And Baby Makes Four: for the First Time a Surrogate Bears a Child Genetically Not Her Own

As Shira toddles around the rug of her parents’ living room, she looks like any inquisitive 1-year-old. But that impression can change with the viewer’s perspective. To her parents, who had been trying for 13 years to have a baby, Shira is a miracle; to science she’s a marvel; and to ethics professors and lawyers, she a cute, plump, brown-eyed hot potato.

After exhausting every other means available to them of having a baby, Elliot, now 42, and Sandy, 39—they have asked that their last names not be used—hired suburban Detroit housewife Shannon Boff in 1985 to carry their offspring from shortly after conception to birth. At first glance that’s old news: In the past few years hundreds of women, usually for a fee, have allowed themselves to be artificially inseminated with the sperm of men whose wives cannot bear children. But Boff’s case was different: Her womb was implanted with one of Sandy’s eggs, which had been fertilized in a plastic dish with Elliot’s sperm. Boff became, in effect, a human incubator, or, as she puts it, “the world’s first fetal baby-sitter.” In contrast to every previous surrogate birth, Boff has no genetic relationship to the child. Sandy and Elliot did not have to adopt the baby, the norm in other surrogate arrangements, and only their names—not Boff’s—appear on Shira’s birth certificate.

For her efforts Boff was paid $10,000 by Elliot and Sandy. “I wasn’t going to turn the money down,” says Boff, who is married and has a 4-year-old son of her own. She claims, as do many surrogates, that the fee was not her main reason for having another couple’s baby. “I love my own son so much, I feel sorry for people who can’t have kids,” she says.

Sandy and Elliot had wanted a child since their marriage in 1973. Because Sandy’s fallopian tubes, damaged by a childhood disease, had been removed shortly before she was married, their only hope was to have her eggs re moved, fertilized in vitro and implanted in her uterus. They attempted that procedure in 1982 at the Steptoe-Edwards clinic near Cambridge, England, run by the British medical team that pioneered the birth of Louise Brown, the first “test-tube baby,” in 1978. Sandy became pregnant on their first try, but 28 weeks into her pregnancy she went into labor. She delivered a 2-lb. baby girl, Heather, by cesarean section, but after two weeks Heather died, as did Sandy’s hopes of bearing children: During the delivery doctors had been forced to remove her womb. Says Sandy: “I felt defeated.”

Not so her husband. “I couldn’t believe God would let us have her, create a miracle, just to lose a miracle,” says Elliot, a cardiologist. The couple considered, then rejected, the “conventional” surrogate mother route. “I didn’t want the mother of my child to be someone else,” says Elliot. “I wanted it to be my wife.” When he suggested implanting his and his wife’s fertilized egg into the womb of another woman, Sandy pronounced the idea “crazy.” So, for several months, did every hospital her husband called.

The first doctor to consider his proposal was Wulf Utian, director of obstetrics and gynecology and co-director of an in vitro fertilization and embryo transfer team at the Mt. Sinai Medical Center in Cleveland.

When the hospital approved their plan, the couple began looking for a surrogate. They contacted Michigan attorney Noel Keane, the so-called “godfather” of surrogate motherhood, who has arranged more than 150 such births since 1976. Keane was intrigued by the legal and medical ramifications of the idea. “Everybody would love to have a genetically related child,” he says. “Before, in the surrogate process, only one half of the couple was related.” He took Sandy and Elliot on as clients and introduced them to a Michigan surrogate. Three separate attempts at implantation over the next six months proved unsuccessful. Ten months later, in the spring of 1985, Keane contacted Shannon Boff, then 22. A year earlier Boff, the wife of a tile layer, had acted as a surrogate for another couple, also clients of Keane’s.

The Boffs flew to New York to meet Sandy and Elliot. “We approved of them, and they approved of us,” says Shannon. Ten weeks later Dr. Utian’s team implanted a single fertilized egg in Boffs womb. Fifteen days after that she learned she was pregnant. On hearing the news, Elliot insisted on a second test. Says Boff: “He kept putting a damper on it. I don’t think he believed it until the baby was in his arms.” Nonetheless, Boff and the couple talked almost daily during the pregnancy. Boff crocheted a sweater, bonnet and booties for the baby, and Sandy sent maternity clothes to Boff. Elliot fretted about Boffs smoking, sending her articles about the dangers. When Boff went into labor, Elliot and Sandy flew to Michigan, arriving in time to witness the birth on April 13, 1986. Boffs obstetrician handed the baby to Sandy. “Shira was so beautiful,” Elliot says. “The miracle we had lost we now had back.”

Before she went home to her husband and son, Boff visited the hospital nursery to say goodbye to Shira. “With the first surrogate baby, I had to keep telling myself that this was the couple’s child,” she says. “This one I knew wasn’t mine. That made it easier.” In any case Boff has retired from the surrogate business. “My son told me while I was pregnant to hurry and give them back their baby so that we could make one of our own,” she says. She has since complied, and is now seven months pregnant by her husband.

Other couples have since attempted to follow Sandy and Elliot’s lead, with one reported success. The Hagar Institute, a Topeka, Kans. surrogate agency, helped orchestrate events leading to the birth of an 8-lb. baby girl in Texas on March 4. The procedure is far more complex than standard surrogacy—which involves only artificial insemination—and thus far more expensive: Each attempt at implantation can cost $7,000. And, like standard surrogacy, the in vitro process has provoked controversy. Dr. George Annas, a professor of health law at Boston University, is concerned that “the mother is just an incubator and has nothing to do with the mother-child relationship.” He’s also worried about the “money aspect—the notion of trying to commercialize childbirth. It cheapens it to put a price on it.”

Dr. Utian is somewhat ambivalent. He says that if he had known Boff was a paid surrogate—afraid Utian would back out, Elliot had told him Boff was a family friend—he would have delayed the procedure and consulted further with hospital committees. “I wanted the surrogate to have an altruistic motive so it wouldn’t be construed as selling her body,” he says. “I think, however, we got that from Shannon. She really wanted to do it.”

Elliot, however, defends the payment. “As a physician, when I save a life the patient is charged for my time, skills and education, not for the value of his life,” he argues. “We were paying Shannon for her time, her effort and her energy.” Overall, Elliot and Sandy spent $32,000 on Shira’s conception, gestation and birth, including various travel expenses and $5,000 in legal fees to Keane.

Their reward was a pearl beyond price. When Shira was 3 days old, Elliot and Sandy dressed her in an outfit crocheted by Boff and flew home, stopping only to buy a bassinet enroute from the airport. “My husband wouldn’t let me get one before the birth,” says Sandy. “He was afraid to take anything for granted.” When they arrived at their house, Elliot’s mother was waiting. “She always said I was chasing a dream,” he says. “When she opened the door I said, ‘Mom, this is my dream.’ ”