Monday, May 28, 2012

Surrogacy FAQ

So I'll digress again and post about the top questions we have gotten since we've started our surrogacy journey. This addresses the most common questions we've been asked as well as some of the controversy surrounding surrogacy.

1. “So do you know what you are having?”

This is a popular question, for obvious reasons! However, in India it is illegal to detect or reveal gender. There are some cultural reasons that boys are preferred. The darker side of this is that is in many cases people have aborted girls or even refused to take a girl home from the hospital, which led to the law being created. Some girls have been given a name that means “unwanted” and there was a huge renaming ceremony held recently because of this in Mumbai.

Some reasons for this are that girls require an expensive dowry when they are married, and they typically live with the husband’s family and take care of them in their old age. That means boys will bring home a large dowry and a homemaker/caregiver. Because of this gender preference issue, Indian law is strict about revealing the baby’s sex.

We do get some sonogram pictures emailed to us but will not get videos, so it is pure luck if bits and pieces happen to be at the right angle. The pictures have a huge fax stripe across them and have been scanned into a poor quality scanner before being emailed to us. At the bottom of every page there is a disclaimer stating that the sonogropher has not “detected or revealed” gender. We’ll take a good look at every scan we get and show a few of our doctor friends, but it looks like we are in for a wonderful surprise in October!

2. "So is eggs, and umm...Vinnie's...ya know...stuff?"

(Below is the ddiplomatic answer I gave to acquaintances)

We understand the curiosity factor and why this is the most common question we've been asked so far, but this question is a little personal. We'll let everyone have the fun of guessing, but the important thing is that we'll always be open and honest with our children when they are old enough to understand about how others have helped us on our fertility journey. If it doesn't matter to us, it certainly shouldn't matter to anyone else. We firmly believe that we each are the captain of our own ships and genetics don’t govern our destiny, so we look forward to seeing who our children become regardless of the impact of nature as well as our nurturing over the course of their lifetime.

3. “Why India?”

India is where Vinnie’s family is from, and we have enjoyed their tremendous hospitality in Delhi several times. I’ve been there twice and Vinnie five times, and he does speak some Hindi. We are both familiar with the country and culture, and have much support there and from our Indian community here in the US. We began our life together there when we were first dating before we became a family, and now we return to make our family complete.  It is truly wonderful how it has come full circle and India has become the land of opportunity for us.  Despite tremendous growth and progress as well as embracing developing technologies and becoming a rising economic power, India is still a country afflicted by much poverty. This means the money we are spending will go so much further and will without a doubt change the lives of the surrogate and her family in a truly significant way.

The most simple answer however is cost. Surrogacy in America is easily at least three times the cost in India, and fraught with far greater legal and financial risks from what I’ve read. As we’ve spent 8 years living through the hell of infertility and extreme expenses that go along with it, we don’t have over $100,000 to spare. Insurance covers nothing when it comes to common infertility treatments in our case, not to mention surrogacy. Only 3 companies in the US cover surrogacy when I last researched, and the cost was so high it would be cheaper to pay all medical expenses out of pocket and hope all goes well. That is hardly responsible. To try to cover a surrogate anyway without disclosure to the insurance company would be committing felony insurance fraud, and would likely be discovered during the delivery or after attempts to get the birth certificate altered to the biological parents ($7,000 legal fees for that alone). This made us very sad because at one point we did have a wonderful woman volunteer as a surrogate for us without asking anything in return, but due to insurance and legal costs alone there was no way we could responsibly afford it.

4. "So how does that work with the surrogate?"

This question has come up a lot and it sounds like people are really asking about the surrogate selection process and how they avoid forming an attachment to the baby (or in our case babies!) they are carrying for nine months. In order to qualify as a surrogate she has to be married with at least one child, whom she carried to full term with no complications. The egg implanted in the surrogate is not her own, which in addition to the selection and counseling process provided assures that she does not form an unhealthy level of attachment.

There are legal documents that protect both parties in the agreement, and the contracts clearly put the health of the surrogate as the top priority.  We have found this comforting, and it helps us to trust that our clinic has their priorities and ethics straight. International law can get complicated, so choosing a clinic like Akanksha with a superior reputation ensures that all parties are treated fairly and things will go smoothly.

It will certainly be difficult to let go after nine months of bonding, but this is a decision she and her family have not made lightly and have been well prepared for. I’m sad that I’ll never be able to understand what she has been through to deliver these babies to us, but I am certainly more grateful than she’ll ever be able to understand.  She is doing this not simply as a human kindness, but because her family lives on a few dollars a day and she can now provide support them far better than she could have otherwise. We have no problems with her seeing or visiting the babies after birth if she chooses, and will be offering to pay her to produce breast milk for two weeks if she wants to. After that though, the clinic has told us it is best for everyone to not continue contact.

We did not have the opportunity to meet this surrogate beforehand unfortunately, so we only know her name and that she must be an amazing woman to make this sacrifice and help us in such a profound way. We did get to meet our first surrogate, but the attempt failed so it took a second try with frozen samples that occurred while we were back in the states. Thus we’ll just have to look forward to meeting Manju in October. We are mailing her gifts and pictures of our family and home as well as a heartfelt letter we had translated into her native language. We do plan to pay for the modified baby shower they offer as an option for the surrogates to keep her spirits up during the difficult late stages of pregnancy.

5 “Are the surrogates well cared for?”

One of our greatest comforts, especially with twins, is that she has the sole task of relaxing and focusing on taking care of herself and the babies for the duration of the pregnancy. That along with her history of uncomplicated pregnancy helps us to hope that all will progress well.  Most of them choose to stay in the two “Surrogate Houses,” that are host to about 70 active surrogates. Medical care and exams are provided on site on a weekly basis. Does anyone in the US have their doctor and specialists make home visits weekly?  Organic, healthy food is provided daily along with nutritional counseling.

Family members can visit once a week. Many of them travel from great distances to become a surrogate, so the money provided will allow their family to visit for the 9 months duration. In addition they will now have some spending money typically well beyond their normal income to support their family in the meantime.  Keep in mind many married women are used to their husbands working in a large city while they live in village and only see their spouses a few select times throughout the year.

The surrogates mostly rest and commune, but also benefit from classes to include English lessons, which can provide gainful employment in the future that they would not otherwise have enjoyed. They do often keep their surrogacy a secret, because so many people in the community do not understand the scientific sophistication of fertility medicine, and not everyone understands how they can be pregnant with someone else’s child without having extramarital relations. Their confidentiality is well protected, as is ours to prevent any attempts at seeking additional compensation beyond what has been agreed upon.

6. “But isn’t this taking advantage of poor, uneducated women in the third world who have no idea what they are getting into?”

As much as there has been media coverage sensationalizing the risk of taking advantage of poor women in the third world, we are confident that our clinic and the physician couple who are running are doing things the right way. We initially learned about Dr. Nayana Patel’s clinic from her interview on Oprah.  She has a signed head shot in her office. J  You can see multiple interviews of Dr. Patel on You Tube, and I think you will like her style as much as I did when it comes to how she handles the questions and unwarranted criticisms.  It took us three years to be accepted into the surrogacy program because there was a wait list. She was focused on being careful not to overextend herself and reduce the quality of care to the surrogates when the demand rose because of the publicity that Oprah brings.

Documentaries like "Google Baby" that focus on the questionable ethics of one clinic in particular, raise valid questions, but do not present the whole picture of surrogacy in India. We are confident that our surrogate has entered this process with an educated understanding of the risks and consequences, as well as the benefits. Her husband must have full consent and support her in this decision and sign the contract beside her.  I see her as a very strong as well as smart woman, who has chosen to make huge sacrifices for over nine months of her life. She knows exactly what pregnancy entails from having done it at least once before. Even if she has not had the benefit of a full secondary education she has lived a life that has made her tougher and in many ways smarter than the rest of us. Many of them have experienced a   hard life with living on a few dollars a day, which I argue is an education beyond what someone as privileged as I have been could ever understand.

In return she will gain an amount of money that is a salary of many years of what could have been hard labor.  Most commonly  the money is used to purchase a home and a put her own children through college, raising her own standard of living to an entirely new level and giving her children a better life than she could have imagined for herself. If someone has not personally visited a third world country, it is unlikely that they can even imagine how profoundly such a sum of money can impact the destiny of an entire family. We feel blessed that in exchange for creating our family and granting us happiness more profound that we ever dared to dream, in exchange we are making as profound of a difference in the life of another family on the other side of the world and granting one or more children a far better life.

7. “Isn’t there a risk of wealthy Americans ‘outsourcing’ pregnancy and birth to the third world to avoid stretch marks?”

Fears like this are extrapolated using a logical fallacy call the slippery slope. The pundits latch on to this one because sensationalism sells. It’s like saying that by allowing gays to legally marry pretty soon we’ll wind up allowing people to marry their dogs or inanimate objects. Sigh.

Anyone who has been through the process could never imagine someone doing this as an “easy solution” because it is anything but. Having been through it, I cannot fathom any way where someone foolish enough to try this could even get through a beginning phase of the process.  It would be far costlier, but much easier to abuse surrogacy in the U.S. than to go overseas in my personal opinion.

But Dr. Patel handles her critics below better than I ever could. My favorite part is how she questions the fact that if you do surrogacy in the U.S. no one is using the word exploitation, but once you do the same thing in the third world it is assumed as such.  I'm so glad that she sees the truth around her in the joy she brings to so many, and is strong enough to ignore the criticisms of those looking for headlines.


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  3. This is an older post, but thank you so much for your blog.

    I truly understand what you were going through at this time as my husband and I are going through it too. Hopefully we will be accepted at Dr. Patel's clinic and just starting to research everything. P.S peeked way ahead and your children are beautiful!


    Cheryl M.

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