Alex Johnston | A Journey Through Infertility to Motherhood

Srini Rao: All right. All right, Alex, welcome to the Unmistakable Creative. Thanks so much for taking the time to join us.

It is my pleasure to have you here. So you have a new book out called Inconceivable, all of which we will get into. And having read the book, I know part of the answer to this question, but I wanted to ask you, what birth order were you and what impact did that end up having on what you've ended up doing with your life and career?

Alex Johnston: God, what a great question that is. Such a, such an interesting question. So I'm one of five. I'm number two. My personality was very much shaped by my older sister and vice versa. The five of us were about a year and a half apart, so it's five and seven years. I think the main things that I would say are we all did the same things until our twenties.

The same sports, the same music, wasn't the same schools, and love each other, but a huge amount of intensity and a ton of estrogen. And it really was in our twenties, we started to. I think find ourselves more as individuals and discover some of the interest talents that we didn't know we had growing up because we with five kids did a lot together and did a lot of the same things. We had a lot of very well now, in many ways we did growing up, but we're all pretty intense. We're all pretty assertive. And I found our. later on in life.

Srini Rao: This is something I always am curious about with people who come from such big families, because I grew up in one that was a bit smaller. It was just me and my sister. But if you have five siblings, there are two things I wonder is what impact does having such a small age gap have?

On the bond that you have with your siblings, and then two, what did you learn about human behavior and social dynamics from being one of five?

Alex Johnston: I. Two things. One I think we are close I described this in the book. My older sister and I really struggled with each other until she started her family. And she adopted her first when she was about 32, 33. And for me, it changed everything. Like we had been effectively in significant until then, and carried a lot of the baggage from our childhood into our adulthood. And she had her first child I was like, I don't wanna carry this forward. If I want a relationship with my niece, I need a really strong relationship with my we went up building that. Secondly, I loved growing up with lots of siblings. We always had friends over we were often like 10, 12, 15 kids in the house. My parents were very welcoming and that is a dynamic I know and love. But I definitely discovered later on that I like quiet time

with my kids 'cause we're three and we've got a pretty active household. It's trying to find the same thing. I think it's important to be able to learn how to live with other people.

I think compromise is really important. I think sharing is a great skill that you have to learn when you've got a large family. I also have made a. Effort to spend one-on-one time with my kids to try to see them as individuals, which they very much are. and I think the collective that I grew up in didn't give us a lot of room for that.

My parents were managing five young kids and careers. And so I think that socialization piece, loving chaos and noise and fun and food and smells and all those things is very much part of who I'm, but making sure I build in quiet time for me, for the kids. For our life and seeing people not just as a group, but as individuals has been really important.

Srini Rao: Yeah, I kinda wonder like how your parents juggled five kids like that are that close in age. 'cause I still very distinctly remember going over to my best friend from college's house, and I think her kids are probably about the same in terms of the age gap. I. And I remember they were about to put the kids to bed.

It was probably like eight o'clock, and the girls were just like running all over the place, like screaming and yelling and she's oh. She's they're putting on a show for you, just so you know you need to watch this. And she's by the way, we do this every night. And I was like, oh my God, this is what you do every night.

I wonder how did your parents manage to navigate all of this? 'cause that sounds chaotic.

Alex Johnston: The funny thing is when you become a parent, for sure, even though you say you never will, you have much more gentle feelings towards your parents than you might've previously. I remember growing up. My parents were both active involved parents. It was pretty active lives. I remember that I remember like it was yesterday, my mom just sat down in the middle of the foyer in front of her front door and she just started spitting bananas out of her mouth. And we were high fiving each other going, oh my God, we actually pushed mom to the prank where she's spitting bananas. This is awesome. And we laugh about it. years. That sounds terrible. But then you're a parent and I have three in 15 months and I'm like, oh my God. I know how she felt. I feel like I'm gonna spit bananas and have much more context. I have a lot of respect for them. I have a lot of respect for them having a big family. I have a lot of respect for the fact that somehow, even though we're different, they managed to raise five good humans.

And respect my sisters as much as anyone.

Srini Rao: Yeah.

Alex Johnston: I love the partners they've chosen. But it's not easy and it's imperfect. It's very imperfect. And so for a long period of time we focus on the imperfections. And as I grew and mature and really became a parent, I have a lot of time and a lot of love for the environment that my parents created for us, which involved many people outside of our family who are very much actively involved in and helping us in shaping us.

Srini Rao: Yeah. It, it's funny 'cause I, I remember asking, my best friend he has two daughters. It's I have to ask you. I was like, did you ever find yourself repeating things that your parents did that you swore you wouldn't do? Because I think every kid basically is like, oh, when I'm a parent, I'm not gonna do this to my kids.

And of course they find themselves doing exactly that.

Alex Johnston: A hundred percent. And one of the interesting things is my dad was a university president at two different universities. One when I was nine to about 25. And then the other when I was older. But certainly in those formative years, they would have two or 3000 people through their house over year, just entertaining like dinners and cocktail parties.

And truly, they were very much the center of the community. We loved it. It shaped us like learning how to speak to people, learning how to look people in the eyes. Learning how to engage with an 80 year old or 40 year old or an eight year old a great skill, but that that community influence on us as people was huge.

I loved it then, and I am hugely grateful for it now.

Srini Rao: Yeah. You've mentioned that your niece being born brought you and your sister closer together. My sister and I are five years apart and we never got to the point where we had so much conflict that we were estranged in any way or just had significant conflict. It's just stupid childhood fighting things.

But the thing that did change right after my nephew was born, Was how much I talked to my sister and my sister said that like she went to Berkeley and I lived in San Francisco after I graduated from Berkeley. We probably saw each other once every maybe two months and hardly talked on the phone.

And the funny thing is she called me, she said, do you ever think you'd spend this much time on the phone talking to an eight month old kid, , who can't actually talk? What is it about that, like children coming into our lives that causes that kind of change in a family.

Alex Johnston: I don't know, but it was so fundamental and people had said to me they had kids before I was a parent, you'll love your child in a way that is hard to describe. And I'd say I love my husband David. Like I really love him so much. And I'd say totally different. You're like, I dunno what that means, but can't be that different. Before I had kids just with my niece and I found it fascinating because my niece was adopted, so there's no genetic link. As soon as she came into our family, she changed everything. She changed everybody. Everybody wanted to be a better version of ourselves. She really did become the center of our world of aunts.

And for my sister and her husband as parents and for my parents and grandparents don't know what that love is, and I don't know what that selflessness is,

but happens to you where you're focused. I couldn't believe that up until she was born, I had carried so much baggage righteousness into my relationship with my sister. That overnight was irrelevant and it wasn't that overnight. We built a great relationship. It probably took a couple years, but that baggage was sidelined immediately, and then we found each other in different place, but it was almost entirely her up until that point. I held her for the first time on my shoulder, and I remember thinking, we can't keep. We can't stay in this place because if we do, I'll never be able to have the kind of relationship with her that I like. all of us, without exception terms of my sisters, became better versions of ourselves for sure. It just, there was a maturity that came with that was almost immediate.

Srini Rao: Yeah. I think that whole idea of people becoming better versions of themselves is something that I have noticed even with the presence of my nephew. This kid just lights up her room. My mom is much softer and calmer when he's around. And I noticed like I was just much more mindful about the smallest things that wouldn't have bothered me before.

But I'm constantly thinking, okay, I gotta keep an eye on this kid and make sure nothing happens to him. As I was telling you the day, my sister was like, can you watch him for 30 minutes? He's fascinated by everything he's not supposed to do. And he decided that he wanted to go play with the doorstopper.

Instead of just flicking it, he decided to dismantle it. My dad was like, watch closely, he's gonna put the tip of that thing in his mouth. And they had told me he'd already done it. And literally five minutes after we got upstairs, I was like, damn it. I'm like, put that thing, take that thing outta your mouth.

Alex Johnston: Yeah, a hundred percent.

Srini Rao: Yeah. You have written a book, I think about a topic that is hard to talk about but important to talk about and So one I wanna start by asking you, having grown up in such a large family what did that mean for you in terms of what you thought your future family and having children would look like

Alex Johnston: So I always thought I would have, so I didn't think about it for a

Like many women my age, in my twenties, I was really focused on making sure I didn't get pregnant. And then I'd say once I had relationship stability around 30 I just assumed I would have a big family. I loved growing up in a. And because my mom had five kids in seven years and look a fair amount like her, my assumption is that my experience would be like her. I never. Obviously I'd heard a bit about infertility, but like it didn't seem like it was a big deal. It didn't seem like it was a big issue, and I certainly didn't think it would be something that I would ever have to face. And so I really think that there were a lot of assumptions that had nothing to do with the fact that this sort of I'll be like my mom and I'll have lots of kids and this is gonna be easy because I'm healthy. And why wouldn't it be that I brought into the. Kind of decision making process and started at three, two, and then things really fell apart from there.

But a hundred percent I thought I would be like my mom and none of us ever thought we would have any trouble having kids. And it was a decision that was ours to make and we would have control over it. And that was very much not the case.

Srini Rao: Yeah. One of the things that you say in the book is that An unfortunate side effect of infertility discussions entering the mainstream is that too many people are getting their information from popular culture. This can create harmful misperceptions, making it look easier to get pregnant or get help that, that get help than it actually is.

There are indeed more options for fertility preservation, such as egg freezing. These are being aggressively marketed to younger women as a panacea, but the reality is that few women have the money or health insurance coverage to afford all of these options. All this leaves women. With the erroneous impression that pregnancy can happen at any age, which simply isn't true.

Alex Johnston: Yeah. Do you want me to comment on that?

Srini Rao: Yes, please.

Alex Johnston: Yeah, so I, so two things are going on. One, there's no question that reproductive tech technology has advanced even since I was going through it starting the process in 2003. And even then in the 20 years preceding that it has changed a lot. Theoretically, anyone under the sun could today can become a parent, like single person same sex couple like anyone can become a parent. But the access to those options is very limited. My concern, my primary concern in this conversation is twofold. One think that we're starting to market these things as if they are solutions and they really are just a micro. Access and they are very expensive. And in the US it's health benefits and if we're not covered, most people aren't accessing them. So it's not a real solution to this problem. And two, I think that there's I think there is storytelling around this and we love a great story about 47 year olds with twins.

And you'll see lots more magazine covers now with older public figures or celebrities having Babies. Think the image that we're presenting is that this can happen in any age. When I see the cover of a magazine and it's like a 45 or 46 year old with a child or twins, my assumption is probably it's the use of a donor egg, which is someone's choice. But in the absence of disclosing that or discussing it fully being transparent about how you've come to become parent, it. This happens, of course there are 45 year olds who get pregnant. It's very rare. And my impetus in writing a book is to make sure that women get their own information have their own information about their own bodies, and they are aware of the facts so they can make decisions on the basis of those.

But I think putting people out there as examples or role models, even though some of these stories are beautiful, is very misleading. And I think putting of the technological advances out there, which are real. Is also misleading because they're so expensive. And access to those is so limited. frankly, I still think most people just wanna be able to have a family.

Like I was very grateful that there was help, but I certainly did not want this intimate, private process between me and my partner to become a medicalized process that then required a whole bunch of doctors and interventions. And it, I lost. Any of the beauty, that might have come along with it. I was grateful to come out on the other side with a family, but I don't think most people want to be medicalizing a process that for a lot of people is just got a wonderful to be able to do.

Srini Rao: Yeah. No, absolutely. I think that that's part of the other reason I wanted to have you is because I, I wonder what is the role of media in having a responsible conversation about this? To your point? And I don't think what you mentioned there is isolated just to fertility issues.

I think we see that with success too, where we

,

have. Like serious survivorship bias in the way that the media portrays this. And it sounds like that's effectively what's going on here in, in terms of fertility. So what do you think the role and responsibility of media in like informing society about this is.

Alex Johnston: So I think what's happening now is there's a storytelling piece that's happening, which I think is great. And so I do think more people are being transparent. I love it when any public figure, including Michelle Obama who revealed a couple years ago that her daughters were born through I V F. I think it's amazing when public figures are open about their need for help. I think the piece that isn't yet happening is that second part, which is. So I needed help. I'm, me personally, I'm 53 now. I don't want a 28 year old to have to go down the path that I went down. her to be able to avoid that, we've actually gotta make sure that she has information that she's able to use at the right time. And so I think that second part of I needed help, it was really hard. It was really expensive. I could only go so far in situations because, Resources to access more help. I think those realities are important, but I think then saying, so what do we need to do to make sure that changes is that second part that's not happening.

I think there's a lack of intentionality in the conversation to say, I'm telling my story, but I'm telling it with purpose because these are the things we need to do for someone who's 20 years younger than me to avoid the very difficult path that I had building my family. That piece. I don't think has happened yet. I think the media has a huge platform. I think there's some great movies that have come out about this. I think there's some great stories. I think there's more public storytelling about around compelling public figures, but I think until we get to a place where we're saying, gosh, that is not how I would want someone to, what I would want someone to have to go through to have their family. So what do we need you to back it up? make sure that they get the information, the awareness, the support they need to have a family. These are the two.

Srini Rao: Yeah. It's funny 'cause as a guy, I don't ever, I rarely think about my own fertility as being an issue. And I still remember to this day, like when I went to a doctor's office and he was like, your testosterone is low. You need to go to a, a. Sperm bank would test something and I literally, my first thought was like, does this mean that I'm gonna have trouble having kids?

Of course, it turned out to be like a false positive, but just the thought crossing my mind was one of those weird things. And I realized even in tv, they don't really talk about it. The only time I'd ever seen it from a male standpoint was in the TV show, brothers and Sisters, where one of the characters finds out that he's sterile.

Alex Johnston: Yeah.

Srini Rao: So I wonder one, like prior to seeking fertility treatment, And realizing that you're having trouble getting pregnant, what ends up being the emotional impact on the relationship between you and your partner? And of course, more importantly, like while you're going through this, I can't imagine that it doesn't take an incredible emotional toll on you.

Alex Johnston: Yeah, it does for sure. And I think I read somewhere years and years ago that 50% of couples who end up going through fertility treatments don't. Make it. And in describe our journey in the book and it involves not just infertility treatment, but also losing a first child. I understand that statistic.

I think it puts pressure on as individuals, pressure as a couple, and I think you often end up wanting different things. I was committed to becoming a parent and we had so many failures as we were going through this, that at one point I said to my husband to be clear. I'm not gonna change path one way or another, whether it's through adoption, whether it's continuing treatments, whether it's doing this on my own. I'm committed to becoming a parent. if you don't want to continue going down this road, I am with or without you. And we both ended up aligned. I think that's the saddest thing in some ways is. As soon as you turn your mind to building a family, there is something fun and beautiful. Now, I did this in the book, but I joked with all my friends. Once we made the decision when I was 32, were gonna start trying to have a baby that was like, we're gonna sum sex.

It was gonna be so much fun. It was just this like frivolous, hilarious, fun thing that all my friends were going through at the same time. And then 12 months in, nothing had happened. like embarrassed to admit that. I was like, how is my husband doing it wrong? Like, how on earth can you not figure out how to make a baby?

Like what is going on? And again, assuming I'm healthy and my mom had five kids in seven years, so somehow that would impact my ability to have a baby. these are ridiculous assumptions, but it wasn't until we got into a fertility specialist office almost two years in that I started to get really basic information and facts about what going on, and we realized what we were up against. The lead up to that, there was no fun, there was no beauty, there was tension frustration slowly but surely we're pulling apart. and this thing that we assumed would happen happily, easily didn't happen. And we were left in this, at each other. Where do we go from here? With a lot of question marks ahead of us. So it, it is very difficult and I don't think it's something I would want. to go through. I'm super grateful for anyone that there is theoretically access to help, but it's not a path that you wanna go down unless you need to.

Srini Rao: Yeah, absolutely. You alluded earlier to the fact that the first attempt you actually lost a child. Talk to me about the grief and the, like finding the sort of courage in yourself to risk trying again when something so tragic happens.

Alex Johnston: So the shock for us, and I. P t d, which obviously grieving the loss of a child is very profound. I think it's almost a lead up to that, that it felt like having the rug pulled up from under us. So we had been in fertility treatments for three and a half years by then. and we eventually moved to work with a surrogate because for whatever reason I couldn't get pregnant. She got pregnant very easily and then miscarried, and then she got pregnant very easily again, and she carried. It's a term. I think it was almost taking this three, three and a half year experience and being on the cusp of moving to a different place. And I remember someone saying to me about a week before our daughter was born whatever you've gone through to this point, gonna pale in comparison, becoming apparent.

Like you're gonna forget everything. And I remember thinking, oh, she's right. It's irrelevant. Yes, it was a horrible three years. It was. expensive. It was felt like it sucked the life outta me. But it really doesn't matter. We're here now and I feel like walking into that the day my surrogate called and said she going into labor and really preparing myself for I ran back to my car when we parked the car to put on proper shoes because I had sandals.

I'm like no, you need running shoes. You need your feet to be really grounded. Like you're ting, I'm a mom and you just gotta be feet firmly planted. And then as I described in the book, we end up in a waiting room waiting for the doctor to come see us. And I assumed things were too far along for me to be in the delivery room.

And then they came down to see us and told us that when our surgery got to the hospital, labor was too far along and our daughter was stillborn. I feel like it was the combination of the loss and the combination of, I just don't understand how we were on the cusp of something that we had fought so hard for. And it just, it felt it felt like a, it felt like a terrible movie. This can't possibly be how this ends. And I think the combination of the grief and the absolute shock that three years into this is how our first four into parenthood ended was just, it was almost too much.

It really did say this to people. It didn't just break my heart, it broke my brain. I just couldn't make sense of it. The decision to try again was not difficult. Within husband and I looked at each other and said, if the end of this road for us is this, I don't think we'll ever recover. And the only way we're gonna recover is if we try to become parents again. And I can't just experience the pain of losing a child. I the. Try again and then moving two paths forward. Truly grieving. 'cause there was no way around it. There wasn't moving on to the next thing. It was like, this is real. This feels like it's almost gonna kill me. But keeping my head in a place where I could put the pieces in place for another surrogacy was the parallel path that we move forward and both really unfolded over. Two and half and I would say we only moved to a place that I felt was a level of happiness again and stability in life and our relationship when we became parents the second time.

Srini Rao: Yeah. You alluded to the idea that you would like you would forget about this, and I, from the handful of parents that I've ever talked to, like female friends of mine who I know have lost babies, they said that you never forget. It's not some, it doesn't go outta your mind. Even after like you have your first child, like the healthy child is born.

Alex Johnston: Yeah, a hundred percent. And I remember learning that our Our second child was a daughter and feeling just almost, there was like a, not a resentment, but there was maybe a little bit of a fear, like she can't replace her. Like nothing can ever replace her. And in the end that was irrelevant, but it was almost like there's place for number one.

There's gonna be place for number two, but they're different. Think what surprised me with the not forgetting it is it's not with me every day. Like I truly have rebuilt a happy life. And so early on, you think every single day. I'll think about my daughter every single day. I'll go to bed at night and there's a part of my heart that's gonna break. That's not how I live it. That being said, there is a part of me when I close my eyes doing anything. It could be exercising, it could be washing dishes, it could be sitting and letting my mind wander. When I read a book. There's a part of me that can go back to that hospital room in a nanosecond. And I'm there and I'm there with her. And it's deeply emotional. It's under the surface. There's a level of pain and intensity that in some ways I welcome because it's my connection to her. And I say in the book, I don't wanna live that way. I made a very conscious choice. I didn't wanna live in pain. But I also have it in somewhere in me that I can access whenever I want and go back to that place and be there for a moment because it's my only experience with my daughter. Yeah.

on a day-to-day basis, if not with me My kids. a whole peer group that had babies around the same time.

I had a very dear friend who had a daughter five days before my daughter Sam was born. I don't when their kids graduate from elementary school or high school and move on to, so I don't think of it that way, which is how I thought I would experience. It's a very different experience.

It's very real, it also feels fortunately like it's in a safe place.

Srini Rao: Yeah. Talk to me about the experience of a surrogate because you say there's often a closeness in surrogacy, given the unique nature of the relationship that transcends the limited extent that you actually know each other. And the reason that I am so curious about this is because like for. Most of us.

I think our experience of surrogacy is pretty much what we've seen on tv. Like the only thing I know about surrogates is the TV show Friends , which is not that's literally my only sort of pop culture reference that I can draw on in this moment of, oh, and I think it was Anna Ferris who ends up playing their surrogate and she ends up being the kind of wacky, and like you wonder about all these things.

So talk to me about that experience.

Alex Johnston: So it's a very, for me, it was a, an unusual relationship. And I was on, I was texting with one of my Bay yesterday 'cause her daughter actually is, Caring for a couple who I put her in touch with. And so I was just checking on that. It's really unusual. You do this incredible thing together.

It's very intimate. I have true love for both the surrogates that carried my daughters at Georgia and Sadie. They're very good people. It was a real relationship, like the real people with real wants and needs. And remember at the outset saying, is a pretty significant thing you're about to do with another human being. It's not all going to go the way you want it or think it will. You're gonna have to make it work. And so you left at the beginning like that art of compromise and listening and understanding, it's not just about your needs was real. It was over the course of the year and a half we were working together the prep and doing procedure pregnancy. And forth, and you're dealing with two human beings who are bringing a child into the world or three in with my husband. and it's a real relationship. I think that it's an unusual thing to do. Rarely do you ask someone to do something of this magnitude for you. I obviously had a huge amount of respect for them, but there was an emotion and a love and an intimacy to this, and we had no context before then. I remember being in. Hospital with the surrogate who carried my daughter Georgia. And as I share in the book, she, her water broke 12 weeks early, which was terrible. so at 28 weeks and then she was airlifted to large hospital in Toronto 'cause she lived in a rural community outside of Toronto, Canada. And they put her on bedrest and we were hoping she'd last as long as possible. And she ends up a week later going into labor. So Georgia was gonna be born at 29 weeks, she went into labor before they could do an epidural.

And so she was in huge amount of discomfort. We're alone in this tiny room near the N I C U and The doctor says, all you can do to make her comfortable is try to straddle her hips when she's going through contractions to try to make it more comfortable for her. So I'm basically straddling her and straddling her hips and I'm giving her water ice chips and going through this experience where effectively at the early stages, going through the labor process together.

And I remember thinking for both of us in some ways, I can't believe we're here. This isn't how we thought it was gonna unfold. And remember thinking, I don't know her favorite color. I don't know. There were so many questions. I was like, I'm going through the most intimate experience of my life and there are 55 things I don't know about this person. despite the fact that we're going through this together and it was that disconnect. There is a level of gratitude. I think most people feel that's quite profound. I would certainly hope they do and a level of love and affection. But congresses, they're not also day-to-day friends. They live in a different, unique part of my life.

Srini Rao: Yeah, that's the part that I wondered about too is like legal ramifications. Like what happens after does this person have any contact with your kids? You'll have to forgive me, . Since my references are all based on popular culture, but this is another one I saw in the TV show Parenthood where they find a girl who gets pregnant, who's decides to give,

,

you know her baby to them, and then they get to the delivery room where she's delivered and she changes her mind.

And it's this really heartbreaking episode. But what is all that, like how do all those like dynamics work in, in terms of surrogacy.

Alex Johnston: It's actually a great question. In that situation it was her baby and she has the right to choose to keep it or to put the baby up for adoption in a surrogacy situation like ours there's no genetic connection to the surrogate. So you know, it is our. Genetic offspring that someone is carrying.

I think the misperception, because there were some crazy stories 20 years ago when I was, going in. It is like someone's gonna run off with your baby. I remember the first time I met my surrogate in her home I came out on the other side and I liked her and respected her, and she had two young kids and to meet her in her home.

'cause I thought is this woman gonna run off with my child? And having gone through it now worked with a number of different surrogates. None of them were going to run off with my child. But I do think there is there, there's no legal connection to the baby. I think the really two challenging things I experienced were one with our first child, Sam. I. The hospital hadn't done this before, so they had not done a surrogacy before. They did not know what to make of me. And so it was clear that a person carrying the baby in their mind was the mother. And it was clear that my husband who said he was the father. 'cause that's what they understood. Pregnancy be. It was man that was a woman someone was carrying and someone got her pregnant. Didn't matter how we explained it, they really struggled to figure out where I was in this. I went to all the appointments. The really hard thing was, in asserting my sort of place. of a sudden we lose our child and you've got these two shattered people who can hardly walk. And it's crystal clear who the parents are. We live with this forever. And I was like, how going through this whole process, you not find a place for me? And now that we've lost our child, it's crystal clear the mother because my heart's breaking in a thousand pieces. It was that strange situation of trying to insert myself into the equation. That was 20 years ago. When Georgia was born when she went right into an incubator in the neo native intensive care unit they immediately said your surrogate will make all medical decision making for, and I was like, over my dead body. First of all, she doesn't want that responsibility.

Second of all, we don't know if our child's gonna live or die. There's no scenario where our surrogate is making those decisions. So I was like, I don't know what you have to do. Let's not make this a legal issue. But I'm making those decisions, my husband's making those. So they ended up going to our surrogate and saying, you verbally release relinquish your making authority.

She's of course, like I'm not the parent. And so in those moments it was very clear who the parents were. Think the legal piece can be or not, depending on how much experience and sophistication people have with surrogacy. But I think it ranges and I think for some people it's probably a very difficult.

Srini Rao: Yeah, this is a bizarre sort of fault, but what makes somebody want to do this, like to be a surrogate?

Alex Johnston: I am very honest about this in my book because I think the stereotyping perception that people wanna create is like Mother Theresa descends from the heavens and says you can't have a baby. And so I'm going to do this for you. It's my great gift to you and woman to woman. We're going to make this happen. Surrogates who carried George and Sadie, there's no question. There was like a value set and goodness in them. that was very real. and it mattered to me and I love that. But I wanted them to have something in it for them that transcended just goodness. And there's a financial component to it that is real. And so for them to be able to their family and do this was important. Sometimes people want to be a stay at home parent and this gives them the opportunity to do that for a period of time and be remunerated for caring and pregnancy. It can supplement someone's income. I think both are important and I think both often live in people who do it. I think both matter, and I don't want this to just be portrayed as that mother Theresa goodness piece and nor is it for most people who do this, I think just a financial transaction. I think both are there. I do also think many people who active surrogates get pregnant easily they're very fertile and they enjoy pregnancy and they know they can do it comfortably and well.

And they have a psychology where they say, I could do this. And at the end of this, I'll be delighted to hand someone's child over to them and get back to my life and my family. With my Green Bay surrogate she's very honest. She's got five kids of her own and she cares about my daughter Sadie.

And she loves getting information about her and pictures and stuff. But she's I know what it's like to be a mother. I know what that feeling has is, and that's not this is a different experience and it's an important one for me, but it's not becoming a parent and Sadie's not my child.

Srini Rao: Yeah, so you know, after all this, you actually ended up getting pregnant with your son, right?

Alex Johnston: I did.

Srini Rao: So talk to me about that. After like the, like I'm reading this section of the book where you say when David and I first started trying to have kids, I imagine different ways, I would let him know that he was going to be a dad.

They were all happy and playful. It seemed like such incredible news to share with your partner. In the end, six years after we talked in the balcony Italy and decided to start a family, I sat him down for the most stilted and bizarre conversation we ever had. I told him that I'd taken a pregnancy test and that it was positive.

I told him that we were having a baby.

Alex Johnston: Okay. So it really, it's like I can almost cringe thinking about being in that room because I said I'm pregnant and then it was total silence. And I just, I was like, I don't know where we're going from here. And and we had, so at the time that I realized I was pregnant, our daughter. Georgia was six months old and her daughter Sadie was three months old. So know, they're and I when I'm pregnant and I tell David, and then the first thing he says to me is he goes, am I the father? like, of course you're the father, So I was like, how is this the conversation we're having?

This is not how I imagine this snowfall. So I said, You're definitely the father. I said, I honestly don't remember how anything happened to lead to a pregnancy, but yes, you are 100% the father. And then we just effectively signed silence again. He was like, I don't understand. I was like there's nothing to understand.

It is what it is, and we're about to have three kids and 15 months. I said to him, I'm sure you're scared. I'm scared too. I don't want anything terrible to happen, but now we just have to approach this like a normal pregnancy, which in the end is what it was.

Srini Rao: Yeah. That's the, that was actually, you read my mind in terms of the question I wanted to ask. Next is, after going through everything that you've gone through and knowing that you're pregnant, like to not be scared and obviously for the sake of your own son's health, you have to be able to control your emotions and everything else, right?

Alex Johnston: Yeah, and look, it was probably for me, the first shift that I had to make, which is now you can't in fear, like you actually have to accept that you are now pregnant. I was 39. I think I was gonna deliver at 40. It it for all intents and purposes from the get go, it seemed like a normal pregnancy and you just have to accept it for what it is.

The big shift after that was once. We had the kids. And I said, I just, having been through everything we've been through, this is obviously very unusual. People used to say, you're a cocktail party story. Like you're the story that people tell at cocktail party going, can you believe it? Can you believe this?

And then this happened. And I really said I wanna lead a happy life as much as I can, and I want to be a good parent and my own devices. I would. Potentially live in fear and I can't let that happen. And so I really worked very hard to try to create space for happiness and fear is in me. And. More than manage it. I really have been able to create room for a lot of different things and with the pregnancy, I did not like pregnancy. My mom was shocked. My mom loved all of her pregnancies and she talks about skiing and playing tennis and doing all these crazy things the night before we were born. And I'm honest that there wasn't a day. I enjoyed it. Very that I was able to experience it. I found it painful. He was 10 pounds. He, basketball, I mean it. But I am very grateful that I had a.

Srini Rao: Yeah, let's finish this up by talking specifically about policy, because you say that the stakes for women are too high to simply allow the issue of infertility to be ignored. The majority of babies in countries are now born to women in their thirties, so we need to adapt to the realities that go along with that are public and health

Policy related to infertility needs to involve governments related. Governments have a crucial role to play it. And you say if governments truly value children the way many say they do, then family building policies should be high up on their public policy agenda. And like I know you alluded to certain businesses actually incorporating this into their health benefits, but I didn't even realize this was on the agenda of public policy, or is it not?

And it needs to be.

Alex Johnston: I think it's both. There's been a shift in the last three or four years in the US There's now a shift starting in Canada where I live. and there has been very generous fertility support for heterosexual couples and women in many countries for a long time. But many of those of policy approaches to family building are not occlusive.

It really is women or heterosexual couples. I think in the US. The shift is in many large companies banks and Fortune 500 companies. This now is on the policy agenda. It's a recruitment or retention tool for people, men and women knowing that this is increasingly an issue. People move to their thirties to have babies. in Canada, because it's a publicly funded health system, it really is government that has to drive this and say, we're going to fund this part of the funding we provide for. Healthcare to I think in the US what you would need to do, and I think it's important to do this, is to really mandate coverage of this in insurance policies and prioritize it that way. This is a time-limited issue for people. This is not something that you're going to live with forever. For people between the ages of maybe 28 and 42, at most, they may or may not need this kind of help. I think the challenges as the age of pregnancy has moved into our thirties. The things that I want women to know is on average our fertility peaks at 28, so by the time we're actually turning our mind to this, as fertility is already in the decline, you can get your fertility information. And so it's a very easy set of tests that your doctor can order. inexpensive.

A lot of it would be covered by Insurance regardless. once you have that, you actually can learn a lot about your body and what that would've done for me isn't expedited my family building by years. But I would've jumped right into getting help three, two, and not wasted a year and a half, two years, I would've been red flagged as someone who was on the fast track and my fertility was declining more quickly.

Another woman getting it would be like, no, your fertility is actually kicking along like the average woman. And so this is what you can expect. It doesn't tell you everything, but it tells you a lot. Doing that alone and pushing that conversation and making sure doctors are having it routinely with women in their twenties and normalizing this would be a big step.

Getting their information from the age of 28 onward annually as part of their medical checkout would be a big step. And then separately, I think you've gotta work on the bigger policy changes with insurance coverage and health benefits to to make sure this is accessible for women, men, single people, things up couples. Lots of people have the desire to become a parent. I think it's a really important decision for people to be able to make. I don't think it is unique to women. I think women and men are both interested in becoming parents and it's a very difficult thing to take that choice away from people. I.

Srini Rao: Yeah. I want to finish this up with two final questions. For potential parent aspiring parents who are listening to this, people who may be dealing with these same issues what do you want them to know? Especially when it comes to dealing with the emotional toll this takes on you.

Alex Johnston: I think we'd like to end on a positive. I think the emotional toll is real, and I think as much as possible if people can avoid it. They should. I do think getting informed is really important. So at 25, people are not thinking about babies generally. and so that's probably too young. I think that by the time you're in your late twenties, for sure, as a woman, you should be getting your fertility a checkup done As a man, if you're doing this with a partner you should be getting your fertility checkup done as well, just to make sure there, no she's there, or the man generally, if you're interested in having a baby, it's a really easy, fertility workup to do much easier for men. Much, much easier to address issues on the male side than the women's side generally. I think that information piece is huge. And I think trying to make sure that you end up doing this as easily as possible and getting to the other side as easily as possible is important. The one thing I see people do often is just trying the same thing over and over for years, thinking it's gonna happen. that might be what people hope happens, but I think being informed, making decisions. Facts and information that's relevant to you is important. And I'd say to anyone, don't put your head in the stand If you need help, get it. And the first step in that is getting information that's relevant to you about your own body.

Srini Rao: Yeah. I have one final question, which is how we finish all of our interviews. The unmistakable creative. What do you think it is that makes somebody, or something unmistakable.

Alex Johnston: that's a good question. You're really throwing me with that one. Unmistakable, I guess is memorable. I think doing something valuable, I think doing something unique, I think doing your best to have an impact and make an imprint. And that 100% is what I've tried to do with my family building experience and the book writing about my infertility experience to do as much as possible to ensure that. Don't face the same obstacles. So I think doing something impactful and unique would certainly fall in that category.

Srini Rao: Amazing. I can't thank you enough for taking the time to join us and share your story, your wisdom, and your insights with our listeners. Where can people find out more about you your book and everything else you're up to?

Alex Johnston: The book is on and many local books first, so I would find it online. Inconceivable my life altering eye opening journey from infertility and motherhood. And then I've got an author's bio online, just Alex Johnston. Inconceivable. A little bit of social media, but I'm not a social media, amazing. And for everybody listening, we will wrap the show with that. Oh, you were fantastic.

​