Ep 173: Surrogacy with Carly Joseph
Fertility Forward Episode 173 :
Surrogacy is often considered a ‘last resort’ for people dealing with infertility, but it can be an incredibly beautiful (and challenging) way to start a family. In this episode of Fertility Forward, Carly Joseph joins us to share her surrogacy journey and to talk about her surrogacy concierge service that gives families going through surrogacy the support they need. Tuning in, you’ll hear about Carly’s infertility and IVF experience, what inspired her to start her surrogacy business, how she helps her clients, and so much more! We delve into the first steps to take when considering surrogacy before discussing how you can make the decision to go that route. Carly even tells us the one thing she wishes she had done differently in her surrogacy experience. Finally, our guest does not hesitate to share gratitude for her wonderful nanny. Thanks for listening in!
Rena: Hi everyone, we are Rena and Dara and welcome to Fertility Forward. We are part of the wellness team at RMA of New York, a fertility clinic affiliated with Mount Sinai Hospital in New York City. Our Fertility Forward podcast brings together advice from medical professionals, mental health specialists, wellness experts, and patients because knowledge is power and you are your own best advocate.
I am so excited to welcome to Fertility Forward today, Carly Joseph who went through two surrogacy journeys herself and then used her experience to start a surrogacy concierge and I'm so excited to have her on to tell us her story of strength and hope and what she is doing now to help other women. So thank you so much, Carly, for coming on to speak with us.
Carly: Thank you so much for having me. I'm so excited to be here!
Rena: So tell us your story is really, really…
Carly: Crazy?!
Rena: Yeah, yeah, I, I don't wanna say that you said it, not me. So yes, tell us your story.
Carly: Yeah, I'm happy to. So my story kind of started in 2020. My husband and I were trying to conceive it was not working and we decided to go the IVF route. And you know, I kind of always say at the beginning of our story, once I knew we were going to do IVF, I sort of thought it was the magic solve for getting pregnant and it would happen quickly. And of course that's not how it went. And without getting into like the nitty gritty, though, I'm happy to, if that's of interest, we basically went through eight rounds of IVF. I had four failed transfers, a chemical pregnancy and we kind of had setbacks at every stage. And this was across working with a number of different clinics and doctors. I'm born and raised in New York and we were living there and we ended up moving out here to LA in 2021. And so that also complicated things further in terms of, you know, working with new clinics and moving embryos and all those things. But it took us a really, really long time to make good embryos and then we were not seeing success with transfers. So at some point in 2022 we decided to start thinking about surrogacy as an option while like kind of continuing to parallel path with getting me pregnant. And so we found a surrogate and she unfortunately had two miscarriages. So you know, we sort of thought of this similar to how I kind of felt about IVF at the beginning as, like, once we get a surrogate that will resolve everything for us. And did in some sense. I mean our surrogate was amazing and so resilient and awesome to work with. And the first transfer worked, she miscarried at about nine weeks and then we, you know, tried again a couple months later and miscarried at five weeks. And so after that, that was kind of like our rock bottom moment. We didn't know if she would want to continue with us for a third transfer, how she was feeling... There was like a lot of grief and healing across all parties, all sides of, you know, this saga as it were. And so we decided to go ahead and look for a second surrogate. During that time we found another surrogate who was willing to work with us. She was fully aware that we, you know, had had this loss and we were working with another surrogate and we might continue and then Tori, our first surrogate was willing to do a third transfer. And so while we were onboarding Crystal our second surrogate, we did go ahead with the third transfer. It worked again, but like we didn't know at what point we would feel like safe in that pregnancy because of the two miscarriages that we'd had and the losses that I'd had. And so by the time it was, you know, may of last year and we were ready to do a transfer to Crystal, Tori was about five months pregnant and I think for a minute there we were like, is this crazy? Like our fertility doctor who she herself has kids that are five months apart because she got pregnant when her surrogate was pregnant. She was the only one who was like, you should really, like, think about this. This is a little crazy through it. But we were just so desperate for our family at that point. And so we went ahead and it worked with Crystal and they were meant to be, our two kids were meant to be five and a half months apart. And then my son was born in August and my daughter was born at 34 weeks, so they're exactly 17 weeks apart.
Rena: Oh my gosh. Wow. What a story!
Carly: Yeah. And so, you know, going through this, so many people have sort of come my way through different networks and communities of just sort of like, you know, does anyone know anyone that's used a surrogate? And it's, I don't even know that it's so uncommon, but I think it's like pretty like it's not talked about very frequently and there are all these great, you know, trying to conceive communities and podcasts like this and you know, things where people are sharing stories and resources but there's just not like a ton of surrogacy chat. And so I felt like I was having conversations all the time sharing my experiences, what I had lived through, what I learned and I felt like I really had like a calling in this somewhere like that this sort of like tragic, very challenging, difficult thing happened to us. And then I was like, oh, maybe this is like the silver lining of it. Maybe I'm like learning a lot from this whole experience that I can actually share with people and provide value. And so just after my daughter was born I started thinking about what that could look like in terms of a career pivot and I started helping people intended parents identify surrogates that they could match with. And so now I have a concierge service where I match intended parents with surrogates through my own relationship with agencies that I have. And so I cut down significantly on match time and kind of help advocate and guide them through the entire journey.
Rena: That's amazing. I mean I, I think like so many women, you know we have on this podcast, you know, you're another one who you went through something and saw that this could be better. You know, my experience was hard, this could be better and now I don't know how you have the time to be building this
Carly: Me neither!
Rena: But you're doing it and I mean what a service. I know that with patients I work with, everyone's always asking you know about right how to go about finding a surrogate and it can be tough and if we think there's still stigma or difficulty around talking about just seeking infertility treatment in the first place, you know, I think to find a surrogate as a whole other thing and I'm so glad that you're raising your voice and starting a dialogue and trying to make it easier.
Carly: Thank you. Yeah, that is like my number one sort of goal here and I, you know, anyone that's interested in talking to me, I always do free intro calls where honestly I end up spending a lot of time with people educating them about the sort of landscape of surrogacy, how to approach it, different ways to think about it because that is the most important thing to me is that like if someone can walk away from a conversation with me and feel like they understand things better or know what questions to ask or how to advocate for themselves, obviously I would love to help them and work with them but even if not that is so fulfilling to me to be able to pay that forward.
Rena: Yeah. Well so maybe let's do like what would you be saying on an intro call? Because I bet that's just so full of information that our listeners are
Carly: Yeah, yeah. So I think that the number one thing that is kind of groundbreaking, maybe that's too traumatic of a word, but that, like, sort of that the process that is set forth by most reproductive endocrinologists is not the full picture necessarily of how to approach surrogacy. And, and what I mean by that is not that any doctor's doing anything wrong but typically like, and I'm speaking specifically about surrogacy for couples who have come to the decision to use a surrogate or work with a surrogate after an infertility journey. It's a little bit different If you have like known necessity for a surrogate or a same sex couple, obviously it's like there's a little bit less trauma and grief or maybe different trauma and grief, but in any case, typically the doctors will sort of say, okay, here's a list of a couple agencies that you know we work with or recommend, call them and we'll go from there. And number one, the first thing I always tell any potential client or anyone that I speak with is like the first conversation should be with an attorney. I think people think that you have to wait to see where your surrogate is like in terms of what state they live in to get an attorney. And that's not really true because you need someone to represent you and you know, manage your contracts in addition to sort of doing the parentage, which is like state specific but attorneys in this space are the ones that I know and work with are very gifted and intelligent and know all sort of the ins and outs and rules of this process and what questions to ask and can be such great advocates. So I think that's a really important conversation to have first even before identifying an agency. And then sort of this greater issue that I'm kind of trying to point out in terms of the system not being like fully explained or the options that people have is that you don't have to work with, you know, one of those three or four agencies that your doctor shares on a list. There are many, many wonderful agencies across the country but also you don't have to commit to one agency. So the sort of standard model of surrogacy is you know, do some research, find an agency, get on a waitlist many times pay a fee to be on a waitlist and then wait and depending on where you're looking for a surrogate and what type of agency you're working with, you know the wait list time can be anywhere from like 4 months to 18 months. And I think when people are coming to surrogacy from a fertility journey that has not gone well, waiting is not really an option, that you already feel so behind. And so what I do is I, through relationships that I've cultivated with agencies, I kind of like go out to and cast a wide net to many agencies and look for surrogates that are available at those agencies at the time where my intended parent client is looking for one. So I build a profile for them and kind of go out to you know, a group of agencies and look for the right surrogate for them. And so, you know, I'm explaining sort of what I do to illustrate that. Like there are many different ways to approach this. Obviously people can do their own research on agencies as well and contact ones that they're interested in. It is quite literally a full-time job. It is my full-time job. There are many agencies and sort of like not all of them are equal in terms of understanding how their screening processes are developed and how they think about and vet surrogates and manage those relationships. But there are so many different ways to approach this and you know, I think that that's not always explained at the doctor level of things. And so having that initial conversation with an attorney doing more research about specific agencies and then considering potentially working with a concierge service like myself are sort of different ways that you can think about approaching this.
Rena: So it sounds like you're sort of like a fast pass?
Carly: Yeah, I mean I obviously bring up fast or match time for sure, that's like one of the main sort of value props of what I do. But I think above that I'm really also like an advocate and a guide. I think beyond just the match there are so many things that come up in a surrogacy journey that you need to think about that there isn't always someone to ask, you know, who's just in your corner when it comes up. So how does the relationship change when you graduate from the re to the surrogates OB and like losing that sort of sense of control and the relationship that you had with your doctor, it's now her doctor how to think about planning for birth, like and bringing home a baby when you're not pregnant. It's different, you know, thinking about what the hospital arrangements will look like and travel and sort of all of those things. There's a lot to consider.
Rena: Yeah, a lot of nuances. I mean I think what you're doing is great. It's how I feel about anyone starting treatment that everyone should have, you know, a counselor, right? I mean I think there's so many things in this process, whether it's starting treatment, surrogacy adoption, whatever, all the things that this can bring up where it should be required that you have someone to work with who can help you through this because how are you supposed to know all of this and all of these questions and anxieties and everything comes up and it's kind of like you're just a deer in headlights at the whim of maybe you meet someone that's nice and can tell you this or otherwise it's just so overwhelming.
Carly: Totally, totally. I think that it is overwhelming even with that support but you know, having someone to sort of hold your hand every step of the way is, is so important.
Rena: Yeah, absolutely. What would you say would be if you had, you know like three things if someone said okay I'm thinking about using a surrogate, like where do I start? I guess how would you maybe answer that question?
Carly: That's a really good question. I think it depends on where they are in their sort of journey. So assuming they already have embryos made, I would say something to think about is like what are you looking for in a surrogate aside from like you know, basic medical and you'll hear sort of this like there's a list of kind of requirements that most doctors will kind of refer to as guidelines, but like kind of beyond that, like do you have a specific location in mind? Is there a lifestyle that you are looking for a surrogate to have? What do you want that relationship to look like? Do you want it to be transactional? Do you wanna be really close with them? What do you kind of envision it looking like after the baby is born? So I think having sort of a sense of how you imagine that being and what's important to you is really critical before you sort of start looking for a match is kind of having a sense of like what your priorities are, thinking about what the plan is. Is it only going to be the surrogate? Are you gonna still try to get pregnant on your own? I think that's something that comes up a lot for people that are exploring surrogacy coming out of like a unexplained infertility situation where like maybe it feels like there's still room to keep trying and what will that feel like or you know, do you wanna kind of make peace with you not carrying and you know let sort of the surrogate be the focus. And then I think just you know, thinking about logistics and what your bandwidth is for handling this. So it is a very, very large stressful undertaking. You know to look for a surrogate, go through the matching process, go through the legal and this psychological evaluation process waiting to see how a transfer goes. Not just for yourself but like there's another person involved and you know, what's it gonna look like in terms of going to appointments and things like that. But like understanding sort of what your appetite for taking all that on is going into it and like what support you need before you take that on yourself.
Rena: Those are all great points. And you touched upon something that I was gonna ask also, which a lot of clients come to me about, which is how do you know, or let's have, since everyone's different maybe, how did you know when you were ready to say like okay I'm gonna use a surrogate? Because I think that is what is so often quite difficult for people.
Carly: Yeah, it's a really difficult sort of subtle inflection point kind of that like, I don't know that I knew when I was ready I just felt like we had gotten bad news enough that it felt like we had to do something different. Like continuing to try the same things like there's only so many different protocols for transfer you can do. Or you know, every time we had a transfer that didn't work we felt like we were wasting an embryo. And for me and you know this is very different for everyone. Like for me, like I didn't have 20 or 30 embryos like sitting on ice that I could you know, do transfers with I I think honestly I like numbed out at a certain point in terms of the physicality of it. So like I probably could have done more transfers. I just simply didn't have enough embryos to afford doing endless numbers of transfers and it was wearing on me psychologically just the sort of up and down process of like, will we, won't we, is it going to work? Is it not gonna work The, you know sort of oh my god, like if this works, when will I have the baby and what will that look like? And watching everyone around you get pregnant and I think we just got to a point where something had to drastically change and we had to try something completely new and different. And again as I said like when I decided to explore surrogacy I had not fully given up on the idea of me getting pregnant. In fact I did after we matched with our surrogate and she was like in the legal clearing process, I actually did another retrieval at that point to make more embryos and I made more embryos in that one cycle than I had in seven previous cycles combined. And it was completely random. Like there was nothing so different about it except maybe there was something to the fact that I knew I had another option in terms of carrying if it didn't work for me and like maybe somewhere even subconsciously that like was a release of stress but I don't think it was so clear. And so you know when people are sort of wondering like is it time yet to start thinking about it? You can always start thinking about it, you can always start gathering information. So much has to happen before money changes hands and you are on a match call with someone and you're committing to this process. So if it's something that you think might be needed or you're curious about, like start learning, you know,
Rena: Well I like what you said at the beginning which is you're working in parallel and I always say that to clients you know about, you know, and we say on this podcast all the time, knowledge is power. And so the idea of working in parallel and okay if this is something you're thinking about, start the research now, start the conversations now put this in your back pocket because I think it also feels easier and better to do it when you still feel like you have options rather than you feel like you're backed in a corner and you don't really wanna be doing this. It's the only choice you have. And that I think just feels a lot worse.
Carly: A hundred percent. And you know, you can think of it as like a parallel path and then like decide to go one way or the other at some point too. Like there's, you know, as you said like knowledge is power. Like get all the information, figure out kind of what feels good to you and you know, then you can make decisions later.
Rena: Sure. And I think as you said, you know there was no like bow on the top of it. You don't wrap everything up in a nice box of the bow, put it on the shelf and like, okay now I'm ready. And I think a lot of times people are looking for that. They wanna wrap things up, they want it to look pretty, they want it to look nice and then move on. And this process can be messy because it can involve exactly what you said. Like, well I'm still doing a retrieval but I'm also talking to agencies and lawyers 'cause I might use a surrogate and there is no like, okay, I'm done with one thing and now I'm moving on to the next. It's kind of messy.
Carly: It is messy and it was messy for us all the way through. And that's another thing that I tell people too is like you should expect that. And that looks different for everyone in different journeys and you know, manifests in different ways. But like this process is not smooth and straightforward for everyone. Like it's very rare that you just like match with a surrogate quickly and then she gets pregnant right away and then the baby's born and there's no complications and like you move on with your life. Like that's not how, that's not usually how fertility treatment goes. It's certainly not how surrogacy goes. As I said, like you know, we experienced some losses with our surrogate. We had like some appointments where like things came up that like we were not sure about that were scary. Like there's sort of like always bumps in the road and then, you know, my son was born and I was like, oh my gosh, like everything's like it's here, everything's happening and we're having another one in a couple months. And then like right around that time, like our surrogate went to the hospital and her membranes had ruptured prematurely. So like, you know, there truly is always something and like I'm not just saying this to like, you know, make an excuse for it or make people feel better about it. But like I do really think that that is very good learning for parenting because that's like literally just having kids is like, it's not smooth, it's not straightforward. You can't always anticipate what will happen, you know, what somebody will need, what it will look like, what it will feel like, and sort of that loss of control is taught through these things.
Rena: Sure, absolutely. You know, and I work with people a lot on that mindset and saying like, this is setting up for life, right? Because life isn't predictable, it doesn't always go your way. You know, we're not forced ever to change or look at ourselves in times of ease because then we're just coasting. Why do we have to, things are good, you know? But when we're in what you know is called a contraction state, right? When things are hard, that's when we're forced to change, right? And an end rise up and learn things about ourselves that then we can file a way that we can use in the future. And so sometimes when you're in it, it's really hard and you can feel like, why me? You know, this isn't fair. All those things which are super valid, but then it's okay, what can I learn from this? And you take that with you to the next thing.
Carly: Exactly.
Rena: So what would one thing be maybe that you would have done differently for yourself going through your journey?
Carly: Giving myself more grace. I mean, and that's something I'm still working on honestly. Like I think I was very hard on myself in terms of like my expectation of myself and how I would be and how I would feel because I always felt really fortunate that like we had these options to you know, explore different paths to having our family. I felt very lucky but like that doesn't mean that it doesn't feel hard. Like both things can be true. And so I don't think I gave myself enough space to like really grieve the trauma that we had been through in like the years of me trying to get pregnant and all of the losses and bad news and challenges and then the same complications with the surrogacy journeys. And like I think I spent a lot of time in the months after like both of our surrogates were pregnant, feeling very confused by like how like detached I felt from the whole process and everyone around me sort of being like, oh my God, it's so exciting like you're having two babies. And I, I like couldn't really connect with that. And I think that like looking back, maybe that was because I didn't really give myself a chance to process the difficulty of it all and then like move into the excited phase and then it just happened. So like I wish that I had just given myself more time to like process a and digest sort of everything that had happened and like be okay feeling excited and really sad about it.
Rena: I work with people on that all the time, right. And I was just talking about that with someone. It's the idea that you know, we're going through something and not giving yourself a chance to pause and acknowledge and it can be something difficult like this or it can even be something happy like getting married, right? And you kind of barrel through these things in life and then we don't often pause and take a breath and say wait a second, now I am a different person. Let me meet the new me, acknowledge the new me. And it's about taking the time and acknowledging and then also what you said about having these two juxtaposing emotions, right? How can I be sad about something but also excited about the same thing and the push-pull of that. And I think that can feel super confusing, right? Like how can I be sad that I'm not using my own body to conceive and, and I'm using a surrogate but also excited about it And that can feel really confusing. And so
Carly: Yeah, that push pull feeling has come up for me a lot also since having the babies and like I think this is, you know, something else that's not really spoken about in fertility world is like, you know, you can spend years and years and years wanting to have your babies and then you have them and it's really hard. And likeparenting has been very, I mean not because of any like unusual circumstance other than the fact that I have two kids who are 17 weeks apart. But like even just with when my son was born, I felt like it was much harder than I had anticipated and I felt really guilty feeling that way because I wanted this for so long. But like I am trying to give myself that grace of both things can be true. Parenting can be really hard. I can be grieving my old life as like, you know, a no kids couple, like with no responsibilities and you know, also feel incredibly grateful and this sort of surrealness around having these kids that I fought so hard to have. Both things are true
Rena: And I think that's what I see so many people go through, right? That you know, I fought so hard to have this kid or children, you know, whether it's through IVF or surrogacy, like whatever route you took. And then therefore I do not have permission to complain and I have to be happy all the time and I have to look like, you know, an Instagram picture. And as you're saying, parenting is really hard. Yeah. And I don't think you fought really hard to get here. Parenting is really hard. So everyone has the right to feel that and not everything looks like it does on social media. And to give yourself permission, yeah, you could have wanted this really badly, but it doesn't mean that you don't have the right to get frustrated. To get irritated to say, oh my gosh, you know, I missed the old days. Right,
Carly: Exactly.
Rena: You got that right. So what a journey. Anything else that you wanna share with listeners about, you know, your own experience or what you've created?
Carly: You know, just reiterating that like there are so many different ways to approach this and in my work, like yes, as we talked about, like I do sort of like bring that faster match, but there are so many different facets of the surrogacy process to think about and you know, having someone to lean on like that, what I had something similar in my journey and I was so grateful for that and I'm seeing that that is a huge value add for my clients. So I would just encourage anyone who's listening and thinking about exploring surrogacy if you have questions, even if you're not sure how this works, how I would fit into your journey. Like, you know, talk to me and ask me questions. I love meeting different people and hearing different stories and you know, I'd love to help in any way that I can.
Rena: Amazing. And how can people find you? Where can you be reached?
Carly: Yeah, so I have a website, it's carlypjoseph.com. I'm also on Instagram at Carly P Joseph and through my website you can find more about my story, which I write about on Substack and there's a form to contact me and I hope that I can help.
Rena: Amazing, thank you so much for taking the time to come on and share your journey and what you've created. It's super inspiring. Yeah,
Carly: Of course. Thank you so much for having me. It was great.
Rena: The way we like to end our episodes is by something that we are grateful for. So any gratitude that you have today.
Carly: My nanny
Rena: That was like quick and not even, yeah, thought about just bam. I don't think anyone's ever answered that concept.
Carly: She is the one that makes this all possible, honestly. Like it's been crazy to build this business during this time and like that is the reason that I can do it. And you know, because of her I like can do what I love professionally and also have time with my kids and I'm just so thankful for that
Rena: Well, I hope she's listening.
Carly: I hope so too.
Rena: That was, yeah. The fastest response ever. I love that. And I guess I'll say in line with that. Yeah, I'll just say, you know, my support system and my help, I'll go specifically with my mom today because she helps me so much with my daughter and is currently taking her to her afterschool activity right now so I can be here working and it takes a village.
Carly: It really does.
Rena: Yeah. Well thank you so much for coming on.
Carly: Thanks, Rena.
Dara: Thank you so much for listening today. And always remember: practice gratitude, give a little love to someone else and your yourself, and remember - you are not alone. Find us on Instagram @fertility_forward and if you're looking for more support, visit us at www.rmany.com and tune in next week for more Fertility Forward.