Family Matters

My Sister, My Surrogate: After Battling Cancer, One Woman Receives the Ultimate Mother’s Day Gift

Melissa Brown survived breast cancer at 26. Advised not to get pregnant afterward, she accepted with joy and trepidation her sister's offer to be her gestational surrogate.

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J. Marie Photography

Jessica Brown, at left, with her sister, Melissa, brother-in-law, Steve Mohler, and niece and nephew, Gabriella and Brendan — twins whom Jessica carried for her sister, after Melissa survived breast cancer.

This is a Mother’s Day story, but it is really about sisters, about how it took two of them to make one of them a mother. It is a story about cancer and the shadow it cast over the lives of these women, since Melissa Brown was 2 and her sister, Jessica, was a baby. It’s a story, in part, about death. But ultimately, it’s about life — two new lives, to be exact — and the unexpected roads that women sometimes travel to motherhood.

Melissa, an attorney, and Jessica, a jeweler, grew up in Cape May, N.J., sharing clothes and secrets. They’re best friends who talk on the phone every day. When Melissa got engaged, Jessica was the first to know. Melissa had just finished law school; her fiance, Steve Mohler, was working as a software engineer for Lockheed Martin. It had been five years since they met at the Lobster House in Cape May — she had waited tables, he’d bused them — and they were planning a June 15, 2008, wedding, one year from the day Steve popped the question.

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There were other things Melissa, now 30, and Jessica, 27, shared: the specter of cancer, for one. Their mother, Gail, was diagnosed with breast cancer in 1984 at the age of 30, when the girls were too young to understand what it must have been like for her to undergo treatment, including a bilateral mastectomy, as the parent of a baby and a toddler. Her treatment — from her initial Stage 3 diagnosis until scans showed no signs of disease — lasted three years. Melissa, who was 5 by that time, remembers going to doctor’s appointments with her mother. After the doctor finished injecting saline into her mother’s breast-tissue expanders, readying them for implants, she’d use the syringe to squirt water at Melissa and Jessica.

Gail was always open with her girls about the need to do breast self-exams; after all, she’d found her cancer herself in the months after Jessica’s birth. As soon as her daughters developed breasts — it may have been around age 12 but certainly by age 13 — Gail taught them how to creep their fingers in spiraling circles around their breasts, searching for anything that didn’t belong.

In early 2006, Gail discovered another lump. In a very rare occurrence after both breasts had been removed, the cancer had returned. Chemo cleared it up. But in Nov. 2007, it resurfaced. It would be Gail’s third time fighting the disease, but she wasn’t feeling defeated. “I did not let cancer prevent me from seeing my girls grow up,” she told Melissa and Jessica. “I will not let it prevent me from watching you both get married. I want to see grandchildren.”

Then one month later, another setback: this time, it would be Melissa who found a lump — five months after getting engaged and more than a decade after she’d begun examining her own breasts. The lump was small and hard, about the size of a pea. In a journal she’d kept since she was a teenager, she wrote:

Jan. 16, 2008

Happy Birthday to me. Twenty-six is starting off to be a horrible year. Most people celebrate with friends and family, cake and candles. I spent the day in Dr. Bar’s office waiting for my biopsy. The prognosis is not good and I am so scared.

Two days later, Melissa learned she had breast cancer. She would go on to have chemotherapy infusions side-by-side with her mother. She had a bilateral mastectomy. Unwilling to tempt fate, eventually so did Jessica.

But before the first toxic chemical dripped into her bloodstream, Melissa’s oncologist — the same doctor who’d cared for her mother for more than 20 years — recommended a sort of insurance policy for the future. If you want children, he told her, preserve your fertility now. Along with killing the bad cells, cancer treatment can wreak havoc on a woman’s ability to bear children. It can catapult you into early menopause. You may stop ovulating — or you may not — but if you know you want children, rolling the dice on whether you’ll be able to conceive post-treatment is probably not a risk you want to take.

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Melissa was lucky. Not all oncologists advise their patients to freeze their embryos or eggs before treatment. Increasingly, though, doctors are addressing the issue. Men and, more notably, women, with their incredibly complex reproductive systems, are being routinely advised to consider their future fertility before rushing ahead with cancer therapy. Melissa immediately started taking fertility drugs designed to spur the release of multiple eggs.

Valentine’s Day 2008 was bittersweet, laden with the possibility of new life and the probability of untimdeath. A week earlier, the Browns had learned that Gail’s cancer had spread. It was aggressive, and doctors had given her four months to live. That would be June, the month Melissa and Steve were supposed to get married. They decided to move the wedding to March. If Gail couldn’t see both daughters get married, at least she could walk one down the aisle.

Feb. 14, 2008

I am scared. We are harvesting eggs today. We have one shot at this…

They were able to remove ten eggs but only four fertilized. They froze the four. I am devastated. There is nothing more I can do.

I had my first chemo treatment this afternoon. It was a long day full of doctors, IVs and medication. Treatment was not as bad as I thought it would be. I am mostly tired; a little nauseous. On the whole, I feel okay.

Jessica was Melissa’s “chemo buddy.” She cracked jokes and tracked down a woman in Brooklyn who would lop off Melissa’s dark brown hair and fashion it into a wig.

Feb. 20, 2008

We are going to have my wig made this week. Cancer and chemo will not take my hair too. I will have my hair for my wedding day. Cancer 2, Melissa 1. 

Melissa wore a beaded strapless gown on the day she married Steve. She carried a bouquet of pink and white roses. She and Steve exchanged their vows at a picturesque reception hall, its white balconies and winding staircases conjuring up Gone with the Wind. There had been many compromises in order to hastily pull the wedding together in four weeks, like the cheap, out-of-the-box invitations purchased at Michael’s that subbed for the classy, pocket-fold designer invitations Melissa had originally chosen. But it’s the guest list that was most important, and everyone had rearranged their schedules. Most importantly, Gail was there, resplendent in black lace, her auburn hair perfectly coiffed. Mother and daughter, both wearing wigs.

March 9, 2008

Today I married my soul mate. We had a spectacular day from start to finish. I could pretend that my mother was not dying. I could pretend that Thursday was not a chemo day. I could pretend that I was a normal 26-year-old about to begin the next chapter of her life.

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The following months were hard. Four days after her wedding, Melissa had her fourth chemotherapy treatment.

March 13, 2008

I am sitting here on my chemo drip. Mom is sitting across from me having her treatment. At least we can share this time together.

In June, Melissa finished treatment. In July, her mother died.

July 27, 2008

Today Mommy lost her battle with breast cancer. I have never felt as hopeless as I did standing there holding her hand, looking into her eyes as she coded. She was 54 years old, too young to leave this world. There are so many things she has missed. So much she wanted to do but never had the opportunity. So much that has been ripped from us. What more can our family take? 

Melissa spent the next year trying to find a new normal. She had battled breast cancer, mourned the loss of her mother and gotten married in the span of six months. What seemed normal — at least in her group of friends — was to have a baby. By the summer of 2009, at least six of her friends were pregnant.

Aug. 15, 2009

Babies are a blessing and I am so thrilled for all of our friends. Yet I cannot stop crying. I can’t help but feel the loss of children. Steve and I may never be able to have children of our own. Even if we are lucky enough to have children, I will never be able to carry them. I will never feel my child grow inside me. I will not get to feel the first kick. I will never hold my husband’s hand on my belly as we feel our child move. I feel as though so many moments have been stolen from me. Cancer has stripped me of so much; my mother, my breasts, my hair, my twenties, my immune system and now my fertility. How do I cope with this loss too?

Melissa had four embryos to work with — not a lot when it comes to the trial-and-error nature of assisted reproduction. What if some didn’t survive the freeze-and-thaw process? What if IVF failed? And how would they go about becoming parents anyhow?

Melissa asked her oncologist what advice he’d give to his own daughter about getting pregnant if she were in Melissa’s situation. He said doctorly things about there being no long-term studies about pregnancy after estrogen-positive breast cancer, the type that Melissa had survived. There is some concern, however, that pregnancy could spark a recurrence as estrogen levels rise naturally during gestation. Ultimately, he said he’d probably tell his daughter to use a surrogate.

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Jessica had accompanied Melissa to that doctor’s appointment. The two sisters went to lunch afterward. “You’re not carrying those babies,” Jessica told Melissa.

A few weeks later, Melissa, Jessica and Steve had dinner together. In between bites of pasta, Jessica shared a thought she had spent many hours considering: “I will be your gestational surrogate,” she told her sister and brother-in-law. Jessica was 25, unmarried, with no children of her own — the antithesis of the ideal surrogate, actually. Gestational carriers are typically women who have finished building their own families, a precaution in case something should go wrong during the pregnancy.

But Jessica was adamant. “I don’t care what you have to say,” she told Melissa and Steve, not unkindly. “You are saying no because you feel bad. But what is nine months of my life when I could give you a lifetime of happiness?” Melissa and Steve wept.

March 3, 2010

If I cannot carry our children, there is no one else that I would rather nurture our children through birth. She is my sister. She is the closest person to me. I may not get to carry a child, but I will still be able to enjoy the beauty of pregnancy and take this journey with her. It feels so selfish of us to allow Jessica to put her life on hold to carry our children. We have to discuss this further.

These days, surrogacy is practically commonplace. Sarah Jessica Parker’s twins were born with the help of a gestational carrier; last week, Mitt Romney’s son, Tagg, tweeted “big thanks” to the surrogate who delivered his twins. But being a surrogate is not as easy as simply offering to bear someone else’s children. There are numerous bridges a potential carrier must cross, including persuading a battery of counselors and physicians that she is capable of growing another woman’s baby, then giving it up.

Dr. Clarisa Gracia, director of the fertility preservation program at the University of Pennsylvania, where Melissa and Steve had frozen their embryos, generally requires surrogates to have completed their childbearing. “There is a whole list of requirements a gestational carrier should have,” says Gracia. “Jessica didn’t meet any of those criteria. I was very concerned from the get-go.”

But Jessica came alone to meet with Gracia. She said all the right things — that she understood that unforeseen complications could leave her unable to have children of her own, that she wasn’t being coerced. “She just really wanted to do this for her sister,” says Gracia. “I definitely would carry a pregnancy for my sister, but I don’t think I would do it for anyone else. I don’t even know what you do for your sister after that.”

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In Aug. 2010, Gracia thawed two of Melissa and Steve’s four embryos, then transferred them to Jessica. Many women endure months and months of IVF cycles in their quest to get pregnant, but with just four embryos, that wasn’t an option.

Aug. 17, 2010

We transferred two embryos into Jess’s uterus today. I have prayed to everyone today; G-d, Mommy and Bubbe. I feel them with us today. I took Jess out to lunch before we headed to Dr. Gracia. As we pulled into the restaurant, Jess was saying that she wanted broccoli cheddar soup (not exactly a summer food). However, when we walked into the restaurant we saw the specials board that listed broccoli cheddar soup. It had to be a sign! They are all with us today.

Aug. 24, 2010

Jess took a pregnancy test. SHE IS PREGNANT!!!

Sept. 5, 2010

We had our ultrasound today. There are two embryos and two sacs. IT’S TWINS! I have never been so happy in my life. Steve is over the moon happy. We are pregnant. We are going to be parents. I am going to be a mother. I am in awe. Thank you. Thank you. Thank you.

Years ago, Jessica had had a benign cyst on her ovary. “We used to joke around, and I’d say, I will carry your babies for you,” says Melissa. “It’s funny how it’s turned around.”

As Jessica’s clothes began to feel snug, she decided it would be too awkward to continue dating. She broke up with someone she’d been seeing casually rather than tell him what was going on. She was fastidious about referring to her swelling abdomen as “Melissa’s belly.” When strangers inquired about her due date as strangers are wont to do, she’d issue her stock disclaimer: They’re not mine; they’re my sister’s. I’ll tell her congratulations for you. Reactions were varied. “Some people said that’s amazing,” says Jessica, “and others were like, You’re weird.”

To keep from getting overly attached to the babies growing inside her, she would silently repeat her mantra: I’m just the oven. “I will always have a different bond than just a random aunt or uncle,” says Jessica, “but from Day One, I always said in my head that I was just a little oven.”

She was scheduled to have a C-section at 38 weeks. About two weeks before her delivery date, however, she nursed a headache all day. At the doctor’s office, she found that her blood pressure was elevated, so she was put on bed rest in the hospital. Tests confirmed preeclampsia, a dangerous complication of pregnancy that can be resolved only with delivery.

Wheeled into the operating room, Jessica lay naked on the table. Most women who are about to give birth throw modesty to the wind. But Jessica had a unique concern. She beseeched the doctor to cover her up quickly before her brother-in-law entered the room, and in a nod to the unique set of circumstances that had gotten her pregnant, the doctor complied. Later, Steve, Melissa and Jessica would all crack up over it.

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Soon, it was time for the babies to be born. The doctor asked Jessica who should be delivered first, and Jessica chose Brendan, figuring a little girl should have an older brother to look up to. He arrived at 12:48 a.m. on April 17, 2011; Gabriella followed a minute later. Steve crossed the room to where the nurses were cleaning them up and was the first to hold them; Melissa stayed glued to Jessica’s side.

April 17, 2011

Our children were born this morning at 12:48 and 12:49 am. Big Brother Brendan weighed 5 pounds 14 ounces. Little Sister Gabriella weighed 5 pounds 6 ounces. They are perfect. I have never been so in love with my husband as I was watching him hold both of our children in his arms for the first time.

Jessica is doing well. I haven’t left her side and will be sleeping with her at the hospital until she comes home. I have the most incredible sister. She has given me the gift of my children, and I can never repay her for this gift. I cannot believe how lucky I am.

Three weeks later, Melissa celebrated her first Mother’s Day. Her gift? Dinner, cooked with Jessica’s help, and a full night’s sleep, courtesy of Steve, who juggled both babies by himself through the long, dark hours.

This year, on her second Mother’s Day, Melissa and Jessica — and Steve and the babies — will celebrate together again. They’ll celebrate Brendan and Gabriella, who are just learning to walk. They’ll celebrate their mother’s memory. And they’ll celebrate the bond between two sisters, a bond that was always strong but grew even stronger when one sister gave birth to the other’s children. Forget flowers or chocolate — a sister’s gift has been the best Mother’s Day present imaginable. 

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