancer, alcoholism, drug abuse, higher IQ, etc. (No one will know! It’s ‘anonymous’ right?)

*Padding the bill

*Holding escrow when you are not licensed or bonded to do so

*Encouraging a surrogate to waive the right to an attorney in order "to save" the IP's money

*Telling Surrogate that selective reduction seldom happens and so just agree to it and other demands that IPs may want her to do

*Not contacting the donor with an IPs further questions…instead just guess at the answer

I could go on. I don’t want to you to think I am totally innocent from all of the above! I held escrow…once! Back in 2003 and it just turned out to be a bigger pain then it was worth. We quickly found a local attorney to hold all of our escrows for us. (Instant relief!) I, myself, have waived the right to an attorney for my second surrogacy (2004-2005)…shame on me because I could have really used some advice about half way through…but that’s called the classroom of life. The other issues that are listed are being done by someone, somewhere, right now. Maybe just one or two unethical practices but still…more then one "someone’s" as a matter of fact. And most are changing their ways…it’s hard to change when you want your business to flourish but if you continue along this unethical path you soon will have zero clients to worry about!

How Surrogacy and Egg Donation Agency Owners Fail: Lack of Continuing Education

There is no School of Surrogacy and Egg Donation. (or of any donation for that matter) There are no ‘how to run an agency’ classes out there, unless you hire LaMothe Services, LLC, but that is beside the point. You won’t find any courses offered at your local University or Community College on how to start an agency, run a donation program or serve your Intended Parents. We are just not that mainstreamed yet…sorry to say it. So when I talk about continuing your education I am talking about reaching out, taking the initiative and attending seminars and conferences that will allow you to become more knowledgeable in your field. The field of Third Party Family Building.


A great example is START ART which is an annual REI Nursing Congress. START ART stands for Scientific & Therapeutic Approaches to Assisted Reproductive Technology. (Every August) I found this great seminar about 15 years ago (when it was called SMART ART). It offers CNE’s (Continuing Nursing Education Certification.) Although I don’t need the nursing credits I know that this is a great learning experience for me and my peers.  The networking opportunities are wonderful as well! This is a two and a half day seminar in Las Vegas. Is it worth the time and money! Yes! Do *I* come back to my office with useful information and energized by those I interacted with? Again, Yes! Am I getting paid to promote START ART? NO! But you should attend next year! (I will announce it on my blog. Subscribe so you won’t miss it!)

Another not to be missed conference is the American Society of Reproductive Medicine’s annual meeting in October this year. The ASRM holds an annual meeting every year and as an agency owner you should already be a member. The program is jam-packed with useful sessions and this year it’s being held in Salt Lake City October 15-19th. Because thousands of people from all over the world attend, this is a great learning and networking opportunity! (again, I am not being paid to promote the ASRM annual meeting however I will be attending as usual.)

               

Personally I tend to lean toward the mental health portion of this meeting. I also belong to the Mental Health Professional Group and will be attending their usual Saturday evening welcoming dinner. (Again, meeting people in person where, for most of the year, we might only interact via the Internet). I don’t want to forget to mention Postgraduate Courses on both Saturday and Sunday before the conference.In 2011 I was a part of the faculty focusing on The Psychology and Ethics of Marketing a Mental Health Practice in Infertility with the chair being William Petock, Ph.D. and Jeffery Barnett, Psy.D. It was a very rewarding undertaking!

Another, newer conference is also available via The Society for Ethics for Egg Donation and Surrogacy (SEEDS). This is a nonprofit group created for all U.S. agencies to have a voice in defining a set of ethical standards for egg donation and surrogacy programs. The registration is now open February 26 and 27, 2016 in Long Beach CA. CEs for professionals. Debate, controversy, esteemed speakers, discussion, networking, professional development, shmoozing, fun, food, and more. Go to seedsethics.org, then click on EVENTS to register.

Ok…so is your business going to FAIL if you don’t attend these (or other) conferences? No…you can get by without traveling a half a continent away. Learning about what’s happening in the legal arena, the clinics, and in the ART world of mental health is always educational. But attending these and other seminars and workshops will reassure your clients that you invest in yourself and your agency and are knowledgeable about what is going on ‘out there’ in the field of Infertility today! (Plus you get out of the office! See the world! And meet new people! A win-win situation!)

How Surrogacy and Egg Donation Agency Owners Fail: Sticking to the No Refund Policy

I know how this sounds…refunding money is never something you want to do but there are times when you have to even if it states quite clearly in your agency retainer agreement that there are NO REFUNDS. We had a no refund clause in our retainer agreement when my partner and I owned Surrogacy Consultants of Florida. However we found out quickly that our policy could not be set in stone.

Before I talk about refunds here I want to make a mention about your income. Intended Parents pay your bills. You are counting on their money to run your program all in the name of helping them reach their dream of parenthood. This is a good and needed service. However, if you mismanage your money, your income, it will come back to haunt you. I work with both large and small agencies and I have found that some live ‘hand to mouth’. Not a good idea. What I am about to suggest maybe hard for some especially if you are counting on living on the income that your agency is providing you. Do not spend any retainer money that comes through your office until your IP’s are matched with their donor or surrogate AND their contracts are signed. Not one penny. Bank it. This money may need to be refunded and if you spend it then where will you be?

Here is my refund ‘what if’ list:

*What if the surrogate/donor doesn’t want to work with the IPs that chose them? (and the IP’s don’t see any others they want and would like a refund)

*What if the surrogate/donor doesn’t pass the medical evaluation? (and the IP’s don’t see any others they want and would like a refund)

*What if the clinic rejects the donor or surrogate for failure to follow medical protocol or other reasons? (and the IP’s don’t see any others they want, don’t trust your pool of GS or Donors any longer and would like a refund)

*What if the Intended Parents have a medical or financial issue of their own and need to back out of your program? (After just a few weeks and they are not matched so they would like a refund)

*What if you find out the IP’s are delusional and YOU want to give them a refund after a few weeks of trying to please them and you see that it’s an impossible mission!?

*What if the donor/surrogate is not mentally able to perform their commitment and back out before contracts are signed? (and the IP’s don’t see any others they want and would like a refund)

There are quite a few scenarios but you get the picture. A refund maybe in order. If you can’t rematch, have a difficult client, someone is threatening to sue unless you do refund, or the surrogate/donor has been disqualified, someone may be asking for some sort of refund. (full or partial) If you don’t have any money in your account then this is the place where your reputation is put on the line. I can assure you that your clients will go on message boards to complain about you and your services, they will call their RE and attorney and they may even bring you to small claims court. Having their retainer money on hand could resolve a lot of problems.

If you manage your income and have a ‘cushion’ in your account equal to at least 3 retainer payments you will rest easier. Remember refunding is a hallmark of great customer service and if you have truly done all you can to make your client happy and a refund is the last resort then just give them the money! You will learn from this encounter and find that refunds are few and far between but less painful when you have the money set aside ‘just in case”.

How Surrogacy and Egg Donation Agency Owners Fail: Poor Customer Service

You give them everything and they still want more! Well…that’s the attitude that will put you strait on the road to failure, especially in the surrogacy and donor agency business! Clients are paying out of pocket for your specialized services and they expect the best once they commit!

One thing that you need to do first and foremost is charge a fair amount for your services. If you are not getting paid enough to cover your expenses and your payroll then you will end up cutting corners. Corners that your clients WILL notice! I realize that there is a lot of competition out there (more in some states then in others) however charging far below the minimum of your closest competitor is not the way to go. My suggestion is to first figure out how much your competitors are charging and for what services. Next look at what you are offering and your overhead costs. Remember that it takes time to build a great reputation and a lot of hard work before an agency starts to make a real profit. Quick example: In the case of the effort spent on behalf of the surrogacy agency, it may take 3 IVF cycles and 2 surrogates for some IPs to reach the goal of having a baby. This could take 2 years of your agency’s time and commitment.

What is great customer service? You don’t have to look far to find out the answer…you only need to ask yourself what you would expect if you were in the same shoes as your clients. I know I may be preaching to the choir here because quite a few agencies are owned by past Intended Parents, Donors or Surrogates. Below is my short list for exceptional customer service:

*Phone calls or messages answered or returned promptly

*Clear communication

*Easy Accessibility to you or your staff (24 hour hot line available to clients who have retained your services)

*Taking responsibility for problems that may arise with you or your staff

*Going above and beyond when necessary

*Don’t avoid ‘difficult’ clients

*Never let more than 2 weeks go by without a phone call or e-mail to all parties involved (especially when things are going well)

*Refund when warranted (Read the post on Refunding)

*Offering up-to-date educational information to all clients. This means attending conferences and workshops within the infertility field so that YOU are educated and well informed!

So what if one or two of these little points are not on Your list? That doesn’t matter…because these items ARE on your potential client’s list along with many others. As I stated above, all you need to do is ask yourself how you would like to be treated, how you would feel "IF" and go from there. The way to build a great reputation is to offer the very best of you all in the name of customer service!

How Surrogacy and Egg Donation Agency Owners Fail: Lack of Communication

It doesn’t matter how large of a business you own, if there is little or lack of communication either between you and your employees or between staff and clients you will fail unless this problem is corrected. In the field of surrogacy and egg/sperm donation there really is a lot of room for miscommunication.

First is the non-verbal cues that are given when your telephone is not answered during business hours or messages are not returned within a reasonable amount of time. What this says about your business is that you have no interest in who is calling or why or that you are too busy to take or return the call. This leaves potential clients, donors or surrogates wondering about the quality of services provided by you and your staff. (If they ever do hire you. This is where you might lose a great GS or IP.)

A second common problem with miscommunication is when a client has been given different information by different people in your office. This can happen when staff has not been updated regarding new or existing donors or available surrogates, when the client is quoted different pricing for services, or regarding case management and program protocol.

Speaking of available donors or surrogates, remember to keep your data base updated. When you have unavailable profiles listed in your data base it sends the signal that you are misinforming the public and are sharing more donor or surrogate profiles then you really have available. It also raises hopes if someone is really interested in a profile only to find that the candidate is not available. Always remove a profile once she is talking with other IP’s. If it doesn’t work out you can simply return the profile to your data base. Adding available profiles as soon as you can is a great indication that you have full control of your data base and know exactly who is on there plus all the details.

My third point is continued communication throughout the donation/surrogacy process. Often times once the match is made and the surrogate becomes pregnant, agency owners assume all is well and may not contact the IPs, donor, or surrogate for weeks or maybe even months. If you are advertising ‘full service agency’ that should include checking in on all parties and making sure that procedures have gone smoothly, if the relationship is going well amongst all parties and if anything extra is needed, In the case of the donation it is important to make sure the donor has recovered from her procedure and it’s always nice to see if a pregnancy resulted.

My forth and final point is the communication with other professionals in your field. I am taking about the clinic and nursing staff, attorneys involved, escrow agency and the mental health professional. It is so important that every one know exactly what is going on with your clients. Even if you are not the one directly communicating with these other professionals it is a good idea to remind your clients to make contact at certain points of a match. For instance the attorney should know when the birth is expected to take place and whether it is a singleton or multiples so the proper paperwork will be ready, it’s also a good idea to remind a surrogate to make arrangements for a hospital tour with her IPs, you should tell the clinic if a miscarriage takes place or a twin is lost and the mental health professional might like to know how the match is going and if there is a need for follow up.

Failure to communicate with all parties involved such as your agency staff, clients, and other professionals can give you and your agency a poor reputation. These are all issues can be worked on and eventually fixed. Your future as an agency owner depends on great communication!

Happy New Year from LaMothe Services

Wishing you a very happy and prosperous 2016! 

Wishing One and All a Very Happy Holiday Season! From LaMothe Services

“What am I looking for when I talk with a potential egg donor?” by Andrea Bryman, LMFT

It has taken many years to create the niche I have in my profession, a mental health therapist specializing in egg donation and surrogacy.  I have learned that people are not gray on the subject of third party reproduction.  They have strong opinions.  Once all the opinions have been aired (this can take awhile), one of the first things I am asked is “What am I looking for when I talk with a potential egg donor?”

I thought I would start this initial blog by discussing four of the main
areas that I emphasize in my evaluation of an egg donor: her family mental
health history, her stability, her desire to be a donor, and her ability to
make an informed decision to be a donor.  

In exploring a donor’s family mental health history it is important to gather information regarding any potential psychiatric diagnoses.  Some diagnoses are linked to genetic predispositions that can be passed onto a child.  If there is a diagnosis, i.e., depression -it is important to determine whether it was triggered by an event, which would be considered situational or whether it is an organic disorder.  I also discuss family history of alcohol or substance abuse.  There is potential for a genetic predisposition to alcoholism that both the recipients and donors should be aware of.  Finally, I explore any emotional, physical or sexual abuse the donor may have experienced and if they have received any professional help.  A donor who has experienced some abuse without seeking help may find the
donation process can trigger unresolved issues related to the abuse.  Above all else, my hope is for the donor to have a positive experience. 

One of the major concerns for many intended parents is whether a donor will be stable enough to follow through with all that she needs to do throughout her cycle.  There is a vast amount of information to digest, forms to be filled out, appointments to attend
and medications to be administered.  A donor will need a lot of support throughout the process.  There are many aspects in exploring a donor’s stability – her living situation, her career, her upbringing and current relationship with her parents and siblings, her social network, her personal relationships and any possible legal issues she may have experienced. It is important that a donor be able to form and sustain healthy relationships as well as manage conflict resolution.   More importantly, you want to be sure that she will to do what she is supposed to do! 

What is the donor’s motivation to donate?  Why would she want to inject herself with medications and undergo medical evaluations and procedures?
While initially enticed by the monetary compensation, most donors after
learning more about the process have an altruistic yearning to want to help
others while helping themselves.  In determining a donor’s desire to help others, it is significant to understand how she learned about the process, why she wants to donate, if she has told others about her desire to donate, what she plans to do with the money she receives from the donation and how she feels about the future contact and
disposition of her eggs and the embryos they create. 

Lastly, after determining a donor’s mental well-being, her
stability and her motivation, it is very important to determine if the donor is
cognitively mature enough to make an informed decision to be a donor.  I gather this information by exploring the donor’s educational background and her self-perception.  This information determines if she knowledgeable enough to have the ability to educate herself about the egg donation process and understand the potential medical and psychological issues that may arise.  Is she able to seek out information and ask questions or does she passively take the information given to her?  Often I encourage donors to talk with other who have donated before to get peer guidance in addition to professional guidance.  The bottom line on informed consent is “Does the donor really understand what she is agreeing
to?” 

To say “Choosing an egg donor is a difficult process” is an understatement.  It is important to realize that many donors have just as many questions about the intended parents as the intended parents have of the donors.  We interpret data and evaluate
information to ensure suitability.  We educate others and ourselves.  We hope
that all parties are being truthful and forthright.  

Andrea Bryman is a licensed Marriage and Family Therapist with a specialty in assisted
reproduction, which includes mental health assessments and evaluation of egg
donors and surrogates. Andrea’s focus on assisted reproduction stemmed from her own personal experience with infertility over 15 years ago when she was beginning her family. Since that time, Andrea has had three children, two with methods of assisted reproduction. She continues her professional growth in the field of infertility through research and involvement as a professional member of the American Society for Reproductive Medicine including their mental health professional group, the American Fertility Association, European Society of Human Reproduction and Embryology and Resolve. Andrea is the Past Psychological Chairperson on the board of directors for the Egg Donation and Surrogacy Professional Association.  

Frequently Asked Questions About Washington State Surrogacy Laws: Guest Post By Christina Park, Esquire

Christina Park is a reproductive attorney and founder of the Law Offices of Christina Park in Seattle. She graduated from Yale Law School. Christina assists intended parents, egg donors, embryo donors, and surrogates and is proud to help build families. 

We are considering surrogacy. What legal issues in WA state should we be aware of? 

It is highly recommended that the intended parent(s) and the surrogate enter into a written surrogacy agreement. This is true even if the surrogate is a friend or relative. 

Surrogacy agreements describe the terms of the arrangement in detail, outline each person’s rights and responsibilities, and document your wishes for who will be the child’s legal parents (with parental rights and duties under the law). 

Surrogacy laws are relatively new and untested. It is difficult to predict the outcome of court cases in this area of law. If disagreements do arise, Washington courts will likely examine the written agreement to understand your intentions and resolve disputes. 

It is important to document the terms of the surrogacy arrangement in your contract. This can provide you with additional confidence and security (both during and after the pregnancy). A qualified reproductive attorney can help you prepare the contract. 

What issues will the legal agreement cover? 

By addressing key issues and potentially sensitive topics, the legal agreement can help set clear expectations from the start and prevent disputes in the future. Surrogacy agreements address several issues, including the following: 

Parents: Who will be the child’s legal parents, with parental rights and responsibilities? 

Payment:What will the surrogate be paid? (In Washington, surrogates can only be reimbursed for pregnancy expenses, actual medical expenses, and attorney fees). 

Involvement:How will the intended parents be involved (for example, with important decisions related to prenatal care and testing)? 

Unexpected Events: What happens if one or both of the intended parents die before the birth? Who will have custody of the child? 

Future Contact:Will there be future contact between the surrogate and intended parents? If so, under what circumstances? 

Can we pay a woman to be our surrogate?

In Washington, you cannot compensate a surrogate. Washington courts will not uphold an agreement to compensate a surrogate; it would be considered a gross misdemeanor. However, you can reimburse the surrogate for her pregnancy expenses, actual medical expenses, and reasonable attorney fees for drafting the surrogacy contract. 

We’re a married same-sex couple, and our child will be born to a surrogate. Do we need to adopt? 

Under Washington law, both spouses in a marriage (including same-sex marriages) are presumed to be the legal parents of a child born during the marriage. However, other states may not recognize this parentage for same-sex spouses. 

If one spouse is not genetically related to the child, you should consider an adoption to establish and confirm parental rights. An adoption proceeding can provide additional peace of mind and help ensure that both parents receive full parental rights, even if they move outside of Washington State in the future. 

I’m single, and my child will be born to a surrogate. Do I need to adopt? 

If you are single and not genetically related to the child (your eggs or sperm were not used to conceive the child), you should consider an adoption or parentage proceeding to confirm your status as the child’s sole parent. 

If your eggs or sperm were used to conceive the child, you may still want to consider a parentage proceeding to establish that the surrogate is not the legal parent. This also protects the surrogate from having financial obligations to support the child. 

Do the surrogate and intended parents need separate attorneys? 

It is highly recommended that the intended parents and the surrogate be represented by separate attorneys. This makes it much more likely that the surrogacy contract will be seen as legally valid, if you ever wind up in court. It is in the best interests of everyone involved to hire separate attorneys for the intended parents and surrogate. Typically, the intended parents pay all attorney fees (including fees for the surrogate’s attorney).

What happens after I hire an attorney? 

The intended parents’ attorney will collect the necessary information and prepare the first draft of the surrogacy agreement. The surrogate’s attorney will review the draft agreement and may request changes. 

You will have the opportunity to read and review the legal agreement. You can discuss questions and concerns with your attorney, or suggest revisions to the agreement. 

Typically, meetings with your attorney may take place either in-person or by phone.

The entire process can take 1 to 4 weeks, depending on how quickly the agreements are read and approved by the surrogate, intended parents, and their respective attorneys.

Disclaimer:  The information provided here is for educational purposes only. The information is general in nature and may not apply to your specific situation. Before taking further action, you should consult a qualified attorney in your state.