Even when tantrums abound and any our houses resemble war zones made of spaghetti, most of us are acutely aware of how lucky we are to have our children. Personally, it takes approximately five minutes of my children being asleep for me to pull out my iPhotos to gaze at them again.
But I have perhaps never felt more grateful to have my children than in listening to the remarkable story of Anna Buxton and her incredible children. While very few of us have a straightforward path to motherhood, there are few stories that would be as winding and spectacular as Anna’s.
We were delighted to speak to Anna about everything from IVF, to surrogacy, to needing to travel across the world to bring her three children into the world.
Grab a cup of tea and get ready to dive into the wild, beautiful ride of Anna Buxton …
For those of us who aren’t familiar, can you please explain what surrogacy is? And in particular, the two different types of surrogacy?
Surrogacy is where a woman carries and gives birth to a baby for another couple or a single person.
There are two types of surrogacy, gestational and traditional. Gestational surrogacy, most commonly what people are referring to today when talking about surrogacy, is when the egg comes from either the intended mother or an egg donor, and the sperm is from the intended father, or a sperm donor. There is no genetic link to the surrogate. Traditional or straight surrogacy is the use of the surrogates’ egg and the sperm from the intended father, or donor. So, there is a genetic link to the surrogate.
In any surrogacy arrangement, as prospective parents, you are always referred to as the “intended parents”.
Can you share the journey that led you to explore surrogacy as an option? Particularly your health diagnosis and the operations you had to undergo?
Like all women who turn to surrogacy, it was after a long, painful and complex gynaecological and obstetric history. Ed and I got married in December 2011, I was 32 and Ed, 34. We both wanted to try for a family straight away, and so set to it! Three months later, I was pregnant and we were thrilled. At that point, I didn’t have many friends who had struggled with conception but none the less, we felt lucky that it had all seemed so easy. At about six weeks, I had some bleeding and cramping and so went for an early scan. The doctor told me that we were still pregnant and they detected a heartbeat. I was asked to return two weeks later for another scan to check the heartbeat. I can still see the change in the look on the doctor’s face as she performed the scan. The heartbeat was no longer detectable, I had had a miscarriage, specifically a missed miscarriage because my body had not miscarried the pregnancy. I had to return the next morning to have an ERPC (Evacuation of Retained Products of Conception) under general anaesthetic. The procedure was painful and upsetting but it was over quickly and I could return home knowing that I could look forward. A week later I was still in terrible pain and knew something was not right. I returned to the hospital and a scan revealed that the surgical procedure had not removed all the pregnancy tissue and that it would have to be repeated. Another general anaesthetic, another upsetting procedure but finally it was done. We were told that as soon as I my period started we could try again. The next month we were pregnant. It was the same month that we moved into the house we had bought after getting married and it all just felt right. We put the miscarriage behind us and excitedly looked forward to a new home and a new pregnancy. Given my history, I decided to have an early scan at eight weeks. Once you have miscarried, that fear of losing a pregnancy never leaves you. I lay on the bed looking at the doctor’s face as she started the scan and I saw that look again. I knew there was no heartbeat. We were devastated. 24 hours later I was back in the compression tights and backless hospital gown being put under general. A week later, I recognised the same pain as I had previously and again another operation was required. In only four months, I had conceived two pregnancies, had two miscarriages and had four surgical procedures. Ed and I were exhausted.
Although two miscarriages, under NHS Guidance, is not considered recurrent miscarriage, we knew that we couldn’t risk getting pregnant again and having the whole process repeat. We wanted to know if there was something, either me, or Ed, or the combination of the two of us, that was making us prone to miscarriage. We went to a specialist in recurrent miscarriage and had the usual tests that might indicate why we were miscarrying. Everything came back normal but the consultant was concerned about me having four ERPCs in such quick succession and so wanted to perform a hysteroscopy. This is a procedure whereby a doctor uses a small camera, past through the cervix, to view the uterus. I was diagnosed with Ashmerman’s Syndrome. The formation of adhesions, or scarring, in the uterus which meant that my periods stopped because the scarring prevented the lining of my womb from developing each month. Left untreated, it can be very difficult to get pregnant because an embryo does not have a healthy lining in which to implant. Over the course of 16 months, I had five more operations to remove the scarring from my uterus. It was a very difficult period because we were in this awful cycle of operation, wait three months to see if there was any improvement, operation, wait, repeat. Having a baby had once felt so normal and achievable. It now felt a very long way away.
After each operation, the scarring would reform and after the fifth procedure, my surgeon said that he could not operate again. The damage to the lining of my womb had been too severe and he felt it wrong to put me through any more surgeries. Our only hope was to do a round of IVF. The theory being that the extra hormones of the IVF might stimulate my lining to develop and if that was the case we could transfer an embryo to my uterus with the hope that I’d be able to carry a pregnancy. We started IVF but my lining never grew to more than 1mm (doctors like to see a minimum of 7/8mm) and we were informed that it would be a waste of an embryo to transfer it back to me. The embryos were frozen and the doctor told us that the only way we could use our embryos was with the help of a surrogate.
What about your experience with IVF?
IVF is hard. Ed and I did six rounds of IVF to have our three children. We did rounds in London, India, London again and shipped embryos to Canada and then finally the US. The needles, the appointments, the blood tests, the internal scans are all unpleasant but for me I found the loneliness of IVF the most difficult part. Every round I did, I did without telling me colleagues at work. For two weeks, I would have to pretend that everything was normal despite the daily surge of hormones coursing through me. After the collection, I jumped every time the phone rang thinking it might be the embryologist with news of my precious embryos.
I think one of the cruellest but equally remarkable parts of infertility and IVF, is that the more negatives you have, the more failed IVF rounds, the more negative pregnancy test results, or miscarriages, the less you can ever believe is going to happen for you yet you do find the strength to keep trying. I cherish that strength and reserve I found during this journey and when something isn’t going quite right now, I remember I’m capable of more than I think.
How did your mental - and indeed your physical - health struggle in this time?
Physically it was a very challenging time. The endless procedures and hormones meant that I never felt like myself. Mentally, it was a battle. Some days I felt like I was winning but others I lost. For a period of time, I suffered from panic attacks. I just didn’t know how I could continue to get up each day and be a wife, a friend, a colleague, a sister, a daughter when I was carrying so much pain and disappointment.
I was also angry. During this time, all my friends and my sister were also trying to have children. As the years went on, friends became pregnant, bumps appeared and blossomed, babies arrived and second pregnancies quickly followed. I remember that look on friends’ faces when they awkwardly and apologetically would tell me they were pregnant. Friends didn’t want to share their concerns about their pregnancy or their excitement about their babies. I was angry, angry for me and Ed that were weren’t pregnant, and angry that this thing was not allowing me to the friend I wanted to be.
What kept me going was my relationship with Ed. Infertility of any kind changes you as a couple. That level of pain and anxiety can never be forgotten but the resilience, the patience and the strength you find together ends up defining your relationship.
Was surrogacy immediately a consideration? Or did it take some soul-searching to arrive at that point?
The conversation around surrogacy started with our doctor. Given that we had viable embryos and that I had been categorically been told I could not carry a pregnancy, surrogacy was the next natural step for us. For any women, surrogacy is not a choice, a luxury or the easy option. We felt very lucky to live in a time and a country where surrogacy is an option and that there are women in the world who want to be surrogates.
It sounds strange but we were lucky in that we were told 100% I could not carry. For lots of couples, turning to surrogacy can be a much longer and harder decision. If you aren’t told definitively that you can’t carry a pregnancy, rather that you may not be able to, and given that surrogacy is still shrouded in misinformation, it can just be a much more difficult decision. The reason I speak so openly about my experience is to make that decision-making process just a little easier for others.
What are some of the reasons that an individual or a couple might start to explore surrogacy?
For heterosexual couples, there are many medical reasons that mean surrogacy is necessary such as cancer, uterine issues, unsuccessful surgeries, multiple IVF failures, early menopause or genetic disorders. A single person might use a surrogate if they want to have a baby but don’t have a partner. And for male same-sex couples, surrogacy is the only option for a baby that is biologically linked to them.
Can you share a little bit about the legal implications of surrogacy in the UK, and why this led you to India?
In the UK, it is legal to have a child through surrogacy, but, you can’t advertise for a surrogate and a surrogate can’t advertise to be a surrogate; also, there can be no commercial brokering, i.e. a third party cannot provide a matching service for-profit and thirdly, you cannot pay a surrogate a fee (over and above any expenses she will have incurred during pregnancy) to be a surrogate.
Also in the UK, a surrogacy agreement, or contract is unenforceable by UK law. And, at birth UK law treats your surrogate as the child’s legal mother; if she is married or in a civil partnership, her husband or partner, is your child’s other parent. If she is not married, your husband or partner, can be a legal parent. Essentially the law is very complicated but who the biological parents are plays no part. Both the surrogate and intended parents can feel exposed.
The result of these two issues is that in the UK there are many more intended parents than surrogates. There are two main charities, Surrogacy UK and COTS, who help intended parents and surrogates meet, and Brilliant Beginnings, a not-for-profit organisation. These are three wonderful organisations who have helped many couples but the waiting times to find a surrogate can be very long. When we started looking in the UK, we were told that we would wait between 18 months – 3 years to find a surrogate and then would need to spend 1 year to 18 months getting to know each other before we could go ahead with any arrangement. We didn’t have a friend or a family member we could ask and after everything we had been through, and I was 34 and being reminded by doctors of my ever-increasing age, we decided to look at our options abroad.
The US is the most well-established destination for surrogacy. Surrogacy in the US is regulated by state law, which means it differs state by state. Some states, such as California, have fully-fledged surrogacy friendly laws offering an airtight legal framework. Before a baby is born, the intended parents are named as the legal parents and the intended parents are named on the original birth certificate. Combined with the fact that agencies can match surrogates and intended parents, and that surrogates can be paid a fee, in addition to expenses, means there are many more surrogates within a more regulated environment. Given all of this, the costs in the US are very high which meant that it was not an option for us.
India was a good option because surrogacy was legal, regulated and well established. However, I had read both positive and negative press about surrogacy in India. Ed and I agreed that no matter how much we wanted a family, that could never be at the expense of another woman’s well-being. So, we researched and researched. We spoke to lawyers and charities here in the UK, we found couples who had done it and we went to India and visited 10 clinics in three cities, as well as more charities and lawyers. We found a doctor and a charity in Delhi that were doing amazing work in terms of supporting surrogates and their families, it was a holistic programme centred around bettering women’s lives. We returned home happy and excited about India and decided to go for it.
We’d love you to tell us about your surrogacy experience in India, and ultimately, the arrival of your daughter, Isla.
We were matched with our surrogate Chaphala by an agency and doctor and were then introduced via Skype. Once we had all decided we were happy to move forward and had finalised the legal requirements, we started the IVF stimulation process in the UK, and then flew out to India to have my eggs collected and the embryos created. It was at this time that we first met Chaphala in person. I remember our first meeting, we were both so nervous! I was so worried that she wouldn’t like us and she felt exactly the same. But as soon as we started talking about families, about her children and about our want to build a family, we chatted happily and it felt right.
We flew home after the transfer and all we could do was wait for the blood test two weeks later. For two long weeks, you can’t do anything but just wait and wonder if another woman thousands of miles away is pregnant with your baby. Then the call came… Congratulations!
We received weekly updates from the doctor and Chaphala via email and every two weeks, Chaphala would have a scan and the results were again emailed. Because the communication was so regimented, I realise now with hindsight, that it made the pregnancy easier. I still worried every minute of every day but I knew that I just had to get through each week and wait for my updates. Thankfully, the pregnancy was uneventful and at 38 weeks we fly to Delhi for Chaphala’s final scans, appointments and then of course to be there for the birth.
After Isla was born, we had to live in Delhi for six months while we waited for her UK passport. Delhi is not an easy place to live, let alone with your first baby, but we were finally a family.
We are so intrigued to know about the level of involvement you can have/wish to have in your surrogates’ pregnancies. How much of a ’say’ can you have in what they do? Their environmental factors, their food, their lifestyle, and so on?
I always tell people that you should only consider surrogacy if you think you can put all your trust in another woman. I don’t think it is appropriate or respectful to try and stipulate how your surrogate looks after herself during the pregnancy. I have met many surrogates over the years and what they have all had in common is that they are dedicated mothers. I believed that both our surrogates would care for our pregnancy in the same way they cared for their own, and that they did.
Pregnancy is such a time of immense worry for women. How did you manage this when it was somewhat out of your own hands?
I didn’t! Having never been pregnant, I can’t compare that worry but for me our two pregnancies were tough. Knowing that your baby, or babies, are in this world, albeit in utero, and that you aren’t there for them, that you are thousands of miles away is a very difficult concept to describe. I would never downplay how hard a surrogacy pregnancy is. The highs are so high, your first scan, hearing that heartbeat, getting to each milestone is immense. You are 100% emotionally attached to that baby yet physically you are totally removed. Yes, you can do everything you can to support your surrogate but tangibly you have no role, or control, in the pregnancy. It is hard.
When did you decide you wanted to give Isla a sibling, and what led you to the USA?
When we started to think about a sibling for Isla, India had stopped allowing foreigners to have children through surrogacy. The UK was not an option because one charity had closed their books to intended parents and another was only taking on intended parents who didn’t have children. We felt that the US was our only option and we specifically wanted to go to California – largely regarded at the most surrogacy friendly state in the US and therefore the world.
In the US, you need an IVF clinic and separately a Surrogacy Agency, as in the US it is legal for an agency to match surrogates with Intended Parents. We were recommended a wonderful IVF clinic in San Diego and so also looked at Surrogacy Agencies in that area as well. Finding a surrogate in the US is a bit like dating! Surrogates write a profile, you write a profile, and if you match, you go for it! Obviously, it is much more complicated than that – much of the profiles are about finding someone who is aligned with you on pregnancy-related factors such as do you share the same views on invasive tests if deemed necessary by a doctor or views on terminating if advised. And then also, your expectations for your relationship during the pregnancy and after the birth of your babies. All these are really important, but the most important factor is ultimately respecting each other. Once you’ve seen a profile, if the surrogate agrees you meet over Skype. We spoke to a number of women but when I first met Holly, I knew she was the one. You can’t tell from one phone call if someone is perfect, but I knew I liked her, I liked her reason for doing surrogacy, her husband joined the call and was supportive, and her children knew – for them, it was a family affair. She had a large support network of friends and family who all supported her. Given how far apart we were, that support network was really important to me.
On our trip to San Diego to create and freeze our embryos, we were able to meet Holly and her family. We had arranged to meet for brunch between our hotel and were they lived. And so one Sunday morning, we turned up at a diner off the 805, me, Ed and Isla and there was Holly, her husband and their three children. On the surface, we didn’t have much in common but once we got chatting – family, food, the weather – we didn’t stop for hours!
After that first meeting, we were all excited to move forward and committed to doing so. It is a complex process but we were surrounded by highly experienced medical and legal professionals in surrogacy and about six months later our embryos were transferred to Holly.
What was the experience like in the USA, throughout the pregnancy and then ultimately the birth?
People often talk about the two-week IVF wait, from transfer to the blood test to find out if you are pregnant. It is very hard, and with surrogacy, you have two couples waiting for that result and your friends and family who are also waiting. Day of the test result, the email came through to me and Holly – congratulations we are pregnant! A few more blood tests all of which were looking very positive and then at eight weeks we had our first scan, two babies and two heartbeats!
The pregnancy was relatively uncomplicated in terms of medical issues, although given that it was a twin pregnancy Holly had many more scans that we had experienced with Isla’s pregnancy. For most appointments, the doctors were happy for Holly to call me during the scan so that I could hear what was happening in the appointment, hear the heartbeats and just feel connected throughout. Compared to our pregnancy with Isla, in the US it felt closer because we had more means of communication but this also meant more stress! Because California is eight hours behind the UK, Holly knew to WhatsApp as soon as she woke up so that I wouldn’t worry. She was amazing at managing me and my need for constant updates and reassurance.
One of the things that Holly and I loved to talk about was our birth plan. We had it all agreed and worked out. Holly and I would be together, Ed and Isla would be waiting next door and Holly’s husband and children would be nearby. As soon as the babies arrived, me, Ed and Isla would get to spend time with the babies, Holly could be with her family and then as soon as she was ready we would bring the babies back to her to meet her and her family. It would be the two complete families of five in one room! Then at 34 weeks, the day I’d stopped working and a week before we were due to fly, Holly went into labour. I got a call from the doctor saying, “Anna I don’t want to alarm you but we are doing a C-section in 20 minutes”. An hour later, two nurses called to say they were the NICU nurses responsible for our babies that night and did they have names. I managed to get a flight out to San Diego the next morning and was with Olive and Art about 18 hours after they were born. It was so far removed from what Holly and I wanted, but both the babies and Holly were healthy, and for that, we will be forever grateful.
As a new family of five, we stayed in San Diego for two months and enjoyed life in Southern California. Although surrogacy is a well-trodden path in California, the paperwork is still very complicated, from agreeing on the medical insurance to applying for American passports. The stay also gave us the opportunity to spend time with Holly and her family. We all felt it important for her children to see us with the babies, the family they created, and appreciate the magnitude of what their mum had done.
How did it feel when you first held your babies in your arms?
I’m not sure I have the words. It felt like every dream I have ever had had come true. It felt magical.
Tell us about life now with Isla, Art and Olive.
Hectic, noisy, messy and truly wonderful. I still pinch myself every single day that we have Isla, Olive and Art. That we were fortunate enough to have found two remarkable women to help us create our family feels like a miracle. Surrogacy reminds me every day how good people can be.
Do you feel that the fact your children were born through surrogacy changes the relationship you have with your children at all?
No! However your children are brought into this world, whether you are genetically linked on or not, I believe has no impact on your relationship. When you finally have your children, however you do, you realise that the ones you have are the ones you were meant to have and the journey to get there finally makes sense.
Of course, honesty is key. From before Isla could understand it, we have talked about how she came into this world and continue to do so proudly, repeatedly and consistently. She knows that my tummy is broken and so another mummy helped us by growing Isla in her tummy. And, we are doing the same for Olive and Art.
What do you wish you’d known when you first started the process of trying for a family?
Never did anyone suggest it was my fault but I went through this whole journey feeling like it was my fault because it was my body which had failed. I always felt guilty and sad that Ed would never see me pregnant and that I was less of a woman because of it.
If I knew then what I know now about what it means to be a mother, I don’t think I would have felt like that. To me being a mother is about being there every day for my children, doing the best I can every day, probably making mistakes every day, but being there for them. I wish I hadn’t carried that guilt for such a long time.
What advice would you provide to individuals or to couples who may be thinking about surrogacy?
Being a surrogate is an extraordinary gift and sacrifice. Whether you are doing surrogacy with a friend, independently or with the help of a charity or agency, you cannot short cut the process. Everyone needs to be emotionally, medically and legally informed. Spend the time to get to know each other, talk about all your expectations and surround yourself with experienced professionals who can help guide you through the process.
Surrogacy has given me the family I always dreamed of, profound respect for my relationship that I will always cherish and I have come face-to-face with the generosity of women that makes me smile every day.
Anna has given up her 20-year career in investment management to help others on their journey to parenthood. Working with the San Diego Fertility Center, the clinic where her twins were conceived, Anna supports couples navigating surrogacy. For more information, you can reach Anna on Instagram @anna3buxton or email directly at abuxton@sdfertility.com.
