This will be a very special Christmas for Maureen Ensminger, but it arrives with a very special problem.

"My dilemma," Maureen said, "is what do I get Ellen for Christmas?"

Ellen Mahoney is Maureen's younger sister. Finding just the right gift for Ellen is thorny this year, not because of what Ellen already has but because of what she already has given to Maureen and her husband, Dan Ensminger.

 

Because of a medical condition, Maureen couldn't have children, so her sister had them for her.

Implanted with frozen embryos, Ellen, at age 40, gave birth in July to fraternal twin girls, delivered by way of a cesarean section, for Maureen and Dan. The babies - Ellen Marie and Danielle Elizabeth, now almost 5 months old - are healthy and happy and doing just fine.

As gifts go, you have to admit that's pretty much a showstopper.

Mom and Dad are understandably ecstatic as they approach their first Christmas with the girls, and so is Aunt Ellen.

"I love to come and visit them," she said with a smile, "and be their favorite aunt."

. . .

In the summer of 1998, Maureen was on a business trip when she began experiencing the debilitating symptoms: vertigo, double-vision, an inability to walk. She was initially diagnosed with multiple sclerosis, and she was devastated.

Engaged to be married that fall, she told Dan, an architect, he was welcome to walk away. No way, he said. They were married in September.

Despite the diagnosis and treatment, Maureen's conditioned continued to deteriorate. Her vision was often poor, her speech slurred. She doesn't remember much of her wedding day. At a holiday party later that year, Dan recalled, Maureen completely shut down and was unable to speak.

She also couldn't control her emotions - emotional lability, it's called - and would burst into laughter or begin crying for no apparent reason. She might be talking on the phone or standing in line at the dry cleaners when she would begin laughing uncontrollably and then, seconds later, start weeping out of frustration and embarrassment.

"That was the worst part," she said. "There's nothing worse than being unable to control your emotions."

Dan talked to friends with MS and determined Maureen's symptoms seemed extreme for that disease, so he began calling other doctors for help. He found it from a doctor at Georgetown University Medical Center in Washington, who suspected by the description of Maureen's symptoms over the phone that she did not have MS.

His diagnosis: central nervous system vasculitis, an autoimmune disorder involving inflammation and narrowing of blood vessels. In short, she was not getting sufficient blood to her brain and the result was a series of ministrokes.

Treatment involved 2½ years of chemotherapy and steroids. The good news was, the treatment saved her life, although damage had been done.

"She couldn't sign her name," said Dan. "I had to teach her to drive again."

The bad news? The drugs fooled her body into premature menopause, meaning she was no longer able to bear children.

Maureen and Dan really wanted kids, however, so they decided to try in vitro fertilization. Since Maureen had been left infertile, Ellen volunteered to donate eggs for the process. Her eggs were mixed with Dan's sperm, and several embryos were implanted in Maureen.

The process failed.

Maureen and Dan considered seeking a surrogate, but found it expensive. They were looking into adoption when they met Ellen for dinner one evening in the fall of 2002.

"I have something to tell you guys," said Ellen. "I've thought about this a lot, and I want to carry your babies."

Maureen and Dan were stunned, overwhelmed and grateful, all at once. Recalled Maureen, "For the first time in his life, Dan was speechless."

Two days later, the three of them saw a local fertility specialist, Dr. Kenneth Steingold. On Nov. 15, 2002, four frozen embryos left from the failed in vitro attempt - Ellen's previously harvested eggs and Dan's sperm - were implanted in Ellen.

Two of the embryos developed.

The pregnancy progressed routinely, and it was almost as if Ellen and Maureen would be giving birth together. Maureen, 43, read every baby book she could get her hands on and drove to Northern Virginia to accompany Ellen to doctor appointments. Maureen and Dan's friends held baby showers, bringing Ellen into their circle. Everyone she encountered was positive about what she was doing, Ellen said.

"Someone told me, 'You're going to heaven with your boots on!'" said Ellen. "I don't know what that means, but I think it's good!"

After 36½ weeks, a 30-pound weight gain and a good bit of discomfort toward the end - as well as a whole lot of longwinded explanations to anyone who asked about her pregnancy - Ellen underwent a C-section on July 10 with Maureen at her side. The babies weighed more than 5 pounds apiece at birth.

"I can't believe you delivered my miracles," Maureen told her sister.

Maureen and Dan had long decided the first baby out would be called Ellen Marie.

. . .

Exact numbers of surrogate births are unknown, but it is estimated that 20,000 have occurred internationally since 1975, said Shirley Zager, spokeswoman for Organization Of Parents Through Surrogacy (OPTS) and director of a surrogacy agency in Chicago.

Based on estimates, relatives serve as surrogates in less than 5 percent of arrangements, Zager said. Most prospective parents must seek out an unrelated person to carry a baby for them.

Surrogacy often receives attention for the wrong reasons - agreements gone bad and the ensuing legal and custody disputes. But those situations are extremely unusual, Zager said.

"While the success rate with arrangements has been extraordinarily high - more than 99 percent - lawmakers and media often react to surrogacy based on rare aberrational cases," she said.

No disputes are brewing in the Ensminger household.

"These were their babies from the start," Ellen said as she held little Dani during a recent interview at Dan and Maureen's home. "I have my own babies, and I didn't want any more."

Ellen is the mother of two daughters, Erin, 14, and Rachel, 12, who were across the way helping Dan with little Ellie.

Actually, Ellen said, it was kind of nice to go home and not have to worry with middle-of-the-night feedings or dirty diapers. Plus, she got eight weeks off from her job as an insurance company administrator.

"This was a short-term commitment on my part," said Ellen, "but a lifetime commitment for Moe and Dan."

One, it seems, they've happily embraced.

The Ensminger home is bright and airy and filled, it seems, with two of everything: bouncy chairs, cool-looking saucerlike contraptions the girls sit in to play, and assorted other toys.

"Large amounts of colored plastic," laughed Maureen.

And the babies?

"They're just perfect," said Maureen. "Absolutely perfect."

Asked if she ever wondered - particularly as she grew uncomfortable during the pregnancy - why she'd gotten herself into this, Ellen said no. "I knew why," she said. "I knew it was the only way. It's as close to having biological children as they could get."

When Maureen and Ellen told their mother, Jane Charneco, of the arrangement, she summed it up nicely:

"Man," she said, "that's love."

Now, Ellen has returned to her job. Ellie and Dani are sleeping through the night. Dan, 39, is delighting in his new role as a dad. Maureen can't wait to be called "Mommy," and she still has no idea what to get Ellen for Christmas. But she also knows it is a fruitless search.

Said Maureen, "I can never repay her."