Sometimes when Amira Mikhail is caught up in the chaos of everyday life, getting her two young sons ready and out the door, she has to pause and remind herself what it took to be where she is today.
For while Mikhail always longed to have a family, her body was never on-board with the plan.
Becoming a mother has involved years of medical procedures, setbacks and heartache and, through it all, she held on to her dream, fiercely determined to see it realised.
"Honestly I didn't have a plan B," admits the Christchurch vet. "I just could not imagine not having kids. There was nowhere in my mind where I grew old and had no children."
The problem? Mikhail's uterus was a disaster zone – fibroids, ovarian cysts, painful endometriosis. She needed medical intervention simply to lead a normal life, so a successful pregnancy was always going to be a challenge. She gave it her very best shot.
"I've always been a really determined person," she explains. "My parents brought me up to believe I could do whatever I wanted so long as I put some effort into and if I failed the first time, then I should try again."
Born in Canada, Mikhail has called New Zealand home since graduating from vet school in 2006 and coming here to take up an internship. She was in her early 30s when doctors advised her to hurry up and get pregnant, otherwise it would never happen. So began her attempts to conceive, first naturally, then when that didn't work, with the help of IVF. By the time she reached the top of the waiting list for funded treatment, her relationship had fallen apart. Knowing it was now or never, Mikhail carried on with donor sperm.
In her book, Mission To Motherhood (Calico Publishing), she describes the roller coaster of hope and despair as she went through seven rounds of fertility treatment, the joy of finally conceiving a baby, followed by the heartbreak of losing her longed-for daughter Vienna to miscarriage when she was 12 weeks pregnant.
"That was the hardest moment of my journey, the toughest part of my life so far," says Mikhail. "After all the years of trying, it finally felt like it was happening and then it was ripped away from me in a moment."
It doesn't matter how far along a pregnancy is, she points out. In your head you have already pictured your baby and planned a life with it. To lose all that and be left with nothing is devastating. For Mikhail the despair was compounded by the realisation she was never going to be able to bear her own children. A specialist had told her the best option was to look into having a baby using a surrogate.
"I'd never heard of anyone in New Zealand doing surrogacy," she says. "I didn't know where to start."
Now when her four-year-old son Kairo asks where he and his younger brother Toren came from, Mikhail tells him that Mummy's tummy was broken so they both had to be in someone else's tummy to be born. Perhaps when he gets older she will share the full story of how hard the journey was, with obstacles every step of the way.
In New Zealand commercial surrogacy isn't permitted, although Mikhail reckons payments do happen under the table. Those that are arranged by a fertility clinic have to be approved by ECART (Ethics Committee on Assisted Reproductive Technology) and the surrogate and intended parents must have a historical relationship – like broadcaster Toni Street whose best friend, Sophie Braggins, carried her new baby son, Lachie.
However, Mikhail didn't have any family in this country and her close friends were still busy having their own families. "I had zero options as far as I could see."
So when, following her miscarriage, an acquaintance turned up on her doorstep and offered to carry a baby for her, she leapt at the chance. Eventually it became clear this woman (referred to as Sharon in the book) was not an ideal candidate but Mikhail was desperate.
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"I would have done anything, paid anything," she says. "That's the reason I didn't back out from surrogacy with Sharon, even though there were red flags along the way. I was so desperate to get to the finish line that I put blinders on. I thought I could handle anything that was coming so long as there was a baby."
By then Mikhail had a new partner, Simon McMurtrie, so using his sperm and her eggs, moved forward with plans for a surrogate pregnancy. As the situation with Sharon grew more stressful, Mikhail admits they were walking on eggshells, almost to the point of being afraid of her. When the pregnancy failed, with an early embryonic loss, Sharon pulled out of being involved in any future attempts. Their sadness was mixed with a measure of relief, because it was obvious there was so much potential for things to go wrong.
The situation around surrogacy in New Zealand is a complex one and, like many infertile women, Mikhail has found herself becoming an expert in the several pieces of legislation that cover it. These include the Human Assisted Technology (HART) Act, the Status of Children Act and the Adoption Act. It is the latter that is creating the most angst as it dates from 1955, decades before anyone imagined modern-day fertility techniques, and means no matter whose genes a baby carries, the woman who gives birth is its legal mother for the first 10 days of its life.
Only after that is she allowed to put the baby up for adoption and the intended parents able to take their child home (so long as they have passed medical exams and police checks, provided character references and had the suitability of their home assessed by a social worker).
And surrogacy arrangements aren't legally enforceable in New Zealand, which creates a lot of insecurity. "It's not what anybody going into one wants," says Mikhail.
With their six remaining frozen embryos, she and McMurtrie decided it would be wiser to set their sights overseas. Given Mikhail's roots in Canada, it was the first place they looked.
Immediately it became easier to find out clear information about surrogacy and no longer did Mikhail feel as if she was blindly stumbling along. Very soon she had contacted an agency and through friends found a woman prepared to be a surrogate – Natalya, a mother of young twins.
"At first I was pretty guarded with her," admits Mikhail, who was nervous about what might lie ahead. "I couldn't let myself get excited. But Natalya was amazing. Right from the get-go she was so open and she never faltered, there was no weirdness, no surprises."
There was one last hurdle though. As they were transferred from Christchurch to Ottawa their six precious frozen embryos went astray and there was a panicked few days before they turned up safe and sound at a fertility clinic in Japan.
From then on, everything went without a hitch. The couple had a comprehensive agreement that everyone had signed covering all eventualities and detailing the financial compensation allowed, as well as a healthy pregnant surrogate who seemed as excited as they were.
Arriving in Canada for the birth of their son, they found themselves feeling pretty nervous. "I've always been an optimistic person but I was so paranoid something was going to go wrong," says Mikhail.
Thankfully Kairo's arrival went smoothly and the couple were present when he was delivered via Caesarean section by Mikhail's best friend, Lynn, an obstetrician at the hospital.
"Seeing him for the first time was such an amazing moment."
Mikhail calls Kairo her angel baby. He was soon sleeping through the night, was never colicky and has grown into a quiet, sweet little boy. But she wasn't finished with surrogacy. Both she and McMurtrie wanted a sibling for their son and besides they still had those five frozen embryos.
"When you know what your embryos can produce, what do you do with the ones you have left over?" asks Mikhail. "When they're just a concept you can donate them to science or another couple, or maybe just destroy them. But once we had Kairo we knew we had to keep trying until there were none left.
There were four more attempts at pregnancy with Natalya that failed. With one last remaining embryo, their surrogate introduced the couple to a friend who agreed to take over.
"I thought it couldn't possibly go as well as it had with Natalya but it did," says Mikhail. "We lucked out so much with those two."
Second son Toren is now 9 months old and Mikhail (40) says their family is complete. But if things hadn't worked out she knows she would still be trying.
"My next plan was to go back to Canada to try and adopt because it's easier than here. I'd probably be single again because I don't think Simon would have put up with too much more. He joined in halfway through the process, just before my miscarriage, and he's been incredible. Not many guys would have stuck around when their partner was trying to have a baby with donor sperm. But I think if I'd said we're moving to Canada so I can go through the adoption process, he would have drawn the line there."
Sheer determination is Mikhail's superpower. She is the kind of person who hates being told she can't do something and isn't used to failing. Those characteristics have helped in the battle for motherhood. But it shouldn't be such a battle, she argues. The surrogacy process in this country could be made so much easier.
"At the moment it's so confusing and leaves people really vulnerable."
When surrogacy clients come to see Margaret Casey QC, she gives them a flow chart so they can better understand how to pick their way through the process. Casey is a leading authority on surrogacy and part of an international panel of experts that meets in The Hague to consider the issues around it.
Generally she is positive about what she sees happening in New Zealand compared to other countries, in particular places where the process is fully commercialised. Surrogacy is more common these days, she says , with everyone familiar with the process of plaiting together the separate pieces of legislation so it goes smoothly.
In the past 18 months Casey has dealt with 50 babies born via surrogacy – only 11 of these were domestic arrangements and in the other cases the infertile couples had to go offshore. If she had a magic wand this is one thing she would change.
"I would make it easier for people to find surrogates in New Zealand," says Casey. "I would allow us to pay surrogates something that would compensate for their costs. And I would allow us to import eggs because we don't have enough donors."
If it were a really big magic wand, Casey might even draft a piece of legislation - she cites one in Tasmania that covers altruistic surrogacy as a good model – and also improve birth certificates so they provided more information for the babies of surrogates later on in life.
"That's the kind of stuff being talked about at an international level. A country like New Zealand could do it because we're small. But I'm not holding my breath," says Casey, who doesn't expect change any time soon. "And in the meantime, these babies keep coming."
Waikato academic Ruth Walker would like to see a professional model with a regulatory body to maintain a register of surrogates, plus determine a fair rate of compensation and protect the rights of everyone involved. Along with her colleague, Liezyl van Zyl, the ethicist has published a book, Towards A Professional Model of Surrogate Motherhood (Palgrave Macmillan) and conducted a research study involving 13 participants.
She views the current process as both time-consuming and nerve-racking. "We feel that surrogacy is tolerated rather than supported. It's a very grudging 'if you must' approval and that's out of touch with the way people feel which is that it should be another form of assisted reproductive technology," says Walker.
As for Mikhail, she has her two much-loved boys – cautious, shy Kairo and her noisier, more demanding new son, Toren.
"They couldn't be more different even though they're from the same batch of frozen embryos, born three and a half years apart, which is kind of mind-blowing."
It has cost around $85,000 to create a family but Mikhail doesn't regret a cent of it. What she went through feels unreal now, almost as if it happened to a different person.
"In this new chapter of motherhood now I'm just normal, like everybody else," she says.
• Mission To Motherhood by Amira Mikhail (Calico Publishing)
