The Pacific Fertility Center on Los Angeles’ Wilshire Boulevard is the place where the people who have it all make their babies. With its crystal chandeliers and plush velvet and leather upholstery in shades of cream and mink, you’d be forgiven for thinking the waiting room was the changing room of a high-end bridal shop. But the pictures on the flatscreen on the wall give it away: digital photos of newborns in scratch mittens, thank you notes, family Christmas cards, tiny heads cradled in grateful hands. The images float upwards and disappear like bubbles in champagne.
In the 25 years Dr Vicken Sahakian has been practising, he has made families for thousands of the most privileged people in the world. He has worked with Hollywood stars, although he says he is too discreet to tell me names. (“You won’t hear it from me, but of course you would have heard of them.”) His clients are straight, gay, young and old, and they come to him from across the globe, particularly from China, or parts of Europe where surrogacy is either illegal or very tightly regulated. In the UK, surrogacy is legal, but surrogates can claim only expenses for carrying a child for another person. California law allows surrogates to earn a profit, and upholds the rights of intended parents over anyone else who is involved in the creation of their babies. It’s given the state a reputation as the most surrogacy-friendly place in the world.
As diverse as they are, Sahakian’s clients have one thing in common: their ability to afford his services. If you are open to using other people’s eggs, sperm or uteruses and are prepared to pay, anything is possible. “Money talks. If you have money, you’re going to have a baby. It’s sad, but it is the case,” Sahakian tells me less than five minutes after I sit down in his monochrome office. He wears grey surgical scrubs embroidered with his name, his hair slicked back and greying at the temples. On his huge, black desk sits a glass paperweight containing a laser-engraved baby, next to a plastic uterus and fallopian tubes. But immediately after saying this, he checks himself. “It isn’t sad, actually – it’s pretty happy. I believe in this type of science. I believe in family balancing, gender selection, selecting out abnormal embryos, using egg donors, sperm donors, this is what I do. I love what I do. The ultimate goal here is bringing happiness for someone.”
And as the range of fertility options open to clients has diversified, so have their requests. Now, a growing number of women are coming to Sahakian for “social” surrogacy: they want to have babies that are biologically their own, but don’t want to carry them. There is no medical reason for them to use a surrogate; they just choose not to be pregnant, so they conceive babies through IVF and then hire another woman to gestate and give birth to their baby. It is the ultimate in outsourced labour.
Does he have any ethical concerns about social surrogacy? “I don’t have issues with it,” Sahakian says, smiling. “If you’re a 28-year-old model or an actor and you get pregnant, you’re going to lose your job – you will. If you want to use a surrogate, I’ll help you.”
Five years ago, Sahakian says he would preside over a handful of social surrogacy cases a year; now he sees at least 20. “More and more every year. And if I’m seeing that, there are so many reproductive endocrinologists in the area who are very competent fertility specialists – I’m sure they are seeing the same.” It costs $150,000 to have a baby this way. “If social surrogacy was more affordable, more women would be doing it, absolutely. There’s an advantage to being pregnant, the bonding, I understand that, and from experience I can say that most women love to be pregnant. But a lot of women don’t want to be pregnant and lose a year of their careers.”
The women looking for social surrogacy tend not to be the biggest celebrities, he says. Hollywood stars have the leverage to call the shots when it comes to schedules, and can have more confidence that their careers will be waiting for them after they have a baby. The typical candidates are models and actors who are doing well but haven’t yet made their name. “They tell me point blank, ‘If I get pregnant, I will lose my part. I work, I don’t have time because of work. I model, I act, I look good like this and I don’t want to disfigure my body.’”
I wince. Do you disfigure your body when you get pregnant?
“You are definitely disfiguring your body, for that duration, and then if you don’t do the necessary exercises it’s going to take you a while to get back to normal. There’s definitely some truth about pregnancy changing your body. Your pelvic bone opens up, you accumulate fat, you accumulate discoloration that doesn’t go away. I’m not saying that’s a reason to use a surrogate, but it is for some people.”
And what about the partners of the women who are getting other women to carry their babies, so their own bodies don’t get disfigured? He always meets them, but he has never considered what they think about the process. “You know, I never ask that question. I never bring that up.”
Sahakian describes himself as a feminist. “I am very proactive when it comes to women and I believe there is a double standard,” he tells me. “Every day I see how prejudiced this society is, how male chauvinistic it is, how women are judged.” This is more than the unfairness of men being able to have careers and babies at the same time, when it is so much more difficult for women. “If you are a 62-year-old man and you come here with a 38-year‑old woman, no one asks why you’re having a kid at 62. If you come here as a 55-year-old woman trying to have a kid, they tell you you’re old, you’re a grandma, you’re crazy. Larry King was, what, 75 when he had kids?” King was actually 65, but Sahakian has a point. He himself is 56, with a wife who is 20 years younger, and two children under six.
The official guidelines set out by the American Society for Reproductive Medicine (ASRM) say that gestational carriers – surrogates who carry babies conceived through IVF, with eggs from another woman – should be used only when there is a medical need. But Sahakian has no qualms about “defining medical reasons broadly”, as he puts it. “What’s the end result here? Somebody wants to be a parent. I’m facilitating that. I understand that it’s controversial, it’s borderline unethical for some people, but put yourself in the shoes of a 26-year-old model who is making her living by modelling swimsuits. Tell me something – is it that unethical, to say let’s not destroy this woman’s career?”
Couldn’t she wait until she’s older to have a baby?
“Yes. But what if you want to have a child now, and you don’t want to be maybe 40 when you have a kid? I don’t think I’m doing anything unethical by helping those couples. In this field, in Los Angeles, you can’t judge clients. This is the wild west. Twenty years ago helping a gay couple was taboo – it still is in Arkansas. We are so in the infancy of all of this.”
Sahakian has a reputation for pushing boundaries, and he relishes it: it’s given him a notoriety that drives his business. In 2001, he helped the oldest woman on record in France, Jeanine Salomone, conceive using donor eggs and give birth at 62. A scandal erupted in France – where both surrogacy and artificial insemination of post-menopausal women are illegal – when it emerged that Jeanine’s brother, Robert, was the biological father of the son she gave birth to. Robert was severely disfigured after a suicide attempt years earlier, and French journalists suggested the child may have been conceived to secure an inheritance from Robert and Jeanine’s wealthy mother. The press descended on Sahakian, who said the siblings had presented themselves in his consulting room as a married couple, and that Jeanine had lied about her age. “I was put on the map,” he tells me, simply. “The message from that was, this guy can get a 62-year‑old woman pregnant. So I had everybody over 50 calling me in the 2000s.”
Then, in 2006, Sahakian became responsible for the oldest woman in the world on record to give birth. Maria del Carmen Bousada, a retired sales assistant from Cadiz in Spain, had her twin boys the week before her 67th birthday. Bousada was diagnosed with cancer less than a year later, and died in 2009, leaving her toddler sons orphaned.
“That woman from Barcelona is in the Guinness Book of Records as the oldest woman to give birth, actually,” he says with a pride that feels grotesque. But when I ask him if he’s happy with his reputation, he is defensive. “I didn’t push the boundaries with the Spanish woman: she lied about her age, she said she was 57. She forged documents, she forged her medical records. With the French people, they had the same last name, we had their passports. We don’t ask for marriage certificates, we don’t ask for birth certificates. Which doctor asks for a birth certificate?”
He feels no responsibility for her twins in Italy. “That’s why I wouldn’t treat a 67-year-old woman. She was a perfectly healthy 57-year‑old. She died from cancer, so she didn’t have a pre-existing condition. You can get cancer at 28.” He has since cut his upper age limit to 55, but still doesn’t ask his clients for conclusive proof of age.
Sahakian says none of his social surrogacy patients will talk to me, even anonymously. “They have nothing to gain.” This isn’t about vanity, he stresses, it’s about the pressure women are under to maintain their careers at the same time as having children, and the women he sees have no interest in being spokespeople for this new way of having it all.
The taboo attached to wanting to have another woman carry your baby without any medical justification is so great that he says a couple of his clients actually pretended to be pregnant, knowing that their pre-baby bodies would be there for them as soon as the baby arrived. “You can buy artificial, prosthetic bellies, you know. You can buy them in different sizes. There’s a reason why.”
He is right. The current global leader in fake pregnant bellies is a family-run English business called Moonbump. It produces remarkably realistic tummies in silicone and foam, in a range of five different skin tones and four different gestation sizes, with prices starting at £245 for a silicone model. Moonbump’s products are used in dramas from EastEnders to Game Of Thrones to Bridget Jones’s Baby, but it also caters to trans people and men with fetishes, and, as its website says, they are used “in many cases, for strengthening emotional bonds as you move forward with a planned surrogacy”. There are several testimonials on its site from people using surrogates. Moonbump declined to be interviewed for this article, emailing to say: “We provide a discreet service for our customers and prefer not to answer any questions relating to the business.”
Look closely at the wording on any number of California-based fertility clinics’ websites and you will see social surrogacy is on the cards. “Couples and individuals who are unable to have a baby on their own, either biologically or through intention, can still build and grow a family thanks to surrogacy,” says the website of Growing Generations (my italics). “From medical to emotional to logistical and more, the indications for gestational surrogacy can vary significantly,” says the Los Angeles Reproductive Center’s surrogacy page. Neither clinic agreed to be interviewed for this piece. I contacted 10 separate California fertility clinics, and almost all readily admitted to carrying out social surrogacy, but none could provide former or current clients who were prepared to share their stories with me.
Women know it’s not socially acceptable to admit you want to be a mother, but would rather another woman carried and gave birth to your child; but that doesn’t stop some from thinking it, and even expressing it, under the veil of anonymity. Last year, an “Am I Being Unreasonable” thread on Mumsnet titled, “If you had money to burn, would you use a surrogate?” asked users if they would “pay for an American surrogate if you simply didn’t want to wait/go through the pregnancy?” The responses were mainly negative and outraged, but there were a striking number of women – at least seven – who said they would. “Oh God yes. I had horrible HG [hyperemesis] with both my pregnancies but even putting that aside it’s not an experience I savoured,” said one. “Yes I would. Pregnancy is horrible!” said another. “In a heartbeat,” said a third.
Social surrogacy is not just for Hollywood models and actors, Saira Jhutty a fertility psychologist, tells me. She works with women who are about to become surrogate mothers to check that they meet the ASRM guidelines: that they have already given birth previously, understand the process and aren’t going to have attachment issues. Jhutty is based in San Diego, a hotbed for surrogacy with more than 20 fertility clinics and 16 agencies. She used to run her own agency, where she worked with several intended parents who were looking for surrogates for social reasons – and there may have been many more who disguised their reasons. “It’s still taboo to say, ‘I want to be a mother but I don’t want to carry.’ They could have been telling us it was for medical reasons and we wouldn’t know.”
One particular client stands out in Jhutty’s memory: a woman who was campaigning for political office. “It was election year and she knew she was going to have to be on the political trail. If she wasn’t out there doing what she needed to do, her election run could be in jeopardy, but she wanted to have a family,” she tells me over the phone. “She knew the potential side-effects, and how they could impact her career, and she just felt, hey, I have this other option, I can still be a mom and not jeopardise everything that I’ve been working for over the last how many years.”
San Diego-based fertility specialist Dr Lori Arnold estimates that up to 20% of the 100-200 clients she sees in her practice each year are there for social surrogacy. “Mainly it’s women with careers that don’t allow them the time, or the potential risk of being on bed rest,” she tells me. “These are career women where it just doesn’t fit into their schedule but they want to have a child. It’s becoming more of an option, and if it wasn’t so expensive, I think more women would do it.” Many of her clients are wealthy Chinese women. “With patients that come from China, it’s usually about 80% that are social. They feel that after one pregnancy or two the uterus is old, and that the success rate for an egg will be better with a younger uterus. It’s a cultural thing.”
Most of Arnold’s surrogacy clients are women who are unable to carry babies themselves for medical reasons: they might have been born without a uterus, or had a hysterectomy, or have a pre-existing condition that would make pregnancy dangerous for them. “Most women want to experience pregnancy and delivery and breastfeeding. Most women really have that desire. But some don’t and we have to respect that. I don’t think it’s anything bad: they do want to have a child and a family, but they don’t want to become pregnant and go through delivery. In my 25 years of experience I haven’t met anyone who really doesn’t want to be pregnant – it’s mainly a choice that their career has given to them.”
As well as running her own fertility clinic, Arnold has her own surrogacy agency to provide carriers for her patients. Given how crowded the field is in San Diego, she says finding surrogates can be difficult. “It’s a very competitive market,” she laments. When I ask her how the surrogates feel about taking on the pregnancy of a woman who has no medical reason not to carry the baby herself, I am shocked by her reply. “The surrogates really don’t know the medical point of why the intended parents are seeking surrogacy,” she tells me. “If they asked, if we had permission from the intended parent, we would tell them. But it’s a personal medical decision that I do keep private and confidential.”
There is no typical American surrogate. They vary widely in terms of their day job and level of education, but many have college degrees and work full-time. A significant proportion are military wives: surrogacy agencies have been known to actively approach them; the promise of a paying job that allows them to stay at home with their own children can be appealing for women who are lone parents while their husbands are away on deployment.
To qualify as a candidate, a woman must have already given birth to their own biological children, and ASRM guidelines limit the number of times a surrogate can carry to five pregnancies; but they aren’t always enforced. Their average age is about 28. The widely held belief that American surrogates are just doing it for the money is likely be a misconception: this is not easy money, and most say they are motivated by the desire to bring joy to people who would otherwise have no way of having their own family.
“One surrogate made an incredible comment to me,” says Diane Batzofin, assistant to San Diego-based Dr David Smotrich at La Jolla IVF, where she estimates 5% of clients come for social surrogacy. “She said, ‘So I must risk my life to save someone from having some stretchmarks?’ and I said, ‘No, it’s not exactly like that, and she said, ‘That’s exactly how it feels to me.’”
Batzofin wants to make clear that the decision to use a social surrogate is not taken lightly. “There are women who have this thing about the pain of childbirth,” she says. “Then there are women who are on their own and support themselves. What would happen if a woman like that ended up on bed rest? She’s concerned about how she’d survive not even the pregnancy and bringing the child into the world, but how she would survive financially [if complications meant she lost her job].”
The clients she describes tend to be older than Sahakian’s swimsuit models: they are in their late 30s, and often single. “What we see a lot now is that women who are not married or attached, who are in their early 30s, will save their eggs. It’s a much larger market.” If these women remain single and feel their jobs are under pressure, they might be tempted to use the eggs they have frozen with donor sperm and a surrogate for social reasons. “Companies like Apple and Google are much more amenable to helping women, paying for them to freeze their eggs. They are much more progressive, in that sense,” she tells me. That is one way of looking at it. It would be more progressive if these companies made it easier for women to take breaks from their careers to have babies earlier in life. Is there a future where companies will support mothers looking for someone else to carry their baby, so that pregnancy doesn’t interrupt their work? It’s a horrifying thought.
Batzofin is in her 60s; she has spent her entire working life in the fertility field, and several generations of babies have been conceived under her watch. “The field has changed dramatically, but the one thing that has not changed is the desire to procreate, in one way or another, the desire to have some piece of yourself, in whatever way it is,” she says. Sometimes that desire to have some piece of yourself can stretch ethical limits in mind-boggling ways. Last year, it emerged that her boss had helped a wealthy British couple create a grandchild using sperm extracted from their 26-year-old son three days after he was killed in a motorcycle accident. The man had been single at the time; he never gave consent for the procedure when he was alive, making it illegal under English law. Smotrich used a donor and a surrogate, and gender selection to ensure the baby born was a boy. “The English couple lost their son under the most tragic of circumstances. They desperately wanted an heir and a grandchild. It was a privilege to be able to help them,” he told the Mail On Sunday.
There is no doubt that the doctors who offer social surrogacy are at the most extreme end of fertility treatment. But these same doctors have led the way when it comes to creating families for same sex couples, and single men and women; Smotrich was one of the first doctors in the US to help a gay couple become parents, and was behind the procedure that allowed the first single man in the UK to have his own children without a female partner. Could this be another boundary American fertility doctors are pushing through, which the rest of the world will one day follow?
Back at the Pacific Fertility Center, underneath Sahakian’s framed medical certificates, I put this to him: that in 20 years people will think of social surrogacy as no more unnatural than surrogacy for gay couples.
“Twenty? No, a couple of years from now. We’re already almost there. Surrogacy isn’t taboo any more. In the UK, you are so far behind us. Thank God – so many of my clients come from the UK, it’s good for business! But that’s going to change.”
The rise of social surrogacy is one of many possible futures, so long as we live in a world where it can be difficult for some women to be pregnant. These women are shouldering the burden of a society where, in some highly visible or demanding jobs, you can’t become a mother without risking your livelihood. Instead of making their working lives easier, we are creating an industry where they can hire other women to carry babies for them.
But the existence of social surrogacy, and the secrecy that currently surrounds it, perpetuates the idea that it is possible for those women to have it all, to have coveted jobs in business, politics, acting and modelling, and to have children and perfect bodies at the same time – and be utterly unchanged by the process of having babies.
I ask Sahakian if he isn’t creating an impossible illusion? But he shrugs it off. “These aren’t big numbers in the scheme of things. I don’t think it’s a social problem. I can see both sides, but I’m not going to judge.” He sits back in his chair, and smiles. “I am comfortable with what I do. I like what I do. My goal is to make my patients happy.”
Jenny Kleeman is writing a book about the future of birth, food, sex and death, to be published by Picador in 2020.
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