Dawn and Mike Kornstein
Couple's struggle to have a child leads to surrogacy
By Gina Barton of the Journal Sentinel
jsonline.com, August 4, 2012
Dawn Kornstein felt the pain again.
The medication wasn't working. There was nothing more the doctors could do. The contractions kept coming.
Dawn was 5½ months pregnant with twins, and the pain intensified with every breath. Her skin took on a gray pallor. The alarms hooked up to her monitors screamed every 15 minutes or so.
The doctor gave Dawn and her husband, Mike, the grim news: Baby Alex wasn't going to make it. But if they delivered Alex and tied off the cord, maybe they could save Ben.
Dawn and Mike said goodbye to one son and willed the other to wait just a few more weeks before being born. Those weeks could make all the difference in whether he would live.
Ben died the day after his brother.
Devastated, the couple clung to this mantra: We can try again. We can have other children.
The dream is simple: To have a baby.
In generations past, couples faced with infertility had two choices: adopt a child or accept life without one.
Advances in medicine and science have provided more options: Fertility drugs. Artificial insemination. In vitro fertilization. Sperm donors. Egg donors. Surrogate mothers.
Approximately 2.7 million American couples put their faith in one or more of these options every year.
Still, not everyone who begins the quest ends with a baby. Only about 65% of women who seek fertility treatment ultimately give birth.
There are limits to what science can do, what government allows and what society supports.
Laws have not kept pace with medical innovations, leaving judges to make important decisions about the intersection of biology and parenthood with little or no guidance. What is rewarded as innovation in one state can be outlawed in another.
For some couples, the financial costs climb too high. For others, the personal costs become insurmountable.
This was the new world Dawn and Mike were entering. For them, the key to parenthood lay in Wisconsin - 1,000 miles from their Connecticut home.
Dawn was 33 and a financial manager at IBM when she met Mike at a neighborhood bar. Tall and athletic, Dawn seemed on the verge of laughter every time she smiled. Mike was eight years younger, a management consultant with a boyish grin.
Mike grew up not far away, and his parents still lived nearby. Dawn, a child of divorce from south Florida, loved his close family ties.
He was raised Jewish and she was raised Christian, but that didn't matter to them. Mike hadn't been to temple much since his bar mitzvah, and Dawn couldn't remember the last time she'd set foot in a church.
She laughed at his jokes, even when no one else did. He admired her intelligence and determination.
In March 2008, after four years together, they married at a country club on Long Island Sound. Dawn was 37 by then, and they wanted two children. She would have started trying for a family as soon as they got engaged, but Mike was more traditional.
Four months after the wedding, Dawn began to think she might be pregnant. Out with friends one Saturday night, she and Mike passed their glasses back and forth. If their friends noticed she wasn't drinking, they would immediately ask why. So Mike drank and Dawn went through the motions with the empties, not ready to talk about their suspicions.
Dawn awoke at 6 a.m. Sunday to take a home pregnancy test. Slowly, the word she had been hoping to see materialized in the tiny window on the stick: Pregnant.
She shook her husband from a deep sleep. Mike, hung over from drinking for two the night before, smiled and went back to sleep.
Dawn placed the test on her husband's nightstand, where Mike would be sure to see it when he woke up. Soon, she headed to the bookstore for "What to Expect When You're Expecting."
Three days later, they closed on their new home - a Cape Cod they had chosen, in part, because of the school district. They decorated with photos of themselves and their parents as toddlers. Their baby would be the first grandchild on either side of the family.
A blood test two weeks later showed very high levels of the pregnancy hormone, HCG. It was too early to know why, the doctor told them. Dawn would need a six-week ultrasound to find out.
In the meantime, she consulted Google. It could be a molar pregnancy, which isn't really a pregnancy at all, just a lump of abnormal tissue, she read.
Or it could be twins.
The day of the ultrasound arrived.
"There's the heartbeat," the doctor said. "And there's something else."
The doctor couldn't be sure what she was seeing. She sent Dawn and Mike upstairs, where the perinatologist, who specialized in high-risk pregnancies, had a more sophisticated machine.
"There's the heartbeat," the tech upstairs told them. "There's another heartbeat - there's another baby. You're having twins!"
Back downstairs, the doctor explained what had been so hard to see during the first test: There were two embryos and amniotic sacs, but only one placenta, a pregnancy known as monochorionic-diamniotic, or "mono-di."
"Don't Google it," the doctor said. "You'll scare yourself to death."
So they didn't.
If they had, they would have learned their twins had about a 20% chance of developing a serious complication known as twin-to-twin transfusion syndrome, which results when twins share both a placenta and blood vessels. One fetus gets too much blood and the other doesn't get enough. Left untreated, the condition can result in death or serious complications for one or both twins up to 50% of the time.
The doctor monitored Dawn's pregnancy carefully. For the first four months, everything seemed fine.
Her 20-week ultrasound in early December 2008 showed the first hint of trouble. Twin-to-twin transfusion appeared to be setting in.
Twenty-five years ago, couples such as Dawn and Mike had little hope of saving their babies.
In 1988, Dr. Julian E. De Lia, who now practices in Milwaukee, performed the first fetal surgery to treat the condition. Using a laser guided by ultrasound, he was able to pinpoint where the blood was flowing from one twin to the other and close the blood vessels, stopping the transfer.
Today, doctors at about 20 medical centers around the country perform about 1,000 such surgeries every year, according to the Twin to Twin Transfusion Syndrome Foundation.
The surgery itself has not changed much, but doctors have learned a lot about how to deal with complications, De Lia said.
If doctors monitor the cervix and the mother's nutrition and activity after surgery, the odds can be improved to about 90% that at least one twin will survive, De Lia said.
Dawn and Mike's doctor believed the surgery offered their best hope. The doctor recommended a surgeon in Florida.
Dawn's surgery lasted less than two hours. The doctor found the points of transfer and seared the blood vessels closed. Neither baby seemed distressed; both hearts were beating strong and steady.
Dawn would need to stay in the hospital overnight, as a precaution. The doctor told her not to worry if she felt a few contractions. Medication should stop them.
Mike sat, helpless, as Dawn went into labor.
As the couple struggled to deal with their grief, Mike began to question his entire approach to existence. He had based his life and career on solving problems practically, step-by-step. But despite all they had done, their sons were gone.
The couple didn't decorate for the holidays.
They saw a therapist, but only a few times.
Dawn joined a bereavement group, but couldn't handle hearing all the ways a baby could die.
She stopped going.
Her physical recovery was not easy, either. After she lost the twins, the placenta remained. The outpatient procedure to remove it is usually simple. But Dawn spiked a fever and spent three days in the hospital.
Further, the procedure obliterated the lining of her uterus, replacing it with scar tissue, a condition known as Asherman's Syndrome.
Some women with cases as serious as Dawn's have gone on to bear children.
But many have not.
After two surgeries to try to remove the scarring, Dawn and Mike sought help from Dr. Joshua Hurwitz, an infertility specialist in Connecticut.
Hurwitz, a 40-year-old father of two, chose the field because it places him at the cutting edge of surgical and medical science. The best part of his job is hosting a biannual party at a children's museum for all the children he's helped bring into the world.
When things go wrong, Hurwitz tries to keep couples focused on their ultimate goal: to have a baby.
For Dawn and Mike, Hurwitz first recommended artificial insemination. Among the simplest fertility treatments, it takes just a few minutes. At the time of ovulation, doctors deliver sperm cells directly into the top of the woman's uterus near the fallopian tubes.
For Dawn, the result was a tubal pregnancy. Hurwitz suspected the embryo implanted in the fallopian tube because the uterus was still too damaged to accept it. Because a baby cannot grow in the tube, the embryo had to be surgically removed.
Hurwitz's next recommendation, in vitro fertilization, would mean several more surgeries.
With in vitro, the eggs are fertilized in a laboratory. Some of the resulting embryos are transferred directly into the uterus. The procedure can cost up to $15,000. Dawn had insurance that would cover two attempts. If those weren't successful, she could switch to Mike's policy, which would cover a few more.
Collecting enough healthy eggs sometimes takes several monthly cycles. For Dawn, each one started with 10 days of birth control pills. Then she needed daily shots in the stomach to stimulate her ovaries. Each time eggs were collected, it meant another surgery under anesthesia.
The excitement of having a family had morphed into a string of medical interventions. Sometimes, the couple would crack, bickering at each other over nothing.
Mike would walk away and Dawn would hear him muttering to himself: "It's not her, it's the drugs. It's not her, it's the drugs."
Depending on the woman's age when the eggs are collected, the odds of having a baby usually range from about 25% to 65%. Dawn was 39, making her odds 45% under ideal circumstances.
The Asherman's Syndrome reduced her chances even more.
The couple tried in vitro twice. Both times, Dawn developed a chemical pregnancy - an embryo implanted long enough to raise her hormone levels slightly - but quickly miscarried.
Dawn felt her body had failed them. She had run a marathon, but she couldn't do something practically any teenage girl could do.
We're going to get through this, Mike reassured her.
But he wasn't always strong. Many friends were becoming parents, and he felt himself pulling away from them. He couldn't bear the thought of seeing new parents holding babies in their arms.
Dr. Hurwitz told Dawn and Mike to try accepting that Dawn might never sustain a pregnancy. They should begin considering adoption or using a gestational carrier, another woman who would carry their child.
Through in vitro fertilization, a carrier - commonly called a surrogate - could bring to term a child who was genetically Dawn and Mike's.
The couple decided they were more comfortable with surrogacy than with adoption. A woman could change her mind about adoption either before or after the birth, and their perception was that many did. A last-minute change of heart seemed less likely with a surrogate who was trying to help an infertile couple.
Just a generation ago, the technology that offered them this option barely existed. Mike was born the same year as the first child of in vitro fertilization - 1978.
Today, about 57,000 babies are born via in vitro and similar technologies every year in the United States, according to the Centers for Disease Control and Prevention. Of those, about 1,400 are born to surrogates, according to the Society for Assisted Reproductive Technology.
Initially, people worried about whether using in vitro fertilization would stigmatize the children or result in overpopulation. With time, those fears faded, giving way to moral questions about the implications of choosing a baby's gender in the lab or screening out embryos with genetic abnormalities.
Because more eggs are fertilized than can be used, another issue is what to do with the remaining embryos. All the current options are highly controversial. The choices include destroying the embryos, using them for research and "embryo adoption," in which one couple's embryos are donated to a different infertile couple.
"The problem is really difficult, so the way to solve it is going to be really difficult," said Joseph Incandela, a professor of religious studies at St. Mary's College in Notre Dame, Ind. "It's just one of those messy, knotty situations that reasonable people will differ about."
The science behind in vitro, however, is no longer in doubt. Between 4 and 5 million babies have been born via the procedure. In 2010, the Nobel Prize for Medicine was awarded to Robert G. Edwards, who pioneered the procedure, giving couples such as Dawn and Mike the chance to have a baby.
To navigate the process, Dawn and Mike turned to Reproductive Possibilities, an agency that connects couples with potential surrogates.
One of the couple's first assignments from the agency was to write a letter to the woman who might someday carry their child.
"Our names are Dawn and Mike and we have been happily married for 2 years," they wrote. "We live in a cute house in a beautiful town in Connecticut (near New York City) with our 2 cats, where we plan to raise our family. We are the parents of identical twin boys, Alex and Ben . . . who were too small to survive. . . . We are very organized and like to plan things out, though the past 2 years we have learned the hard way that we can't always do that. We want nothing more than to hold a child in our arms and watch them grow up healthy and happy."
They closed with a few words for the woman they hoped would help them.
"We are really glad to have the opportunity to find a gestational carrier," they wrote. "We realize the tremendous personal sacrifice you are making to help us achieve our dream of having a family."
Dawn and Mike were quickly matched with a surrogate in Kentucky. After three attempts at in vitro fertilization, she became pregnant with their baby.
Finally, they thought, they had beaten the odds. Nearly two years after losing their twins, they were on the path to parenthood again.
Dawn and Mike listened to the surrogate's nine-week ultrasound via conference call. Dawn took a break from her job at IBM to dial in. Mike was working from home on a consulting project.
The ultrasound tech's voice came on the line.
"Baby is measuring eight weeks, five days," she said.
And then silence.
"How is the heart rate?" Mike asked.
More silence. Seemingly endless silence.
Finally, a disembodied voice: "I cannot find a heartbeat."
"You have to find the heartbeat," Mike pleaded. "There has to be one. Keep looking. You have to find the heartbeat."
Dawn heard her husband's voice choke, and then her tears began to fall.
Another baby. Gone.
The surrogate mother who had tried to give Dawn and Mike Kornstein the gift of a family by carrying their child did not want to try again.
Dawn and Mike felt terrible that she had been drawn into what they considered the hell of their life. They didn't blame her for giving up. They wondered whether they should, too.
They sought counsel from Joshua Hurwitz, their infertility specialist.
The baby they lost, he said, was chromosomally normal. There was no medical explanation for why their surrogate had miscarried at nine weeks - the odds of it happening were 3%.
Of the thousands of couples who walk into Hurwitz's office, one thing separates those who walk out with a baby from those who do not: Persis tence. He saw that quality in Dawn and Mike.
"If you can handle it emotionally and financially," he told them, "I think you will be successful with a surrogate."
The failures were starting to weigh on Mike. Shortly after they married in 2008, he and Dawn had lost twin sons after she went into labor at 5½ months. Complications afterward damaged her uterus so much that she couldn't get pregnant again - not even with fertility treatments. And now this.
To Dawn, it felt more like bullheaded stubbornness than persistence, but she wasn't ready to give up.
So the Connecticut couple called the surrogacy agency again.
The legal and ethical concerns surrounding surrogacy remain anything but simple, 25 years after the infamous Baby M case captured the nation's attention.
In that case, a New Jersey woman named Mary Beth Whitehead agreed to carry a child for William and Elizabeth Stern. Whitehead provided the egg and William Stern provided the sperm, making them the genetic parents. Although Whitehead had agreed to give up rights to the child and was to be paid $10,000, she changed her mind after giving birth.
A judge declared the Sterns the baby's parents, but the New Jersey Supreme Court overturned that decision, ruling Whitehead was the mother. The court also declared surrogacy agreements illegal in the state.
William Stern won the custody battle, and Whitehead was allowed visitation.
At least five states and Washington, D.C., have followed New Jersey's lead, banning surrogacy or refusing to enforce contracts. Eight states explicitly allow surrogacy but regulate it heavily. Illinois, for example, sets standards for who can enter surrogacy agreements. It also lists what those agreements must include.
Advances in technology, including in vitro fertilization, have made it possible for women to serve as surrogates without providing the egg - essentially providing a womb for another couple's child. The costs of arranging a surrogate birth can climb as high as $100,000.
Those who want to be parents usually are responsible for the surrogate's medical and legal bills, as well as other expenses such as maternity clothes. In many cases, they also pay the surrogate's living expenses while she is pregnant.
Dawn and Mike, who both had high-powered careers, could afford it.
They sent the agency a deposit of $8,900.
Within a couple of weeks, they got word of a potential match: Jennifer B. from Wisconsin.
Dawn and Mike's first introduction to Jennifer B. came from some answers on a questionnaire: Lutheran. Married. One child.
It turned out she also had forged a difficult path to parenthood.
Her full name was Jennifer Boyd, but most people called her Jenny.
She lived in Oshkosh and had been divorced twice by the time she was 33. Her first husband had a daughter whom Jenny loved, but she thought he drank too much. Her second said he wanted children. They had just started talking about trying when their marriage fell apart.
When Jenny signed up with a dating service in search of husband No. 3, she was clear about her intentions: She wanted to have a baby.
That was fine with Tommy Boyd, who had seven siblings but always pictured himself as the father of one child.
Their first phone conversation lasted three hours.
Tommy was laid-back and funny. Although he had never been married before, he didn't mind that she had. He loved her outgoing personality and irreverent sense of humor. He never tried to tell her what to do.
Within 18 months, they were married on a beach in Jamaica. Jenny, then 35, hoped for a honeymoon baby.
It didn't happen.
After six months of frustration, the couple found out why: Tommy had Klinefelter's syndrome, meaning he had an extra X chromosome. The most common symptom is infertility.
Just as Dawn and Mike had, Jenny and Tommy turned to artificial insemination. It is a simple procedure in which doctors use a catheter to deliver healthy sperm cells directly into a woman's uterus.
Jenny was sure it had worked. For two weeks, she felt high, pondering baby names and daydreaming about motherhood. Then a home pregnancy test brought her back to Earth.
They saved another $2,000 and tried again. Not pregnant.
After the third attempt, Jenny felt hope slipping away. By then, she had been trying to conceive for nearly two years. She was 37 years old. Her fertility specialist recommended in vitro, but it could cost up to $15,000. There was no way she and Tommy could afford that, and no guarantee it would work.
The pain was worse than either divorce, and so were the doubts.
Jenny's mother urged her to try one more time.
This time, she sought help from her regular OB-GYN, J. Michael Gonzalez. He recommended she take clomid, a fertility drug that stimulates the ovaries.
Thirteen days later, Jenny woke at 3 a.m. and took a home pregnancy test.
When she saw the result, she cried. This time, tears of joy.
The day the baby was due, Jenny worked 10 hours straight in high-heeled boots. In labor two days later, she went to the hospital wearing makeup and jewelry. A woman in labor down the hall pushed for three hours, but not Jenny. Three sets of pushes and the baby was born.
Gonzalez placed the infant on Jenny's chest.
Jenny spoke her daughter's name: "Macie."
The baby turned toward her mother's voice and smiled.
Shortly after Macie was born, Jenny learned a friend of her mother's was struggling with infertility. The woman and her husband were considering surrogacy.
No one suggested Jenny volunteer to carry the baby, but the idea struck her immediately. Sure, she'd had trouble getting pregnant, but once it happened, it had been easy. She could end this couple's suffering; give them the gift God had finally given her and Tommy.
In the end, her mother's friend decided against the idea, but Jenny couldn't shake the feeling it was something she was meant to do.
She went online and registered with an agency, answering questions about herself, her background and her reasons for wanting to carry an infertile couple's child.
The questionnaire forced Jenny to think about potential complications, and about the differences between carrying her own baby and someone else's.
How much prenatal testing was she willing to do?
Would she have an abortion if problems were found?
Would she allow the intended parents in the delivery room?
Could they tell the hospital she wasn't the baby's mom?
Three years passed with no word. Then Jenny got an email asking for an updated photo. That was all. She couldn't figure out why it was taking so long. She was 41 by then. If she was going to do this, she had to do it soon.
Jenny found a different agency. She answered another set of questions.
Then she said a prayer: "God, if this is the way you want me to go, I need some kind of sign."
Twenty-four hours later, the phone rang.
Jenny Boyd lay on an examining table in Connecticut, a sheet draped over her.
Dawn and Mike Kornstein, in surgical
gowns, caps and shoe covers, stood beside her.
All three watched on a large monitor as a scientist extracted the two chosen embryos - one boy, one girl - from a petri dish in the room next door. Carefully, she delivered them to the doctor, Joshua Hurwitz.
"We're going to put them right there," he said, pointing to the image of Jenny's womb on the ultrasound screen.
Tears came to Jenny's eyes. He was putting life inside her.
It was May 2011. This new chapter in Dawn and Mike's quest for a family had begun four months earlier. That's when Jenny, an Oshkosh woman who felt called by God to carry a baby for an infertile couple, applied online with a surrogacy agency, Reproductive Possibilities. Dawn and Mike had registered there, too, seeking a woman to help them realize their dream.
To have a baby.
The day after Jenny filled out the online question naire, the agency called to interview her. About a week after that, Jenny talked with Dawn and Mike for the first time.
To help her prepare for the call, the agency sent Jenny a letter Dawn and Mike had written and a picture of the Connecticut couple, who looked as if they had stepped out of a J.Crew catalog.
Dawn and Mike knew Jenny as "Jennifer B. from Wisconsin," and Jenny knew only their first names. A woman from the agency was on the line, too, helping the three of them get to know each other.
Dawn and Mike told Jenny their story. They had lost premature twin sons at 5½ months gestation. Dawn was unable to get pregnant again. Surgery to repair her damaged uterus had failed, as had fertility treatments. A previous surrogate miscarried at nine weeks and gave up.
Dawn and Jenny learned they had a lot in common. Both had business degrees - Dawn in finance and Jenny in marketing. Both had lived abroad - Dawn in Paris while working for IBM and Jenny all over the place, growing up an Air Force brat. Dawn's birthday is Sept. 29 and Jenny's is Sept. 30, although Jenny was a year older at 41.
After the 45-minute conversation, Dawn and Mike decided Jenny was the one. She had given all the answers they hoped to hear. She promised to try four rounds of in vitro fertilization. She planned to tell everyone she was not the baby's mother, and she and her husband, Tommy, weren't planning to have any more children.
"It will be great to give birth, and go home and go to sleep," Jenny wisecracked.
She was willing to allow both of them in the room for the transfer of the embryos and the delivery of the baby - or babies, if she became pregnant with twins.
The next day, Jenny called the agency to say she, too, was all in. She figured Dawn and Mike would speak to several women and then choose among them. But that's not the way it worked.
Tommy was at the office when Jenny called to tell him the news: "We're it."
"What?" he asked.
"We're it," Jenny repeated. "We have to decide whether we want to proceed or not."
Tommy wasn't about to tell her "no." He didn't think carrying Dawn and Mike's baby would compromise Jenny's health, so he agreed.
Jenny's choice required sacrifices for both of them. They couldn't have sex for two weeks before the embryos were transferred or six weeks afterward. Both of them had to be tested for sexually transmitted diseases.
Serving as a surrogate did have financial benefits. If things went well, Jenny could earn close to $20,000. She and Tommy could pay off some bills and take their family on a Caribbean cruise.
Before Jenny and Tommy had too much time to think about all the other implications, they were on their way to Connecticut for medical and psychological tests. If they passed, she would return in a few months to have Dawn and Mike's embryos transferred into her.
Jenny felt the first hint of nervousness as they waited in Detroit for their connecting flight from Appleton to the East Coast.
"You don't think they're flying us out there to kill us, do you?" she asked Tommy.
"That would be kind of expensive," he deadpanned. "Wouldn't it?"
As they prepared to get off the plane, Jenny worried that meeting Dawn in person could be awkward. Should she shake hands? Hug her? What should she say?
Dawn hugged her immediately.
"Thank you for doing this," Dawn said. "Thank you."
Back in Wisconsin with a clean bill of health, Jenny prepared to carry Dawn and Mike's baby.
Advances in procedure
When in vitro fertilization was first used in surrogacy in the mid-1980s, the eggs were removed from the genetic mother, fertilized in a petri dish and transferred into the surrogate five to seven days later. The genetic mother and the surrogate would have to coordinate their menstrual cycles with medication for the procedure to work. That's because a five-day-old embryo, for example, can only thrive in a uterus five days into the carrier's cycle.
Due to advances in cryopreservation, or freezing of embryos, Dawn and Jenny wouldn't have to do that.
When in vitro fertilization began, embryos had to be frozen slowly, making them only about half as likely to successfully implant. Today, flash-freezing is the norm, and the success rates are neck-and-neck with embryos that have never been frozen, according to Hurwitz, the infertility specialist.
As a result, doctors could harvest Dawn's eggs, fertilize them with Mike's sperm, let the embryos grow for a few days and then freeze them until Jenny arrived at the clinic.
To get ready, Jenny needed medication to stop her from ovulating. Then, she had to fool her body into sustaining a pregnancy even though she had not provided the egg.
That meant lots of shots.
If she became pregnant, she would need daily shots of estrogen and progesterone. These would keep the baby stable until the placenta fully formed at around 10 weeks gestation. Women who get pregnant on their own automatically produce these hormones, but Jenny would not.
By May, everything was ready and she headed back to Connecticut.
A week after Hurwitz placed the embryos in her womb, Jenny took a home pregnancy test. The resulting line was very faint, but looked positive. She asked Tommy to check it. Looked positive to him, too.
Jenny called Dawn around 8 a.m. New York time. No answer.
Jenny tried an instant message.
"I'm in a meeting," Dawn typed back.
"Well," Jenny responded, "congratulations."
"OMG! OMG!" Dawn replied.
Jenny would take two more home pregnancy tests. On each one, the "positive" line grew darker. A blood test confirmed it: Jenny was pregnant.
It was time to start her hormone shots. Jenny could not inject them herself.
Tommy refused to do it. He absolutely could not poke his wife in the rear end with a needle an inch and a half long. He didn't want to hurt her, and he didn't want to faint. Jenny's aunt, Ginger Heckel, lived next door. Ginger was a nurse, and she was willing to give Jenny the injections before work. Every weekday, Jenny rose at 5:20 a.m. and walked out her back door and up her aunt's driveway with a syringe. On weekends, she recruited different friends or neighbors for the job.
Everyone Jenny told about serving as a surrogate was either impressed or intrigued. Her mother, especially, was proud that Jenny was willing to give such a gift to a couple she had just met. To her mother, it seemed a natural progression from signing up for the bone marrow registry and giving blood, which Jenny did regularly.
When Jenny went for an ultrasound at 5½ weeks, Dawn and Mike didn't fly to Wisconsin, and they didn't listen via conference call - they couldn't bear to hear bad news that way again.
Instead, they asked Jenny to call them afterward.
Miscarriage wasn't on Jenny's mind as she arrived at the doctor's office that day. She was more concerned with whether she was carrying twins.
It seemed all the signs were there. Jenny's levels of HCG, the pregnancy hormone, had skyrocketed. It was normal for them to double every 48 hours early in a pregnancy. Jenny's had quadrupled.
One of Jenny's best friends, Linda Frazier, put even more faith in Jenny's right eye. When Jenny looked up, two distinct red veins stood out. Two veins, Linda said, meant two babies.
The ultrasound technician quickly located one baby and measured it at 2 millimeters.
Jenny and Linda waited for news of the second. But the veins had lied. There was just one baby.
"This little flicker there, that's a heartbeat. That's baby right there," the tech said, pointing it out on the screen.
Jenny sucked in her breath.
"We've got a heartbeat," she sighed. "That's so amazing."
A complication develops
Nine days later, Jenny felt a bit lightheaded as she headed to her Aunt Ginger's house to get her shot. Jenny sat on her back steps and put her head between her knees until the feeling passed, then stood up again.
A few minutes later, her aunt and uncle wondered why they had not yet heard the familiar knock at the door. Her uncle glanced out the window.
Jenny was lying facedown in the driveway, as still as a corpse.
Her aunt and uncle rushed outside. Jenny was just beginning to regain consciousness. Blood poured from her nose, eye, forehead and upper lip, covering her face. Her glasses were broken. She couldn't see. As her aunt and uncle helped her into their house, Ginger suggested that Jenny go to the hospital, just in case.
"No," she said, still a little foggy. "I want to go home."
Then she started throwing up blood.
As Jenny Boyd lay in the emergency room, nose broken, face swollen, the metallic taste of blood in her mouth, what concerned her most was the new life she carried.
The baby growing inside her was precious - to her, but most of all to the infertile couple counting on her to fulfill the promise of parenthood.
"Who is your OB-GYN?" the emergency room doctor asked.
Jenny wasn't sure which name to give. She became pregnant after seeing an infertility specialist in Connecticut, Joshua Hurwitz. A perinatologist in Appleton, who treats women with high-risk pregnancies, had been caring for her for the past six weeks. Her regular OB in Oshkosh was J. Michael Gonzalez. He would deliver the baby, but he didn't even know she was pregnant.
And he didn't know the baby wasn't hers.
The ER doctor called Gonzalez, who ordered an ultrasound.
"He says congratulations, by the way," the emergency room doctor told Jenny.
As soon as the test was over, Jenny called Dawn and Mike Kornstein, the genetic parents of the baby in her womb.
"The baby is OK," she began.
Despite the reassuring words, Dawn and Mike felt a familiar dread. A rare complication in Dawn's own pregnancy had caused her to go into labor at 5 1/2 months gestation. Their twin boys did not survive, and the aftermath left Dawn unable to carry another baby. The first surrogate they worked with, a woman in Kentucky, miscarried at nine weeks.
If this baby was really OK, why was Jenny calling? As Dawn relayed the information about Jenny's fainting spell, Mike started to let go of the fragile hope he had been nurturing and practically curled into a fetal position on the floor.
Dawn worried about the baby, too, but she also worried about Jenny. Dawn felt guilty as Jenny described her battered face and broken nose. If she wasn't carrying my child, Dawn thought, that wouldn't have happened to her.
As soon as they hung up, Dawn called Hurwitz's office.
"It's a sesame seed," a physician's assistant said of the tiny embryo. "Jenny's body was made to protect it. As long as Jenny is OK, the baby is OK."
Nonetheless, Dawn and Mike couldn't shake the feeling that the odds remained against them.
Jenny and her husband, Tommy, didn't share those fears. When she was pregnant with their own child, Jenny had fallen down a flight of stairs. The accident left Jenny bruised and aching but had no effect on the baby. Their daughter, Macie, had since grown into a sassy 3-year-old.
Jenny and Tommy had started talking to Macie about the new baby right away.
They read her a book Dawn bought called "The Kangaroo Pouch."
"Dawn's tummy is broken," Jenny told her daughter. "So I'm helping her."
Macie seemed to take things in stride. Once, she spotted another pregnant woman and pointed.
"Look, Mommy," the little girl said. "That lady has a baby in her tummy, just like you have Dawn and Mike's baby."
From other adults, Jenny and Tommy got fewer negative comments than they expected.
One of Tommy's co-workers told him: "I would never put my wife through that."
"I'm not putting her through anything," Tommy replied. "She's the one who wants to do it."
A customer at Hobby Lobby, where Jenny worked as a custom framer, complimented her jeans.
"Thanks," Jenny replied. "They're maternity."
When the woman offered congratulations, Jenny told her: "Thanks, but it's not mine."
The woman thought Jenny was joking until she explained she was a surrogate.
The question that confused Jenny most was: How could you give a baby away?
Jenny didn't feel she was doing that. She hadn't donated her eggs. She wasn't placing a baby for adoption. This baby wasn't hers to give. It was Dawn and Mike's. She was an incubator. For her, surrogacy was like donating a kidney - except she would get her uterus back.
In Connecticut, Dawn and Mike faced their own set of comments.
"How much do you know about the father?" one woman asked Dawn.
"I know a lot about the father," Dawn replied. "He's my husband."
Another woman insisted on calling Jenny "the mom," even though Dawn told her that was not an accurate description.
"I think of the one who gives birth as the mom," the woman insisted.
Another person asked: "What if she tries to keep the baby?"
In all her conversations with Jenny, Dawn had not seen the slightest hint of that possibility. Jenny even made jokes about what she would say after the delivery if people asked about the baby.
"I'll tell them it cried too much so we got rid of it," she said.
Dawn and Jenny emailed every few days and talked on the phone once a week. Every time Dawn heard a bit of Packers news, she thought of Jenny.
Dawn had been to Wisconsin before, but in September 2011, Mike visited for the first time. He and Dawn arrived the night before Jenny's 20-week ultrasound.
Mike awoke at 4 a.m., nervous and anxious.
In the ultrasound room, Mike sighed as the tech asked Jenny if she wanted to know the gender, if she wanted pictures.
"We're the mom and dad," Dawn reminded the tech.
Mike stood silent.
Finally, the tech said: "There's the heart."
Mike stared at the screen. "The heart's beating?"
"Oh, yes," the woman answered. She turned on the audio so everyone could hear the swish, swish of the baby's heartbeat. It was nice and steady, she said, at 153 beats per minute.
"You OK?" Dawn asked him. He nodded as Jenny wiped away tears.
A few minutes later, the tech gave them the other piece of news they had been waiting to hear: "It's a boy."
Back in Connecticut, Dawn's friends at work wanted to throw a baby shower, but the couple refused.
Jenny was just 20 weeks along. Dawn had gone into labor with Alex and Ben at just under 23 weeks. Back then, doctors had told Dawn and Mike that if the twins could make it to 28 weeks, they would stand a fighting chance. Once Jenny's pregnancy reached that milestone, around Thanksgiving, Dawn and Mike would think about a name, make plans for the nursery.
That's also when they would petition a Wisconsin court for an order legally recognizing them as their baby's parents. Before they could leave the hospital with him, they would need a power of attorney from Jenny.
The baby was due Jan. 21. Jenny planned to deliver him at Mercy Medical Center in Oshkosh, the hospital where she had Macie.
Her insurance would cover the delivery; under a Wisconsin Supreme Court ruling unlike any other in the nation, it is illegal for most insurers that provide maternity coverage to exclude surrogates.
That December, Dawn and Mike didn't decorate for the holidays - they hadn't since losing their twins.
But they went out for dinner with a friend who was 34 weeks pregnant. And they put together a crib.
On the morning of Jan. 2, Jenny woke up uncomfortable after a restless night. She called Dawn around 7:30 a.m.
"I think we're in labor."
As Tommy drove Jenny to the hospital, Dawn and Mike searched for plane tickets. They could get an 11:43 a.m. flight out of LaGuardia, but the airport was about an hour away. They might miss the flight. They opted for a 2 p.m. departure instead.
Just as they had settled into their seats, Dawn's phone rang.
"You want to hear something?" Tommy asked.
It was their baby, and he was crying.
The rental car from Mitchell International Airport had a built-in safety feature that wouldn't let Mike drive more than 80 mph. During the nearly 100-mile trip to the hospital, he futilely punched the accelerator again and again.
Dawn continually called Jenny with updates.
"We're leaving the airport."
"We're in Fond du Lac."
"We're on 9th St."
"We're in the parking lot."
Tommy and Macie met them in the lobby to lead the way to Jenny's room.
Dawn and Mike held hands as they tried to keep from running down the hall. And then, they were in the doorway. Dawn started crying the second she saw the tiny, perfect infant.
"Thank you," she sobbed as she clutched the baby with one arm and hugged Jenny with the other. "Thank you."
She held him close, almost in disbelief.
Mike leaned over his wife's shoulder and gazed at the child, tears welling in his eyes.
Finally, Dawn placed their son in her husband's arms.
His name was Adam.