The ultimate gift

Juliet was 12 and Jen just six months old when their lives were first torn apart. On Friday, October 25, 1985, their parents packed everyone into their silver Honda Accord and headed home from a beach getaway. Roughly halfway through the drive, a van smashed into the passenger side, killing the girls’ mother.

After the accident the family, dazed with grief, tried to regain a sense of normalcy. But within a year, Juliet and Jen’s father, an Air Force officer, began dating someone new. “For me that was too fast,” says Juliet, who ran away to Washington, D.C. There, at age 13, she found herself on her own in the inner city, and the streets quickly turned dangerous. “I ended up eating out of trash cans and exchanging myself for somewhere to sleep,” she says. “You do bad things in order to stay alive.” After six months of toughing it out, she realized that home couldn’t be any worse. But when she returned, the house was vacant. “I just sat there on the porch,” she says. “I didn’t know what to do, where to go. So I turned myself in to the police.” From there she landed in foster care and bounced around from family to family, growing angrier and tougher with each failure. After the fourteenth placement fell apart, her social worker, Tracey Sasso, put her in a car and drove her to a no-nonsense couple in Nokesville, Virginia. “You’ve got to make this work,” Sasso said. “I have nothing left.” That last-chance foster mom, Erma Koontz, took one look at the cocky 15-year-old walking through the door and melted. “I saw this very sad girl with a chip on her shoulder,” Koontz says, “and I think that’s why I fell in love with her.” Juliet stayed through the rest of her teens and came to call Erma Mom.

Thirteen hundred miles away, little Jen was growing up and making the best of things in Houston, where their father had moved her—but by third grade, she, too, wound up in foster care due to physical abuse at home. As one of 200 kids her foster mother took in over the years, she felt more like a passenger at a way station than a member of a family. “It wasn’t the kind of ‘loving’ I ached for,” Jen says. She could barely even recall having an older sister.

For Juliet, however, the memory of a baby sibling was haunting. Among her five or six only possessions were a tattered photo of Jen as a toddler, taken the last time they were together, and a set of tiny barrettes she’d bought and never had a chance to give her. “I always longed to find her again,” Juliet says. “She was the only blood I had on this earth.”

But they didn’t meet again until their father died. When Juliet, by then 28, flew to Houston for the funeral, she drove first to the foster home she’d learned her younger sister was living in. And as she pulled up in a rental car, Jen, 16, stood waiting in the driveway; they hadn’t seen each other in 14 years. “She was so grown-up,” Juliet remembers thinking. “I couldn’t get out—I just sat there crying. I had spent my whole life waiting to find this girl.”

They clung to each other fiercely, and before leaving, Juliet told her sister, “If you want to come live with me after high school, I’ll pay for a one-way ticket.”

It would be a full five years before Jen took her big sis up on the offer. But then, one day, “about to lose the couch I’d been sleeping on,” she called—and flew to Baltimore-Washington International Airport. When Jen stepped off the plane clutching everything she owned in a garbage bag, Juliet took one look and saw her former self, holding that same bag, walking up to so many strangers’ homes. “I knew what it was like to be a foster child and feel like you never had your own family,” she says, “and I was so happy I could finally offer one.”

By then, thanks to the Koontzes’ steadying influence, Juliet had built a solid life in small-town Maryland with a job as a hospital billing manager and an adoring husband, Lester. (Juliet had met him at a bar one night and asked if he was going to kiss her right there in the parking lot. “Because if you can’t kiss,” she’d told him, “this is not going to go anywhere.”) He welcomed their new housemate, and the couple teamed up to get Jen situated with new clothes, a job, a car, and plenty of unconditional love. With the sisters back together, the one thing missing from their homey 100-year-old place, almost a cliché with a white picket fence, was the sound of children playing.

And baby makes four

Even before the sisters were reunited, Juliet and Lester had hoped to have a baby; when it didn’t happen after five years, Juliet went in for tests. Surgery to remove a benign tumor left her without fallopian tubes and only one ovary, and by the time she took in Jen, she’d spent more than a year—and $5,000—juiced up on fertility hormones trying to use a friend’s eggs to conceive. Each failed attempt felt like an unbearable loss, and Jen sensed her older sister’s deepening disappointment.

One morning in the kitchen, out of the blue, Jen turned and said, “I’d love to give you my eggs if it would help.”

“Oh, no, no, no,” Juliet answered quickly. “Don’t do that. It’s too weird. I’m going to figure this one out.”

“I want to,” Jen insisted.

Juliet didn’t take the idea seriously at first. But when Melissa Esposito, M.D., her ob-gyn at Shady Grove Fertility Center, told her in no uncertain terms that the friend’s eggs weren’t working out, Juliet brought up Jen. Having handled other sister-to-sister donations, Dr. Esposito felt it could be a good option, especially because Jen was only 21, with younger, more-viable eggs. But the doctor was careful to explain the drawbacks. “Some women get upset at the thought of sitting across from their sister at the Thanksgiving table and having her say, ‘I don’t like the way you’re raising our child,’” she recalls telling Juliet. The key, adds Andrea Braverman, Ph.D., director of the Braverman Center for Health Journeys in Philadelphia and a specialist in infertility counseling, “is to have a donor who doesn’t see her egg as her baby but instead thinks, I wouldn’t be using it anyway, or, Look, we share the same DNA—my eggs, your eggs, what’s the difference?”

In these cases, experts agree, sisters can feel an amazing connection. “We get close to people we share life experiences with,” says Braverman. “And this—every pun intended—is the mother of all experiences.”

“I felt like we’d come to the end of a long journey and this was our miracle. We had an unbelievable bond.” —Juliet Pearrell, left, on giving birth to a baby made with her sister’s egg

After the visit to Dr. Esposito, Juliet approached Lester, and he was immediately on board. “To me it was a blessing that somebody in the family was willing to do it,” he says. So Jen got ready to donate her eggs by starting ovary-stimulating injections, while Juliet received hormonal shots to sync her cycle and prepare her body for pregnancy. In three months all systems were go: Dr. Esposito could extract Jen’s eggs and transfer an embryo to Juliet. The total cost would be $37,750, an amount Juliet took out a home loan to pay. “Who even writes a check like that?” she says incredulously. “I made Lester stand by me at the kitchen table for support.” (Costs can vary, depending on the medical condition and the number of in vitro fertilization [IVF] rounds. And some sisters actually donate the egg and carry the baby for a sibling, but legally that can be very complicated, says New Jersey reproductive lawyer Melissa Brisman, and doctors shy away from the practice because the surrogate’s emotional bond to the child may be too strong.)

After Jen’s eggs were fertilized with Lester’s sperm, they were implanted in Juliet’s uterus. The first and second attempts didn’t work, but on September 4, 2007, after the third attempt, Juliet learned she was pregnant.

Who will she love more?

The next nine months were a breeze for Juliet—physically. But inevitably, doubts started creeping in. “Initially I thought, Lester and my sister are having a baby, even though I was carrying it,” she says. “One friend actually joked, ‘Why didn’t you just let them have sex and save the IVF money?’ And Erma’s concern was: What happens when Jen sees the baby? Will there be a longing?”

Something else nagged at Juliet. Her biggest worry, she says, was “my daughter wanting Jen—knowing I wasn’t the real mommy. I had many a dream that she would come out of my womb and run straight to Jen.” (Such dread is common, says Braverman: “It’s known as the impostor syndrome and usually diminishes once you have the baby, get busy with the day-to-day tasks of parenting, and quickly become the ‘expert’ on your child.”)

Lester, it turned out, had no hesitations. “Jen did us a favor,” he says. “But I don’t really think about her egg. To me this is Juliet’s and my daughter.” (All the fathers GLAMOUR spoke to in similar cases echoed that sentiment.) As for Jen, within four months of donating her eggs, she became focused on her own exciting news: Having gotten engaged to Erma’s nephew, Josh Kimble—a father of three girls in Richmond, Virginia—she now was pregnant herself.

Jen still remembers racing to Frederick Memorial Hospital the day Emma was born. “My sister was crying as I walked in,” she says, “and I felt immense love for her.” Juliet was overwhelmed with emotion too. “When I gave birth and the nurses said, ‘Congratulations, Mommy,’ I thought, They can’t begin to realize all it took to get to this moment to hold my baby,” she says. “It felt like Jen and I had come to the end of a long journey and this was our miracle.” At one point, both sisters recall, they stopped ogling the new baby and simply looked at each other. “Even though my husband was involved,” says Juliet, “almost everything that happened was between my sister’s body and mine. We had an unbelievable bond.”

Four years later, Lester is still in awe. “Each of these women went through so much,” he says. “It’s crazy how it all came together and happened.” He and Juliet have already started easing Emma into knowing her unusual heritage: “Mommy’s body couldn’t do all the things Mommy wanted it to, so Aunt Jen helped,” Juliet tells her. And “cool Aunt Jen,” now married to Josh and studying to be a nurse, couldn’t be more ready to give another egg. “I don’t feel Emma is my baby; she’s part of the family,” she says of her role, and adds, with a laugh: “I’d love for us to keep going—Jen and Juliet plus 20!”

Maybe someday. For the moment the sisters are content with what they already have. “Our own mom died, our father abandoned us, and Jen and I spent so many years apart,” says Juliet. “We longed for this—to have each other, to have our own kids, and to not feel lonely anymore. But the way we’ve created family has taken it to the next level.”

How Much It Really Costs to Make a Baby

The number-one reason to use a sister’s eggs? To have a genetic link with the child. But it’s also the cheaper choice:

Treatment

…costs with an anonymous egg: $15,000

…and a sister’s egg: $15,000

Medications

…costs with an anonymous egg: $2,000–$7,000

…and a sister’s egg: $2,000–$7,000

Donor compensation and agency fees

…costs with an anonymous egg: $14,000–$19,000

…and a sister’s egg: $0

 TOTAL

…costs with an anonymous egg: $31,000–$41,000

…and a sister’s egg: $17,000–$22,000

Average fees from the Sher Institute, which has fertility clinics in Illinois, Missouri, Nevada, New Jersey, New York, Pennsylvania, and Texas. Treatment costs can vary based on location, medical condition, and insurance coverage.

Liz Brody is a National Magazine Award winner and editor at large for GLAMOUR.

Risk Factors

No one knows what causes autism or why there’s been a spike in the number of kids with an autism diagnosis in recent years. Most researchers suspect a genetic link. Kids whose siblings have an ASD are more likely to have an ASD, and among identical twins, studies have shown that if one child has an ASD, then the other is affected about 60 to 96 percent of the time. Certain medical conditions, including Down syndrome and fragile X syndrome, may increase the risk of ASD. So may some medications taken by the mother during pregnancy, such as SSRI antidepressants. It’s important to know that vaccines do not cause autism. A well-publicized article claimed a link between vaccination and autism, but that article was found to contain falsified data and has since been debunked. No other studies have replicated the results. So you can rest assured that it’s okay to follow your child’s pediatrician’s recommended vaccine schedule. Some suggest that autism could be triggered by environmental causes; others believe certain areas are more likely to have kids with autism because they’re affluent neighborhoods — and people with higher incomes are more likely to have good medical care and get diagnosed. Not all the suggested connections out there have been proven.

Signs and Symptoms

Autism is typically diagnosed when kids are about four or five years old, but many parents report seeing worrisome symptoms before three years of age. About one-third of parents noticed symptoms by one year of age; 80 percent of parents were sure something was “off” by the time their child turned two. Children with an ASD may develop according to schedule in the first few months or years of life but eventually fall behind on certain developmental milestones, such as talking. That’s why pediatricians and autism experts encourage parents to become familiar with the typical developmental milestones and to seek medical advice if baby doesn’t hit them. “We look for cooing, babbling and gestures by one year of age,” says David Perlstein, MD, medical director and vice chair of pediatrics at St. Barnabas Hospital in Bronx, New York. “By 15 to 16 months, a child should be able to say some single words, and by two years, they should have some couple-word phrases.” Peacock says it’s a good idea to keep track of your child’s developmental milestones so you know if and when he falls behind. She recommends “Milestone Moments,” a CDC-developed pamphlet that’s available on the CDC’s website. “You can check off the milestone your child hits, and if there are some you’re concerned about, you can take the booklet along to a well-child check and talk with your child’s pediatrician about your concerns,”

Peacock says. Other early symptoms of ASD include:

• Not pointing at or showing interest in objects by 14 months
• Repeating words and phrases over and over
• Avoidance of eye contact
• Becoming easily upset by minor changes
• Hand flapping, body rocking or other repetitive motions
• Obsessive interests
• Not playing “pretend” games by 18 months
• Unusual reactions to sights, sounds, tastes, smells and physical sensations

Also know that baby’s pediatrician will likely be on the lookout for autism symptoms. “The American Academy of Pediatrics recommends screening all kids for autism at 18 months,” Perlstein says. Most docs use a tool called the Checklist for Autism in Toddlers. If they notice any troubling symptoms, they may ask you to carefully observe your child’s behavior over the next few weeks. “I’ll give them a diary so they can track their child’s behavior, or I’ll tell them, if they have a smartphone, to videotape the child doing things,” Perlstein says. And red flags may mean follow-up treatment.

Diagnosis and Early Intervention

If your child has any type of developmental delay, your pediatrician will probably refer your child for treatment — even if he hasn’t been diagnosed with autism. That’s because early intervention is crucial for children with any kind of developmental delay. “If I find that there’s a language delay, I’ll refer the child to language therapy. If there’s a motor delay, we’ll start motor therapy. If there’s a social aspect where the child doesn’t engage, we’ll try occupational therapy or behavioral therapy,” says Perlstein. Most kids will be eligible to receive in-home services through their state’s early intervention program. (In many states, it’s called the Birth to Three program.) Children who are over three can receive services through their local public school. Meanwhile, your doctor will work to rule out other possible causes of any developmental delays, such as poor hearing. Your child might also be referred to a developmental pediatrician, neurologist or child psychologist for a formal diagnosis. These experts will look for difficulties in communication, poor social skills and repetitive and unusual behavior. If your child meets the criteria listed in the American Psychiatric Association’s Diagnostic and Statistical Manual, your child may be diagnosed with an ASD.

Treatment

Remember: There is no known, proven cure for autism — despite what you might read on the Internet. “There are a lot of ‘quick fixes’ being promoted out there, but there really isn’t a quick fix,” Peacock says. “We don’t know of anything that will cure autism, but we do know that early intervention is beneficial.” Early intervention programs are designed to meet your child’s needs and will vary from child to child. “If a child is having trouble communicating, you need to find them a way to communicate. If they’re tantruming so much that they can’t learn those skills, helping them get that behavior under control makes them more ready to learn,” Peacock says. “The goal of early intervention is to help children learn how to communicate and to get them ready to learn.” It’s impossible to know, at the time of diagnosis, just how much your child will overcome their autism symptoms in the future. “You never know where someone’s going to end up at the time they present,” Perlstein says. “But the earlier you start therapy, the better kids do.” Discuss any promising treatments with your physician. “There are tons of people out there who claim they have appropriate treatments for autism,” Perlstein says. But just because something seems to work for one kid — or even for thousands — that doesn’t mean it will work for yours. Emerging therapies, such as music or immune therapy, may be beneficial for some children with an ASD, but no one knows which kids are most likely to benefit, and unproven treatments can be expensive. “Until we’re better at understanding how to figure out which patients will benefit from which treatments, your best bet is to go with the treatments that have been proven to be effective,” Perlstein says. “If you’re a parent of an autistic kid, number one, get the primary therapies, like the speech therapy and behavioral therapy. Then be very careful about all the other recommendations.” Any treatment plan should involve the family. “It’s really family support that helps these children and families be successful,” Perlstein says. It’s a good idea to get support for yourself too. Look for local support groups for parents of kids with autism, or get involved with an organization like Autism Speaks; you’re likely to meet other parents who are going through the same types of things as you