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Maybe storks don’t actually deliver babies, despite enduring myths about the elegant birds, but a steep-climbing stork takeoff may resemble that of a Marin startup that does deliver babies.

Roots Surrogacy could arrange arrival of nearly 50 newborns in the next nine months or so, more than double the number the company did in its first year.

The agency, founded two years ago by Brooke Kimborough and joined by co-owner Cassie Wright last year, matches surrogate mothers with heterosexual couples struggling with fertility issues and with gay men who seek to be parents.

“We rarely get female couples” to apply for surrogacy services, Kimborough said. They can purchase sperm and one partner may be able to carry the baby. “They don’t need a uterus,” she said, unless there are medical reasons.

Jennifer Gamble, a surrogate mom currently about 11 weeks pregnant under contract with Roots Surrogacy, already has five children, including four biologically related to her and one adopted, now age 19. For Gamble, pregnancy goes easily and delivery has been smooth.

“I’m in the throes of it,” said Gamble, who lives with her husband and children near Sacramento. This is her fifth pregnancy. As a gestational surrogate she has no biological relationship to the baby. Both sperm and egg came from the intended parents.

“I have pretty easy pregnancies,” Gamble said. “I don’t have any medical risks associated with them. I have fairly easy labor.” Her first pregnancy was when she was age 20, and her oldest daughter is 18. She has a son, 11. Her youngest child is a 2-year-old.

Though she welcomes the $35,000 compensation to be a surrogate, “for me it’s not about the money,” Gamble said. “It was about helping these people. To know somebody has the feeling of wanting a family and is not able to do that, if I can help, I’m going to do it. It’s one of the best things in the world to be a parent,” she said.

“I have always had a heart for giving,” said Gamble, who is in her late thirties. “This is what I was meant to do,” she said of the surrogacy. The couple for whom she is a surrogate live in northern California.They are also in their thirties, and were unable to get pregnant.

$35,000 fee plus expenses

A surrogate for Roots Surrogacy earns $35,000 for the first pregnancy plus up to another $10,000 to include their expenses such as legal and medical fees, up to $1,000 in maternity clothes, $1,000 for housekeeping and $3,000 in other expenses. To become a surrogate for the company, a woman must: have already delivered at least one child; be between 22 and 38 years old; not receive government financial aid such as welfare; have a healthy weight; live in California, Nevada or Oregon; have support from family, friends and partner; not smoke, abuse alcohol or take illegal drugs; not use any medication for mental-health issues. Applicants must pass a criminal-background check and psychological evaluation including the Minnesota Multiphasic Personality Inventory-2 test.

“We turn away a lot” of prospective surrogates, Kimborough said. The agency screens every applicant’s pregnancy records to optimize the likelihood of a good outcome. “We do everything we can to create a partnership and a village working toward a common goal of a healthy baby raised by healthy individuals.”

Some surrogates carry babies for others more than once. One Roots surrogate is on her third pregnancy. “We have a second-time surrogate who is 26,” Kimborough said. “She is incredible.”

Surrogacy agencies charge $18,000 to $25,000 for their services, according to Kimborough. Revenue to Roots Surrogacy, based on 40 cases at $25,000, is estimated by the Business Journal at about $1 million in 2017. For intended parents, the entire process costs about $100,000 to $110,000 to have a baby through surrogacy.

Experiencing rapid growth

The business was started by Kimborough then rebranded as Roots Surrogacy, a limited-liability company, when attorney Wright joined in October 2016. Wright had a background in contract law, including litigation, for some 18 years.

“We were growing at such a rapid rate,” Kimborough said. “I knew we were going to expand to a mid-sized agency. I convinced her to leave her high-powered corporate job to come do this risky venture. The emotional reward is huge.”

Kimborough served as surrogate for a single gay man formerly located in San Francisco. “His daughter will be two in November,” she said. “I have three bio-kids of my own” plus another child from her husband’s previous marriage. “I wanted to be a surrogate. I was really good at being pregnant. I am a proud ally” of the gay and lesbian community, she said. Both her own parents are family-law attorneys. She used an agency based in Los Angeles.

“He lived in the Castro,” Kimborough said of the father in the surrogacy. “He was 50 at the time. He wanted to be a parent.”

She estimates that thousands of gay men in San Francisco have become parents through surrogacy. “Surrogacy is a viable part of family-building,” she said, beyond adoption.

Half of surrogates for gay men

In the industry, about half of surrogacy arrangements are for gay men and half for heterosexual couples, Kimborough said. Roots Surrogacy has a higher proportion of heterosexual clients.

“We never take on more than 50 cases a year,” Kimborough said. “In our first year, we did 19. Now we’re on track to do 50.

“If you are a hetero couple, you have already met with a doctor,” Kimborough said. “You are figuring out why you can’t get pregnant. You have done a bunch of stuff, eventually ending in an IVF (in-vitro fertilization) fail or several, or miscarriages — a lot of loss.”

Same-sex male couples typically start by searching for an egg donor, Kimborough said. Dozens of companies in California sell embryos. Some clients hire an anonymous egg donor, who is typically age 20 to 32. Often both gay men contribute sperm then genetic screening can be done to look for chromosomal issues. Cells can be taken from a five-day-old embryo and analyzed for DNA structure. The process “can determine any chromosomal anomaly that could affect the child,” Kimborough said, including Down syndrome (chromosome-21 disorder) and overall viability of the embryo.

“Then they’re ready for surrogacy,” she said. “There are giant corporations that do thousands of cases a year. Then there are very small mom-and-pop shops — mostly moms,” she said.

Roots Surrogacy, a mid-sized agency, plans to eventually add an egg-donor division to the business.

Wright doesn’t act as attorney for the agency’s clients. They are referred to independent counsel.

California is one of the most receptive states in the country for folks who want to enter surrogacy agreements, according to Wright, who practices law in Marin County. Court support through case law for surrogacy in California goes back some 20 years, she said.

In California, a pre-birth court order can grant parental rights in-utero, whether or not the intended parents have any biological connection to the embryo. “When the birth certificate comes out, there’s no mention of surrogacy,” Kimborough said.

Many surrogate mothers report that the most rewarding part of the process is handing over the baby to new parents, who often view the surrogate as angelic. “Anyone who knows me knows I’m not an angel,” Kimborough said, laughing. “Surrogates feel that they gain. It’s not that we give so much.”

Emotional business

The business has powerful emotional underpinnings. “There is an altruism that is unparalleled,” Wright said.

Intended parents usually come into the process from a place of loss, Wright said. “Unfortunately, my husband and I struggled with fertility issues” over nearly seven years, she said. She had both miscarriage and late-term pregnancy loss. Through in vitro fertilization with her egg and her husband’s sperm, they were able to eventually have a son, now age 6. Along the way, they considered both adoption and surrogacy. Infertility is statistically about a third of the time tracked to the woman, a third to the man and a third inexplicable.

“It’s a difficult, traumatic thing,” Wright said of fertility issues. “You hope and then you lose, hope and then you lose — internal battles. Surrogates come from the other side. Pregnancy has been easy, fun, family-building. They come together — this incredible meeting.”

Adoption and surrogacy rarely cross paths, Kimborough said. “We don’t compete with adoption agencies.” Most intended parents choose one route or the other. “It has to do with who you are as a person.” Adoption contains more unknowns, with no biological connection or history on the mother or pregnancy. Adoption through foster care can be invasive, she said.

Some women in heterosexual couples who cannot have children on their own struggle with allowing another woman to be a surrogate.

“Can I watch somebody else carry my child, have another woman in my life who can do something I can’t do,” Kimborough said, “and give my husband something I could not give — very emotional parts of being a woman — insecurity or hurt that’s so deep she can’t get past it.”

State laws vary on surrogacy

The American Society for Reproductive Medicine issued guidelines for gestational carriers in surrogacy, Kimborough said.

In many states, those receiving a child must go through an adoption process after the child is born, Wright said.

California Assembly Bill 1217, which became law in 2013, amended the Family Code to require a surrogate mother and intended parents to be represented by independent counsel before entering an assisted-reproduction agreement for gestational carriers. The law required that such an agreement include certain information and be notarized or witnessed. Parties to a surrogacy arrangement cannot undergo an embryo transfer or injectable medication for assisted reproduction until such an agreement has been properly executed.

Traditional surrogacy agreements, where the surrogate is the source of the egg, may be structured as pre-planned adoption agreements. Gestational surrogacy, such as the pregnancy of Gamble, is not allowed in some states but is common in California.

The Maryland attorney general, for instance, in 2000 issued an opinion that compensated gestational surrogacy contracts are illegal. Nebraska’s position also opposes gestational surrogacy. The attorney general in Kansas issued an opinion that surrogacy contracts are void and against public policy. Washington allows uncompensated surrogacy but declares compensated agreements void, and could charge parties to such an agreement with a gross misdemeanor.

Arkansas, like California, has a statute that validates surrogacy contracts. Courts in many states are generally favorable based on their rulings in case law.

The statutory change in California reinforced already strong case law supporting surrogacy in California. Intended parents in assisted reproduction agreements are declared legal parents of the resulting child even if they have no biological relationship to the baby.

Surrogacy fraud

Surrogacy can go sour. In early August, a federal court sentenced Acharyya (Rudy) Rupak to serve 24 months in jail for crimes relating to his San Diego-based business relating to surrogacy, Planet Hospital. Rupak was ordered to pay a $10,000 fine and restitution to his victims. From about 2006 to 2013, Planet Hospital arranged international surrogacy for intended parents overseas. “Rubak solicited, and instructed Planet Hospital employees to solicit medical tourism and international surrogacy clients by falsely representing that their funds would be set aside” or sent to My Donor Cycle, a San Diego business for surrogacy-egg-donation, the Department of Justice said. Rupak acknowledged that he caused losses of at least $247,000. “Rupak lied to vulnerable victims,” Judge Cynthia Bashant said, “who were desperate for children.”

Technology can help ensure the success of surrogacy. In a blastocyst transfer, the fertilized egg is monitored in a lab for several days. If cell growth is normal, the blastocyst is implanted into the surrogate mother’s uterus, boosting successful outcomes by about 10 percent.

Don’t move pregnant women

As a surrogate mother, Gamble is relaxed about the process. The biological parents were there when the fertilized egg was transferred to her uterus, and when the first and second ultrasound procedures were performed.

“We don’t move embryos and we don’t move pregnant women,” Gamble said, so she traveled to the biological parents for the transfer and they traveled to her for later events in the surrogacy.

She plans to allow the parents to be present when she gives birth. “They’re really involved. I’m all for it. They wanted to be in the room,” she said. “This is their child. As much as I can involve them in the pregnancy, I am absolutely for that.”

Once the baby is born, Gamble said, she and her family “will be allowed to spend up to an hour” with the newborn. “After that, we left it open. If we want to stay in contact, we can,” she said. “But if either party feels like we did our thing and now we’re ready to separate,” then they can cut further ties.

“I volunteered to pump breast milk for them,” Gamble said, “if they want to exercise that clause” in the contract.

“I’m just doing something nice,” Gamble said. “There is the business facet of it. You want everything laid out. I looked at different agencies. I am a researcher. I need all my facts to make an informed decision. A lot of them offer more compensation, but Brooke and Cassie have been in the surrogacy world and IVF. It’s that personal touch.”

James Dunn covers technology, biotech, law, the food industry, and banking and finance. Reach him at: james.dunn@busjrnl.com or 707-521-4257