Fertility/Reproductive Medicine Patient Story: Sarah and Tony Catalano

Surrogacy Gives Couple the Gift of Life

As Sarah and Tony Catalano embarked on married life, things couldn’t have been going better for the suburban Milwaukee couple. Both were established in their careers – Sarah as a teacher and Tony as an attorney – and the couple were happily settling into their new home. When Sarah learned she was pregnant, it was a fulfillment of their dreams. But shortly after their son, Alex, was born, their happy life as a family took a devastating turn: Sarah was diagnosed with cervical cancer.

Sarah was well aware of this form of cancer since several female members in her immediate family had faced and beaten the disease. But she knew treating it might mean she would have to have a hysterectomy, which would eliminate future pregnancies.

“In some ways, finding out I couldn’t have more children was worse than finding out I had cancer,” Sarah said. She researched her treatment options and considered undergoing a trachelectomy, a surgery in which the cervix and upper portion of the vagina are removed but the rest of the uterus is left in place. After trachelectomy, it is sometimes possible for a woman to have children. However, as Sarah learned, there is a greater chance of the cancer reoccurring and the chance of pregnancy is very low. “I decided my desire to have more kids could not be put ahead of my own health for the sake of my son,” Sarah said.

In April 2007 at the age of 27 and just six months after the birth of her son, Sarah underwent a hysterectomy. She was treated at the Froedtert & the Medical College of Wisconsin Clinical Cancer Center under the care of Denise Uyar, MD, a Medical College of Wisconsin gynecologic oncologist with the Gynecologic Cancer Program. Dr. Uyar knew Sarah hoped to have more children and determined that although Sarah’s uterus needed to be removed, her ovaries could remain intact. The cancer had been caught early, and Sarah did not require any additional treatment.

With the same determination she used to research her cancer treatment options, Sarah now turned her attention to researching assisted reproductive methods that might make it possible for her and Tony to have another child. Again, the couple turned to Froedtert & the Medical College, this time to the Reproductive Medicine Center, where they met Estil Strawn, MD, Medical College of Wisconsin obstetrician/gynecologist and director of the Reproductive Medicine Center and Paul Robb, MD, Medical College of Wisconsin obstetrician/gynecologist. “I felt comfortable with the hospital because all of my experiences there had been good,” Sarah said.

The couple learned that since Sarah still had ovaries, they could conceive a biological child through in vitro fertilization (IVF). However, they would need a surrogate to carry and deliver the baby. Amanda, a young, single woman who had been friends with the couple for years, volunteered. “She said she was absolutely certain she wanted to step in and help. She really had thought this through,” said Sarah. Amanda made the offer with the full support of her parents, in part because her own birth was made possible through reproductive medical assistance.

The Catalanos and Amanda discussed the procedure for more than a year before proceeding. The process included psychological counseling and medical testing to make certain all parties involved understood what they were undertaking. The surrogate also met with a perinatologist, (an obstetrician with specialty training in maternal-fetal health) so she would be fully aware of all possible risks associated with pregnancy. Additionally, the Catalanos and Amanda drew up a parenting agreement contract with an attorney, a legal requirement of surrogate pregnancy. The Catalanos also assessed their resources for financing the procedure. Their health insurance did not cover IVF and they were responsible for all of the surrogate’s health-related expenses. And although Amanda did not ask for one, the Catalanos insisted she accept a fee for her service.

Sarah and Amanda were given hormone injections to prepare for the IVF cycle. In mid-November 2008, mature eggs were removed from Sarah’s ovaries with a needle guided by ultrasound and fertilized with her husband’s sperm in the laboratory. Three days later, two embryos were transferred to the surrogate’s uterus and in a week-and-a-half, tests indicated Amanda was pregnant. In late December, an ultrasound showed she was carrying twins. This was especially good news, since the IVF procedure had produced only two viable embryos, leaving none that could be frozen and used for a second transfer. “If the implanted embryos didn’t take, we didn’t have the money to go through another IVF cycle. We only had one shot at this,” said Sarah. “We were hoping for one baby, and now we’re so excited we’re going to have two.”

Shortly after Thanksgiving, the Catalanos, Amanda and Amanda’s parents made a video they showed at gatherings over the holidays to help their families understand what they were doing and their reasons for doing it. In the video, Amanda’s father says how proud he is of his daughter’s selfless decision and Tony thanks Amanda for giving them the biggest gift of all, the gift of life.

Sarah, now a stay-at-home mom and part-time high school cheerleading coach, is looking forward to welcoming her twins in mid-August. “Everything about Amanda just makes her a standout person,” Sarah said. “She’s amazing and so giving by nature. She is our angel.”