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Tamara Belfatto of North Plains was a gestational surrogate last year, carrying a baby for a couple from another country. She and her husband, Andrew, have one child, Arianna, 2.

(Benjamin Brink/The Oregonian/OregonLive)

The first time Carey Flamer-Powell gave birth, she delivered a girl and took her home. The second time, she delivered a boy and sent him to Georgia.

Flamer-Powell, 38, was a gestational surrogate, paid to carry the boy by his future parents, a lesbian couple. As a lesbian herself who'd struggled with infertility, Flamer-Powell found her experience so stirring that in August 2014 she set up a surrogacy agency catering to gay and lesbian clients. Eight months later, All Families Surrogacy does a brisk business from a third-floor office in the Beaverton Round Executive Suites, drawing clients from around the world.

In a convergence of medical advances and cultural shifts, Oregon has quietly become an international destination for gestational surrogacy, an industry banned in many states and countries. Couples from all over the world, especially gay and lesbian couples, come to the state and pay $100,000 or more for the chance to become biological parents, a transaction that mixes business with joy and wraps the resulting babies in a bundle of practical, legal and ethical questions.

Intended parents from countries of all stripes - Israel, Argentina, China, Australia, France, Sweden, Ecuador, Canada, Germany, Egypt - are flocking to All Families and other Oregon surrogacy agencies for a combination of reasons, said those working in the field:

Oregon has no law against gestational surrogacy. Some states, such as Washington, forbid any paid surrogacy; Oregon surrogates are advised not to travel to Washington in their third trimester. In other states, surrogacy is legal for heterosexual married couples but not for same-sex couples.

Oregon has a pre-birth procedure for amending a birth certificate so it bears the names of the intended parents and not the surrogate's. The procedure, devised by Beaverton lawyer

According to 2012 statistics from the Centers for Disease Control and Prevention, gestational surrogacy accounts for about 1 percent of the annual 60,000 U.S. births through assisted reproduction technologies. It's not clear how those statistics play out in Oregon, because the state doesn't track births by surrogacy.

What is clear is that gestational surrogacy has burgeoned to where so-called intended parents can choose from an increasingly varied array of agencies in Oregon: Decades-old agencies with hundreds of babies to their credit, newer "boutique" agencies that work with only a handful of clients at a time, agencies that once specialized in adoption but now offer surrogacy as well.

In fact, surrogacy is now gaining on adoption in popularity. The Northwest Surrogacy Center expects to facilitate 75 to 100 surrogate births this year, Chally said. With more countries shutting down international adoption and fewer women giving up babies, adoption isn't the option it used to be. "I don't know where we would be today if we hadn't added surrogacy," he said.

His comments were echoed by Susan Tompkins, executive director of Journeys of the Heart, a 25-year-old Hillsboro adoption agency, which decided last year, after years of watching adoption rates drop, to start offering gestational surrogacy. The agency now has 15 surrogates and is working toward its first surrogacy birth.

"It's definitely something that is a trend," Tompkins said.

***

In a side room at the Lucky Labrador Tap Room, seven women sit chatting amid plates of pizza and salad and glasses of wine or beer. They're here on a rainy Saturday evening in February to learn more about All Families Surrogacy and what it takes to carry someone else's baby.

All Families Surrogacy of Beaverton has three staff members: business manager Kaylyn Hawkins (left), surrogate coordinator Angela Padilla (right) and owner/founder Carey Flamer-Powell. The agency will hold an open house for prospective surrogates from 6 to 8:30 p.m. Saturday, May 9, at the Lucky Labrador Tap Room, 1700 N. Killingsworth St.

The lights go down. Flamer-Powell and Angela Padilla, the agency's surrogate coordinator, click through presentation slides noting All Families' requirements for surrogates: No one under 21 or over 44. A history of uncomplicated pregnancy and at least one healthy birth since any miscarriage. At least one child at home, because a surrogate should understand what it's like to be a parent. No one who's on any form of government assistance, because "surrogacy is not meant to be a job," says Flamer-Powell. No one with a body-mass index over 34, because a surrogate should be in good health.

The women in attendance learn that intended parents cover all expenses: fertility treatments and hospital bills, prenatal vitamins and maternity clothes, legal fees and more. If they come from overseas, they handle the paperwork for the baby's passport and, if necessary, the baby's immigration visa, a process that can require still more money for potentially lengthy stays in the U.S.

All Families Surrogacy starts new surrogates at $30,000, experienced surrogates at $35,000. In March, the agency offered a $500 signing bonus for qualified surrogates and those who referred them.

Flamer-Powell says she's not in it for the money. She doesn't need to work, she tells the attendees; she's in business to help other people experience the fulfillment of parenthood.

The lights come up, and the questions begin:

Is a surrogate's compensation taxed as income? No, says Flamer-Powell. The money is considered payment for pain and suffering. (That could change: In January, the U.S. Tax Court ruled in Perez v. Commissioner that the Internal Revenue Service could tax an egg donor's $20,000 compensation as income because the donor was paid for services rendered.)

What citizenship does a baby born through surrogacy have? U.S. citizenship, as with any other baby born on American soil. It's up to international parents to decide if they want to seek citizenship in their home countries as well for the baby.

Are embryos screened before being transferred to a surrogate's uterus? Yes. (Dr. Paula Amato, a reproductive endocrinologist and expert in fertility services at Oregon Health & Science University, says in a separate interview that the screening is regulated by the U.S. Food and Drug Administration "because you're transferring tissues.")

Which insurance companies are surrogacy-friendly? Flamer-Powell emphasizes that surrogates with her agency must carry their own health insurance and names three locally available health plans that cover surrogacy.

If a surrogate has a miscarriage, does she still get paid? Her compensation is pro-rated based on the length of her pregnancy. It's also pro-rated if she delivers prematurely.

What about breastfeeding after the baby is born? Surrogates don't nurse. Instead, intended parents who want the baby to have breast milk and/or its precursor, colostrum, will ask a surrogate to pump.

Not asked are the questions everyone outside the world of surrogacy has: Why would a woman do this? How can a woman carry and deliver a baby, then just walk away?

***

John Weltman, founder and president of Circle Surrogacy of Boston, a 20-year-old agency that has recorded 1,000 surrogate births for clients from 69 countries, said he'd rank Oregon among the five best states for surrogacy, alongside California, Colorado, Connecticut and Massachusetts.

"Oregon is a great state for surrogacy, no question about it," Welman said.

And being able to go through surrogacy in a state also known for its gay-friendliness is icing on the baby shower cake for gay and lesbian couples.

Chally, of Northwest Surrogacy Center, estimated that 70 percent of his clients are gay. "That part of the practice is still growing quickly and we're very happy to be doing that," he said. His clients, in turn, are delighted to be in Oregon. "People in Portland have been very kind to our clients, very embracing, very curious in a kind way about what they're doing. ... The acceptance has been high," he said.

Black said that when she first got into surrogacy about 10 years ago, "it was definitely more of a heterosexual-focused family-building opportunity. But as it becomes more popular and more well known, the availability for the LGBT community has just skyrocketed."

Black linked the increase in gay and lesbian clients to surrogates' relatively high acceptance of same-sex couples. "Surrogates have to be a pretty open-minded group of individuals," she said. "And they have that option of choosing who they want to carry for."

Beaverton lawyer Robin Pope's office door bears thank-you notes and photos from grateful clients who are now parents through surrogacy.

"Surrogacy," said Pope, the lawyer, "really has become a gay rights issue."

But the law has struggled to keep pace with the medical and cultural advances. There's no regulatory oversight or licensing for surrogacy agencies, Sperling-Newton said. Instead, there are guidelines for best practices from the American Society of Reproductive Medicine and strong recommendations to use one of the 150 or so attorneys who have AAARTA credentials.

And when lawmakers do try to address surrogacy, they can run into political and ethical opposition.

In 2013 and 2014, Louisiana Gov. Bobby Jindal vetoed bills that would have legalized surrogacy contracts in his state. "(T)his legislation still raises concerns for many in the pro-life community," Jindal wrote in his veto letter, referring to the fact that surrogacy sometimes involves abortion of surplus embryos.

In 2012, New Jersey Gov. Chris Christie vetoed a bill that would have loosened his state's restrictions on gestational surrogacy. He said there were still too many questions about "the profound change in the traditional beginnings of the family" that the proposed law would have set in motion.

Critics of gestational surrogacy also voice concerns about exploitation of surrogates, saying the women might not fully realize what they're signing up for or the risks they're taking.

Sperling-Newton said every surrogate she's met in three decades in the business has known exactly what she was doing, and the objections and concerns are behind the times.

"It's happening," she said of gestational surrogacy. "It's going to be a way for people to build their families, regardless of what the law does, and so we have to catch up and try to create laws to protect people."

***

Tamara Belfatto, 27, is soft-spoken but unwavering; she shows no hesitation in explaining why she decided to carry twins for a couple from another country last year.

Belfatto grew up in Eugene; graduated from North Eugene High School and Pioneer Pacific College; married; and had a daughter, Arianna, now 2. Belfatto worked at a bank and at a Netflix call center, then stayed home with her daughter for awhile before returning to work this spring.

"We have a lot of infertility on both sides of our family," she said of herself and her husband. "That's what originally drew me to surrogacy."

Motherhood was the turning point for her, she said as she sat in her North Plains living room while her toddler napped in a bedroom and a tiny 6-week-old Jack Russell/rat terrier dozed in a basket on the floor.

"I had that self-realization of what it was to be a parent," she said. "I felt more for people that couldn't. ... With my daughter, I don't know what I would do without her now that I have her. I don't think anyone should have to go without kids."

And being a surrogate isn't just about giving, she said. It's also about receiving, in that surrogates and intended parents often form close ties. "I wasn't looking to just help someone have a family but I was also looking for that special relationship and connection that you can make," she said. "We added more members to our family."

Her husband, Andrew, said he was initially surprised when she brought up the idea. "It's not something I ever thought about," he said.

But neither he nor his wife recalled him objecting. She said the only questions she remembers him having were about whether she could truly walk away without a baby in the end. "For so long I wanted a baby of my own," she said. "We were married for five years before we had Arianna."

But the twins were different, she said. To explain, she cited a children's book, "The Kangaroo Pouch" by Sarah Phillips Pellet, which equates surrogacy with babysitting.

"I was kind of distant," Belfatto said of her feelings toward the twins in utero. "Because I knew they weren't mine."

That's a perspective echoed by other women who've been surrogates.

"I never had any attachment," said Padilla, the surrogate coordinator at All Families Surrogacy, who carried twins for a gay French couple last year as a gestational surrogate with a different agency. "It was really cool to feel them moving and kicking but I was never like ... " She gave an exaggerated sigh. Perhaps it helped, she joked, that she and her husband have three children under the age of 6. Her mindset was more along the lines of, "I am so glad I'm not taking these babies home. They are all yours!"

Flamer-Powell said surrogacy isn't about giving up a baby but about giving a baby back. "This is not a bonding experience between you and an infant," she said. "Honestly, this is more a bonding experience between you and the family."

In her case, she said, the women she carried for became close friends who now text her regularly with photos of their growing boy. On the day she delivered their son, she said, her 3-year-old told them, "Here's your baby. My mommy carried him for you."

Black said surrogacy is, ultimately, about families.

"It's one of the most beautiful family-building options out there," she said. "So intentional, with so much love and care and thought. And that's really magical."

-- Amy Wang

awang@oregonian.com

503-294-5914

@ORAmyW