O'FALLON, Mo. -- Kirsten Langhammer has given birth to three sets of twins in the past four years. Not one of those babies is her own.
With each pair of twins, though, Langhammer fulfilled the dreams of a couple wanting to become parents. But using her body to help create three other families has meant navigating a morass of legal, ethical and health issues.
Still, on this past Mother's Day, she was proud of not only her own children, but the families she helped create.
It was a Google search that led Langhammer, of O'Fallon, down a path of flying across the country to fertility clinics, being nurtured by intended parents and making life-changing decisions on an examining table.
It's a rare path not taken by many.
Gestational surrogacy is a practice made famous by Hollywood couples. Increasingly, it's also an avenue for couples who can't have children and gay couples who want some genetic link to their offspring.
There is limited data available on the number of surrogate births because agencies are not required to report them. Voluntary data collected by the Society for Assisted Reproductive Technology shows a dramatic increase. There were 2,236 babies born using a gestational surrogate in 2014, up from 738 in 2004.
Surrogacy is one of the most expensive infertility options, ranging from about $120,000 to far more for complicated cases, for a full-service agency and egg donor. Gestational surrogates carry embryos genetically unrelated to them. In all three cases, Langhammer was implanted with donor eggs.
And it's still a controversial practice. It's illegal in five states to pay a woman to be a surrogate. (Arkansas is not one of them.) Commercial surrogacy is also illegal in many countries, such as Canada and the United Kingdom, while other countries ban the practice completely, even in unpaid circumstances.
WHAT MOTIVATES A SURROGATE?
Langhammer, 40, had easy pregnancies and loved the deliveries of her own children Jacob, 8,
and Ava, 5. She went back to work as a bartender in a country club when Ava was about 2 months old. She and her husband, Jeff, felt their family was complete.
Then she told a co-worker that she missed being pregnant. He suggested surrogacy. Langhammer didn't know anything about it, so she did a Google search, read the reviews of the first agency that popped up and applied online.
The first search result happened to be Circle Surrogacy in Boston, an agency started in 1995 and one that now receives 1,200 to 1,300 online applications a month.
Less than 2 percent of those women make it through the intensive screening, according to John Weltman, the founder and president.
Langhammer made it through all the medical and psychological screening and legal hurdles. For the first pregnancy she would be compensated $28,000, in addition to expenses and benefits.
"If I was doing it for the money, I would charge a helluva lot more than $28,000," she says.
The agency sent her a profile of a couple whose responses matched hers.
She felt a connection to them right away.
For Gabriel Manzon of New York, the hardest thing about coming out as gay was accepting the idea that he would not be able to have his own family.
"It was really upsetting and sad for me."
He and his husband have been together 14 years. Five years ago, they decided to look for a surrogate. Because the practice is illegal in New York, they all met at a fertility clinic in Connecticut to do the embryo transfers. Langhammer was implanted when her daughter was 10 months old. Before that, she had to give herself injections and hormones for weeks to sync her cycle with the egg donor.
Manzon and his husband flew to Missouri for the first ultrasound. They heard two heartbeats.
"One of them cried," Langhammer says. She carried the babies to full term, but suffered terrible migraines and went on modified bed rest, which she never had while pregnant with her own children.
The first baby was born vaginally, but the second baby's heartbeat started to drop. The doctors performed an emergency C-section. She was relieved when the babies' fathers took over after the delivery.
"The last thing I wanted to do was to take care of a baby," she says. "I'm just an oven. These aren't my babies."
The emotional part for her was watching the two men who had grown to become her close friends become fathers. Their daughters turn 4 this month.
"I personally feel very fortunate, blessed and grateful to have a human being who would give up nine months of her own life to give birth for another family," Manzon says.
The girls have asked about their mommy and how they were born.
"We explained that we borrowed a belly," Manzon says. The girls have met Langhammer and know they grew inside of her.
"The fact that we could have children. It was like a miracle."
Langhammer's son, Jacob, was in preschool during her first surrogacy. She explained to him that they would be donating the babies to the couple who had flown down to meet them.
"Can we donate Ava, too?" Jacob asked.
"No, we have to keep her," his mom said.
Jeff Langhammer didn't think his wife would actually go through with it, but he's happy she did. "I think it's a really great thing to do for someone who can't have children," he says.
Kirsten Langhammer was hooked on the experience. She switched agencies and was matched with James Lewis and Randy Roberts in Los Angeles. The couple, together for more than a decade, had suffered through prior failed attempts with a surrogate.
"We were beyond impressed" when they met Langhammer, Lewis says. The doctor implanted two embryos. Lewis remembers the phone call when she called them to say it was twins.
"Your face goes blank," he says. "You start crying. You've been waiting so long." They flew to Missouri for the birth, a scheduled C-section.
"We both got to cut an umbilical cord," he says. A son and a daughter were handed to them, while they sobbed.
Kirsten, who had worked 12- to 14-hour days at the bar through most of this pregnancy, knew how much this moment meant to them. Like the first couple, they've stayed in close touch with the Langhammers. Their expenses totaled more than $200,000, including the prior attempts.
Langhammer was paid $28,000 again.
She waited about a year until accepting the next couple. She was adamant about not carrying twins this time. She was matched with a couple who was just as committed to wanting one child.
When she was on the medical table waiting for the doctor to transplant the embryo, he broke the news to her. Of the eggs that had been fertilized only two were implantable. And neither of those looked good.
Langhammer wanted to cry. She wasn't prepared for the possibility of twins again. In that moment, she imagined how this couple, who asked not to use their names, must have felt and how slim their chances had become.
"Was I really going to say no?" she says. She agreed to transplanting both eggs.
"I knew as soon as they went in, I'm having twins."
Ten days later, she got the results of her blood test. Her hormone levels were more than triple a single pregnancy.
"Apparently, my uterus is magical," Langhammer says.
She gave birth, again by a C-section, to the last set of twins in January.
HEALTH RISKS
Dr. John Rinehart, founding partner of Reproductive Medicine Institute in Chicago, advocates for single-embryo transfers as often as possible.
The maternal death rate is three times as high when a woman is carrying twins, according to research published this month in the journal Obstetrics and Gynecology, he says. Still, death is "a very rare event," with only about 14 deaths in 100,000 cases.
"The problem is it doesn't always go in their favor," he says.
Repeated C-sections also carry an increased risk of complications for the mother -- rupture, bleeding, scarring.
After Langhammer's third C-section, after she had given birth to eight children in eight years, her obstetrician, Dr. Jeffrey Mormol, told her there's always a risk going forward.
Langhammer says she's not one to dwell on possible bad outcomes. "If someone came to me with some big, sad story, I'd probably really consider it."
Her husband shook his head.
"I'm 99.9 percent sure I'm done," she says.
"Oh, I'm 100 percent sure," he replied. He says his wife has done her part helping other families.
"I'm worried about her, and I need her in my life," he says.
Family on 05/18/2016