Oh, BABY - Gestational carrier making friend’s dream to be a mom into reality

Staff photo by Travis S. Pratt - Dr. Melissa Esposito embraces mother-to-be Kristen Jagodowski as sonographer Andrea Duppins works with gestational carrier Jennifer Preston during a recent check-up at Shady Grove Fertility Center in Frederick. Jagodowski, 26, was diagnosed with cystic fibrosis as an infant, which makes it too dangerous for her to conceive.

HAGERSTOWN — From the easy days of childhood, playing house and mommies with her best friend, Kristen Jagodowski knew she wanted to be a mother. She and Jennifer Preston talked about how many children they would have; how many would be boys and how many girls.

When you’re young, it’s easy to believe childhood dreams can become reality. But then you grow up and when you get there, find reality is not always so easy.

Kristen, 26, was diagnosed with cystic fibrosis as an infant. Doctors told her parents she probably wouldn’t live long enough to have children. In the 1950s, children with CF were not expected to live to elementary school age. By 2000, the median predicted age of survival was 32. Today, people with CF have access to medications that were not available a decade ago and the median predicted age of survival is now 37; many can expect to live into their 40s and years beyond that. According to the CF Foundation Patient Registry, more than 45 percent of people with CF in the U.S. are 18 or older.

Cystic fibrosis is a progressive, genetic disease that affects the lungs and digestive system. A defective gene and its protein product cause the body to produce unusually thick, sticky mucus that clogs the lungs and obstructs the pancreas and stops natural enzymes from helping the body break down and absorb food, explains the CF Foundation.

“Until I was 23 I had never been hospitalized but I saw doctors regularly,” said Kristen. CF mainly affected her digestive system. “I played every sport,” she said. “I think that kept me healthy.”

The disease has progressed to her lungs and “since then I’ve had periodic hospital stays,” with a decline in lung function that requires more medication and more treatment. “I think now it’s kind of going to be up and down,” she said.

Dreams shattered

Kristen and her husband, Adam Jagodowski, married 2 1/2 years ago. Kristen’s dreams of being a mother were about to become reality. But after a year and a half of trying to conceive, “I knew something was wrong,” said Kristen. Last fall, her ob-gyn referred the Hagerstown couple to Shady Grove Fertility Center in Frederick.

“Most CF women are hit or miss as far as fertility,” said Kristen.

Working with Dr. Melissa Esposito, a board-certified reproductive endocrinologist, the couple opted for in vitro fertilization. Before the process could begin, Esposito wanted to confer with Kristen’s CF specialist the possible health risks of pregnancy for Kristen.

“It was a big no. That was a rough day,” said Adam of learning Kristen could not carry a pregnancy.

“That phone call was the worst of my life, so far,” said Kristen. “That’s when the reality hit.”

Esposito suggested using a gestational carrier as an alternative. A GC is a woman who volunteers to carry a pregnancy for someone who cannot otherwise carry a pregnancy for herself. A surrogate is someone who donates her egg and then subsequently carries the child.

“At first we shot it down,” said Kristen. “It was uncomfortable for us to ask somebody to carry a baby for us.” Kristen and Adam both have sisters but one was pregnant and the other had recently given birth, “so that was out of the question.”

‘A gift from God’

Kristen and Jennifer are still best friends, Jennifer, 26, is married and has two sons, ages 2 and 4, and works for Capitol One. She was a bridesmaid in Kristen’s wedding and though Jennifer now lives in Richmond, Va., they talk regularly.

“It was almost exactly a month after I got the phone call from Dr. Esposito that I got the call from Jennifer,” said Kristen. “I was telling her we were considering adoption and just catching her up on everything. She was on the way to pick up her kids and said, ‘I’ll have to call you back.’

Later that night, when the two talked, Jennifer offered to be their GC. “I knew she was having problems. When she told me there was no chance she could carry a child of her own, I knew how hard that was for her,” said Jennifer, noting she had already discussed the possibility with her own husband.

“It takes nine months to carry a child. I’m a very optimistic person and nine months is not that long to make a difference in someone’s life,” she said in a phone interview from Richmond.

Her offer was met with “a long silence, then tears” and Kristen saying she would have to discuss it with Adam. “Minutes later I thought this, surprisingly, feels OK,” said Kristen, who is a homemaker and Tupperware consultant.

“Especially when you compare it to my sister or sister-in-law (as a GC),” said Adam. “It was too awkward thinking of my sister having my baby.”

“I called Jennifer back that night and said we don’t know all this entails but let’s go ahead,” said Kristen.

Staff photo by Travis S. Pratt LEFT: Gestational carrier Jennifer Preston, from left, meets with Dr. Melissa Esposito and Jagodowski, after a recent checkup at Shady Grove Fertility Center in Frederick

Now in the second trimester of pregnancy, Jennifer said she has no regrets about her decision. “The biggest concern was deciding if it was the right choice, not just for (my family) but for them, too,” said Jennifer. Her husband was, at first, “taken aback” by the idea. “He left it up to me to make the decision. I decided to put it in God’s hands and if it was supposed to happen it would.”

“It was a gift from God and here we are,” said Adam.

‘There’s nothing I can compare it to’

In the months before the embryo transfer, Jennifer and the Jagodowskis had extensive health testing and screenings for infectious diseases. Adam was tested to see if he was a carrier of the most common genetic mutation for CF. “He’s not. The child has a 50 percent chance of being a (CF) carrier,” said Kristen.

They were also required to have psychological evaluations and counseling. “There was lots that came up — even what are you going to tell your co-workers and what would I tell my children and tell this baby,” said Jennifer. “A few things we left open, such as who is going to be in the delivery room. And there were things that took a lot of time to decide, like what if something should happen to Adam and Kristen.”

“The social work counseling is a crucial part of this for all involved,” said Dr. Esposito, including the GC and her spouse/partner and the intended parents. “We have specific reproductive lawyers who draw up the contracts.”

From the time the intended parents and GC are initially seen for consultation it generally takes six months to complete the necessary pre-screening and synchronization of the cycles between the intended mother and the gestational carrier (putting the intended mother through a cycle of in vitro fertilization to get eggs which will be fertilized with her partner’s sperm and then placing an embryo/embryos into the hormonally primed uterus of the gestational carrier), explained Esposito.

The success rate for IVF depends primarily on the age of the female who is donating the eggs (the younger she is the better the success rates). In women less than 36 to 37 years of age, with normally functioning ovaries, there will be approximately a 60 to 65 percent clinical pregnancy rate (pregnancy with heartbeat seen on ultrasound) with an expected 50 to 55 percent take home baby rate after accounting for miscarriages.

After the embryo transfer, the GC continues to receive intramuscular injections of estrogen and progesterone for about 12 weeks, “until the placenta takes over hormonal production to support the pregnancy completely,” said Esposito. “Once we get past the first trimester and the pregnancy looks fine, routine obstetric care is usually all that is needed.”

Esposito said, during the GC pregnancy, the female intended parent often struggles with the realization she can’t carry the pregnancy and won’t experience the birth. “It’s often a sadness they have to go through and they have to resolve it in their minds.”

The counseling and legal contract “got us to start thinking about those things. It prepared us,” said Kristen.

“When I think about it, there’s nothing I can compare it to,” said Adam, who is a mortgage adviser. His home office will become the baby’s room. “It became real to me when I saw the second ultrasound. I find myself going down the (store) aisles looking at cribs.”

“In those moments it does feel real,” said Kristen. “And there are days it doesn’t feel real.”

The baby is due in February and except for occasional heartburn, Jennifer said it’s like her other pregnancies.

“I’ve learned good ways to (tell people about the pregnancy),” she said. “I tell them ‘I have a friend that is not able to have kids’ instead of ‘I’m pregnant but it’s not mine.’ Most people think it’s an awesome thing to do.”