Karma Daigle of Waterbury, Conn., loved being pregnant with her son Gabriel, who is now 9, but after her divorce in 2004, she longed to have another child and knew that without a husband, it might not ever happen.
So she turned to gestational surrogacy, giving birth to four more children -- first Zoe in 2006, then her twin siblings Sebastiaan and Lukas in 2008 for a American couple living in Romania, and then Lucas Tomas in 2010 for a Chicago family.
Both couples were gay men who used their own sperm and donor eggs for in vitro fertilization.
They paid her $19,000 to $25,000 a pregnancy, and she signed legal papers giving away all rights to the children and holding the couples harmless for any potential medical problems, including her possible death.
But being a surrogate mother can be risky. Daigle developed preeclampsia in the final pregnancy that has left her with heart damage.
Though she might never be able to safely have another pregnancy and give her biological son Gabriel the siblings he longs for, Daigle said she would do it all again.
Daigle, now 32 and married for a second time, appreciated the money, buying a house and paying for her wedding, but most of all she wanted to help others who couldn't carry their own child.
"I am not particularly religious, but I consider myself spiritually oriented," said Daigle, who works as a legal secretary for the State of Connecticut and is currently majoring in public policy and management at a local college.
"I can't run off to Africa and save the children there," she said. "But I can sacrifice my own life and body to be a surrogate and give someone else something that changed my life. I cannot imagine not having my own biological children and for these same-sex couples, this has become a reality."
In fact, Daigle was worried about what her own parents might think about her decision. Her grandparents, who are opposed to same-sex marriage, still don't know about the four babies she carried for two gay couples.
"I didn't know if my family would support me," she said. "I didn't want to be the next Octomom. I just wanted to help someone become a family."
Emotionally, parting with her babies was not a problem, according to Daigle.
"Everybody goes through the baby blues and for every pregnancy that lasted three days. It was hard on my body but it didn't traumatize me. I knew what I was getting in to."
"With Zoe, I carried her and my body fed her," she said. "For those nine months, she belonged to me. But do I feel like her parent, no. I have a child."
Surrogate mothers have been used since the 1970s, but the first highly publicized case -- "Baby M" -- was in 1976.
Mary Beth Whitehead gave birth to a girl she had agreed to carry for an infertile couple. But as the biological mother, she changed her mind. She sued for custody, but was denied.
The American Society for Reproductive Medicine estimates that there were 400 to 600 surrogate births annually from 2003 to 2007, the last year for which data is available.
Support groups and agencies say the total number since 1976 may exceed 30,000.
"Honestly, no one knows," said Karen Synesiou, director of the Center for Surrogate Parenting, which has facilities in California and Maryland.
The agency has about 100 couples a year seeking surrogates, including celebrities like Elton John, Kelsey Grammer, former "Good Morning America" host Joan Lunden and actresses Angela Bassett and Deidre Hall. More than half of their clients are gay couples.
"No one keeps any records and that's the problem with the field," she said. "Doctors have to report how many embryos they planted, but as soon as the pregnancy is announced, you never know about the birth."
Society for Assisted Reproductive Technology (SART) is the only organization that makes an effort to track surrogate births, but at least 15 percent of the clinics across the United States don't report their numbers, according to a 2008 investigation by Newsweek magazine. And private arrangements, most notably in the gay community, are on the rise.
Surrogacy is banned in much of Europe and in 12 states, including New York, New Jersey and Michigan, which refuse to recognize surrogacy contracts. Texas, Illinois, Utah and Florida have recently passed laws to legalize the practice, but in many states laws are still vague.
In Connecticut, Tony and Shawn Raftopol, the legal parents of Sebastiaan and Lukas, recently won a landmark lawsuit granting them automatic parenting rights based on their surrogacy contract with Daigle.
Daigle's interest in surrogacy began in 2004. "I knew that after my divorce I wouldn't be married any time soon and I had the baby itch," she said. "I thought it would be super awesome to get pregnant and do something good for other people."
At first she explored different online websites to learn more.
The first agency she contacted was in Indiana and the director suggested she lie about having health insurance. Another agency in New Jersey could talk only about the publicity they garnered. So she ruled out both and chose Circle Surrogacy in Boston, passing all the psychological tests.
One of the questions was what kind of a family Daigle would help.
"I was not willing to work with a single couple," she said. "It was beyond my comfort zone. I just had gotten divorced and didn't want to have a close relationship with just one person. I was in my 20s, I wasn't ready for that."
But she liked the idea of working with the Raftopols, who had a legal background like hers and were seeking a surrogate for their first child.
Her pregnancy with Zoe, who was born in July 2006, was "perfect," though she had some physical difficulties as her body was lactating but she didn't nurse the newborn.
"Two weeks afterwards I went back to work and they were on an airplane," she said.
In 2008, the births of Sebastiaan and Lukas were, "a lot more physically strenuous," said Daigle. "In a word, carrying twins sucked."
The twins were born a full trimester early at 28 weeks in an emergency Caesarian section. They were a pound and a half each and spent three months in the neonatal intensive care unit. The Raftopols were overseas and Daigle and her soon-to-be fiancé were on their own.
"I was the only legal parent for three days," she said. "I had to be physically separated from the twins and said goodbye to them in their Isolettes. It was really traumatic."
Lukas, born in July 2010, was even also born by C-section, after Daigle developed preeclampsia, a dangerous condition that can cause death of the mother and baby. The high blood pressure associated with the condition stretched out her heart muscle.
Because of this, Daigle will never qualify to be a surrogate again, and doctors are unsure if she will be healthy enough to sustain a pregnancy with her husband, whom she married after the twins were born in 2008.
Surrogacy experts say women need to be educated about entering into surrogacy before completing their families. Multiple pregnancies, especially twins, which are more common in IVF, can be risky.
"What if they remarry and want a child?" asked Synesiou. "Every pregnancy reduces the chance of that."
Her agency turns away what are now being called "serial" surrogate mothers, some who have gotten pregnant seven or eight times. "I have to lose them," she said. "I can't live with the guilt."
"They want to do it over and over again and they can't stop until their bodies make them stop," said Synesiou. "There's something psychological going on."
"The first time they want to help and I get it," she said. "The second time, it's a great experience, and I get it. The third or fourth I wonder what went wrong that they didn't feel fulfilled. I worry about these girls."
But Daigle says she doesn't regret her decision, even though some wrongly accuse her of doing it for the money. "I've also had plenty of people say to me, 'I don't understand why you did it, but thank goodness there are people like you out there.'"
Soon, her doctor will do another electrocardiogram and see if Daigle can have a child with her husband. "There a good chance, and I would like to," she said.
As for her surrogate children, Daigle occasionally speaks to Zoe, who now lives with her twin brothers in The Netherlands. She sends birthday cards to all four of the children and has warm relationships with their fathers and even the Raftopol's egg donor, keeping in touch on Facebook.
"I was never treated like object," she said. "I am like a member of the family. If I do this, I have a permanent lifelong commitment."
"I love all these people -- all the parents, the kids," said Daigle. "I consider myself lucky to have been chosen. There's a lot of trust that goes in to this. They trust that I am careful with my body and I am caring for their most precious thing. I appreciate their trust."