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t m c » p u l s e | m ay 2 0 1 7 21 Pills and shots To prepare her uterus, Nora underwent a series of hormone therapies to simulate the natural cycle of pregnancy. She first took estrogen pills three times a day to mimic what happens during a natu- ral conception cycle. "In the beginning, the uterus is exposed to estrogen," Abdallah said. "We monitor the response of the uterus by doing an ultrasound and measuring the lining of the uterus." Once the lining reached an ideal thickness, Nora needed to take a second medication, pro- gesterone, to prepare the uterus to receive the embryos by inducing the production of nutrients necessary for the embryos to thrive. These pills were taken for five to six days to synchronize the uterus with the embryos, creating the optimal window for implantation. In addition to this combination of estrogen and progesterone, Nora received at-home hor- mone injections of Lupron to prevent her men- strual cycle from interfering with the surrogacy. Her husband, Marco, diligently practiced inject- ing a needle into an orange until he was confident enough to administer the Lupron shots himself. Every day for 11 weeks, Nora endured injections in her buttocks. "Not once did I feel like, 'You know what, I'm not okay with this,'" Nora said. "My heart wasn't racing. I wasn't nervous at all. It felt like this is what I was supposed to do and it felt right to me. It was harsh, but I made it through." Meanwhile, Abdallah and his team insemi- nated the batch of eggs with de Luna's sperm and grew the embryos in culture. After the fifth or sixth day, Abdallah implanted two embryos. Then they waited. "With every treatment ... I can't say I'm as anx- ious as the woman or the man, but I'm anxious to see the results," Abdallah said. "To date, I haven't lost that anxiety." But Nora could not bear to wait the recom- mended two weeks to find out whether or not she was pregnant. A week after the implantation, she bought a home pregnancy kit, eager to find out if she would be delivering good news to the couple or crushing their dreams. The test was positive. De Luna and Vasquez were going to be parents. Fighting stigma Nora knew it would be confusing for her three children to see their mother pregnant, but not with their brother or sister. "We told them from day one what I was doing," Nora explained. "They know their uncles are gay. I told them they wanted to have a family, but they can't have kids because they're boys, so they wanted me to carry their baby." Every day, she read them a children's book about surrogacy, The Kangaroo Pouch, so that, little by little, her girls would understand that she was carrying their cousin. But Nora still fought Mazen Abdallah, M.D., demonstrates the implantation process at Houston Fertility Institute. stigma from friends and family. "I had friends who asked me, 'What are they going to explain to the kids when they grow up?'" Nora said. "'Where's their mom?'" Others questioned whether or not she would be able to go through with the surrogacy. Even Nora's mother, whom she describes as "old-fash- ioned," worried that she would suffer an emotional breakdown from giving birth to the babies and then giving them away. But Nora never wavered. She prepared herself to not feel attached, to not view herself as the baby's mother. "Once I say I'm going to do something, I'm going to do it," Nora said. "I keep my word. I don't back out." Labors of love Towards the end of the 39th week, Nora began experiencing contractions one morning. It was time. As she and Marco sped to the hospital, she repeatedly called and texted Vasquez and de Luna, both of whom had moved to San Antonio by then for work. "I'm already having the baby!" Nora told them once they finally called back. "Oh my gosh, really?" they said. "No, I'm kidding," she joked. While they waited for her to dilate, her doctor administered Pitocin to induce labor. The med- ication didn't take effect immediately, allowing Vasquez and de Luna to hightail it the 200 miles from San Antonio to Memorial Hermann Hospital in Houston. Twelve hours later, Nora delivered Vivienne Katalina Vasquez—born 7 lbs., 1 oz.—at 7:01 p.m. on July 25, 2015, exactly 37 years after the birth of Louise Brown, the first "test tube baby." It was a milestone in the couple's lives that coincided with the anniversary of the scientific breakthrough that allowed their dreams to come true. Six months later, the couple and Nora were ready for round two. They inseminated the eight remaining eggs with Vasquez's sperm, ready to experience the same elation as their first preg- nancy. But of the eight eggs, only one became an embryo. The chances of a single embryo catching were slim. Abdallah was hopeful, but he couldn't make any promises. Two weeks later, a blood test con- firmed the worst. "I was devastated," Vasquez said. "When I thought that I wouldn't have a child biologically, I prayed on it. I asked for things that maybe I had no right to ask for." Financially, de Luna and Vasquez hadn't prepared for a third attempt. They had already spent $30,000 for the first treatment and another $30,000 for the second. But they decided to try again. This time, of the 10 eggs they inseminated, eight became embryos. Abdallah selected the best two embryos and implanted them in Nora. One of the eggs was already splitting; there was a good chance they would be having twins. "Only God knows why He does the things He does," Nora told the couple. "Maybe that's why you didn't come out pregnant the first time. Now, you'll have two." And two it was. Standing at just under 5 feet, Nora's petite frame carried a single baby easily, but carrying twins would be a new and daunting challenge. Vasquez and de Luna couldn't imagine how someone her size would be able to hold two babies. "To me, I was just like, 'I'm going to be suffer- ing for nine months, but you're going to be stuck with them for 18 years, so I'm okay,'" Nora joked. Within three months, Nora's stomach had dou- bled in size. By six months, it had tripled in size and protruded so far from her body that it looked like she was ready to give birth any minute. (continued)