What would you be willing to do for one of your best friends?

Throw a surprise party in her honor? Take her on a trip to Tahiti, all-expenses paid?

How about carry her baby for nine months? 

For Jewish St. Louisan Nikki Freyman, the decision to be a surrogate (gestational carrier) for one of her best friends, Kati Kaup, and Kati’s husband, Gerome Gregory, wasn’t made lightly, but it wasn’t all that difficult, either. 

“It was probably around 2010,” said Nikki, explaining she and Kati became fast friends after meeting five years earlier working in sales at the Palmer House Hilton in Chicago. They were both in their early 20s and it was their first real jobs after college. 

Neither Nikki nor Kati was married or had given birth, but Kati had grown up thinking she would become a mom. “Then reality hits and your health declines and you’re told you can’t have children,” Kati said.

Nikki became worried about her friend, whose health seemed to be getting worse.

“I just knew how much she loved kids, and I had this thought that I would carry one for her one day, not knowing at the time what went into that decision,” Nikki said.

As an infant, Kati was diagnosed with cystic fibrosis. The genetic disease affects the lungs and digestive system, and can produce thick, sticky mucus that can clog the lungs and obstruct the pancreas.

“When Kati coughed, it sounded like she was drowning in her own mucus,” Nikki recalled.  “I watched her go through what she called her ‘tune-ups’ where she’d go into the hospital for a weekend to have a breathing treatment and lung treatment where they literally shake the mucus off her lungs.” 

On Nov. 11, 2015, after Kati’s health had become dire, she underwent a double lung transplant after being taken by medevac from Northwestern Memorial Hospital to the Cleveland Clinic. The transplant didn’t cure her cystic fibrosis — she still has the disease —  but as Kati explains, “it gives you a clean slate, a do-over. The cystic fibrosis doesn’t go away, but it gives you a fresh set of lungs.

“That said, there is a high likelihood in the first couple of years of a rejection,” she continued, adding that she has to take anti-rejection medication for the rest of her life. “I have been lucky enough not to have any rejection with these lungs, so it was a really good match. My physician feels very optimistic that I can have a long life, but a pregnancy would be too risky.”

Now is the right time

The same year as Kati’s double lung transplant — 2015 —Nikki moved from Chicago to St. Louis with her husband of two years, Dan Freyman, who grew up here. The two met a few years earlier in Miami when she was there for a friend’s birthday and he was there for a bachelor party. 

Before they got married, Nikki converted to Judaism; she and Dan belong to Central Reform Congregation. They now have two daughters: Piper, 5, and Meryl, 20 months.

In July 2019, six weeks before Nikki gave birth to her younger daughter, Nikki, Kati and some other friends met for a girl’s weekend at the Chase Park Plaza. Kati, who was still living in Chicago at the time, had recently gotten engaged to Gerome, and she mentioned to Nikki that they were starting to work with a surrogacy agency. 

 “I spent a number of years thinking I would not have children but when I met Gerome and we started talking about it, it was like, ‘OK, how can we make this work?’” said Kati, who is not Jewish and grew up in Orange, Calif., the youngest of seven. “It was important to us to explore having our own children before adoption. We started talking about going down the surrogate route. I had been told by many doctors the medication I was taking (for cystic fibrosis) would essentially fry my eggs and they wouldn’t be useable to make embryos. So I saw a fertility specialist and he said, ‘That’s not correct. We are going to do this. We are going to take you through in vitro fertilization (IVF).’ ”

In the fall of 2019, Kati entered Northwestern Memorial in Chicago to undergo IVF, where her eggs were extracted and combined with Gerome’s sperm in a petri dish. Since Gerome was not a carrier of the gene for cystic fibrosis, they didn’t have to worry about offspring having the disease. Their IVF procedure produced two embryos suitable for transfer, which were frozen until they could be implanted into a surrogate, or surrogates.

Meanwhile, after the girl’s weekend, Nikki kept flashing back to the thoughts she had years earlier about carrying a baby for Kati. “I didn’t say anything to her while she was here because I wanted to talk to my husband about it first,” recalled Nikki, who works as an asset manager for a tax credit syndicator in helping to build affordable housing.

And what was husband Dan’s reaction?

“To call a time out,” he said, laughing. “She had mentioned it and I kind of put it off. I said we could talk about it again, when we decided we were done (having children). 

“After we had our second kid, she brought it up to me literally in her hospital bed. I just said, ‘Yeah, we can talk about it, but let’s give it some time and settle in.’”

After all, there were many variables to consider. Nikki was nearing 40 years old and while her pregnancies with Piper and Meryl were relatively easy, what if this one proved different? And what about her own young children? How would they react?

“We talked about the pros and cons for our family,” said Nikki. “We went through all kinds of scenarios and we still wanted to do this for Kati and Gerome.”

Dan, who works in IT staffing and consulting, added: “We got fully onboard with it and both just felt it was the right thing to do.”

Kati vividly remembers hearing Nikki explain how she had long felt this calling to help Kati by carrying her baby. 

Nikki said she kept these thoughts to herself until the time was right. Now, she felt, was the right time.

And while equally flabbergasted, overjoyed and thankful at Nikki’s generous offer, Kati admits to having a nervous moment. 

“If a friend or relative carries for you there is an added stress of how it will impact the relationship or, God forbid, if something health-wise would happen, could you live with that,” she said. “It’s a heavy, heavy decision. We discussed it at great length, but it didn’t take very long for me to accept this as the best gift someone on this planet could give to me.”

‘It’s like having a baby with your best friend’

As luck would have it, Nikki and Kati had friends in Chicago who were in a similar situation and further along in the surrogacy process. “We literally followed in their footsteps,” said Nikki. “They had a Google doc spreadsheet, and we followed each step.”

They consulted with attorneys and insurance experts because states have different laws regarding surrogacy; Kati and Gerome were strongly encouraged to be legally married before an embryo transfer in Missouri. Since COVID-19 had twice sidelined their wedding, they married at a courthouse in Palm Beach, Fla., where the couple had moved last year, so they would be OK in Missouri to do the embryo transfer. (They are planning a September wedding in Palm Springs, Calif., where a very pregnant Nikki will be matron of honor.)

For the embryo transfer, they turned to Dr. Kenan Omurtag at Washington University Fertility & Reproductive Medical Center. He says roughly half of the surrogacies he sees now involve a friend or relative as the carrier, noting that those arrangements are generally much less expensive because the carrier usually offers to do so pro bono.

“Our charge is about $4,000 and the range for IVF is between $15,000 and $25,000,” he said. “If you are using a surrogacy agency to get a carrier, the price can range from $85,000 to $125,000.”

Many of these surrogacy agencies set age limits for carriers, with 37 at the high end. Nikki was 39 at the time of the embryo transfer, though Omurtag notes that American Society of Reproductive Medicine guidelines suggest gestational carriers be under the age of 45. “More typically, success hinges on the age of the eggs to create the embryos,” he said. Kati was 37 at the time of her IVF.

Omurtag also required and received written confirmation from Nikki’s OBGYN stating she was a healthy candidate to be a carrier, having had two healthy pregnancies and vaginal births. Still, he prefers to take a cautious approach and wait roughly a year post-partum before transferring an embryo to the surrogate. 

“We could have done it in September 2020, a year after my youngest daughter was born, but it took several months more because I ended up having some extra procedures,” Nikki explained. “The fertility doctors are looking to create a utopia for the embryo, so they want the cleanest possible surface for the embryo to implant.”

In order to achieve this, Omurtag needs the uterine lining to have a certain thickness and pattern. 

“After two weeks of preparation sometimes the uterus isn’t ready so we add some medications and give it more time,” he said, recalling that additional delays in Nikki’s case “were a function of our evaluation of her as a carrier and recognizing that perhaps some extra tissue in her uterine cavity could affect implantation so we needed to remove that.”

On Feb. 26, Nikki was implanted with one of Kati and Gerome’s embryos, which had been flown here from Chicago. Dan videoed the implantation on his phone while Kati and Gerome watched on FaceTime. 

They learned the transfer was successful about 10 days later. Nikki was pregnant. 

She immediately sent Kati the pregnant woman’s bible, “What to Expect When You’re Expecting,” and turned her onto an app that gives weekly updates on how the baby is growing. 

Kati and Gerome, when he can, FaceTime for all doctor appointments, and the couple plan to be in St. Louis for the 20 week ultrasound, though they do not want to know the sex in advance. Baby G  — as they refer to he? she? —  is due in November.

“It’s like having a baby with your best friend. You share everything with your best friend, and this literally is all encompassing in the sense of sharing everything,” said Kati, 39, who is now director of sales and marketing at a Miami hotel. “It’s really, really fun. I don’t feel I am missing out on any part of the process — we communicate every day. 

“To have Dan’s support means the world because I don’t know how it affects a relationship or a family or a marriage . . . You don’t want to carry around a sense of guilt that I am burdening someone so much and (neither Nikki nor Dan) ever makes me feel like it is a burden.”

Dan says Nikki, whom he describes as “the most selfless, giving person I ever met,” is the most relaxed and at-ease when she is pregnant. This time around seems no different even though, during the first trimester, she had to inject herself with hormones daily to simulate what her body would be creating if it were her own pregnancy.

The shots stopped this week, and Nikki is back seeing her  OB/GYN who delivered both Piper and Meryl at Missouri Baptist Hospital, where Baby G will debut as well. Nikki also consulted a therapist to figure out the best way to explain her expanding belly to Piper. The therapist explained that kids ages 5 to 8 most often get their frame of reference about new things from an adult. 

“She said, ‘Frame this in the same way you are framing this for yourself. You’re growing a baby for your friend,’ ” said Nikki, noting that Piper and Kati had a close relationship even before the pregnancy. And according to Dan, Piper developed a little crush on Gerome when he entered the picture. 

“We explained to Piper that Kati and Gerome really want to have a baby but Kati’s body doesn’t work like mommy’s so what would (Piper) think about mommy growing a baby for them, and it would be their baby,” said Nikki. “She really seemed to understand that. When she asks about it now, she calls it Kati’s baby.”

As Mother’s Day approaches on Sunday, Kati finds herself brimming with emotion. If all continues to go well, she not only will be a mother in a few months, but she and Gerome also have begun pursuing another surrogacy for their second embryo.

“I never thought I would be celebrating this holiday as a mother — the way I celebrate Mother’s Day is all about my mom,” said Kati. “But knowing a year from now I’ll be a mother myself. I’m still having a hard time grasping that concept.”

Added Nikki: “The significance definitely isn’t lost on me that I’m celebrating myself as a mom and my own mom and other moms in my life, and that I’m helping to make a good friend a mom, too. That’s pretty cool.”