Wednesday, January 23, 2013

Pros and Cons and Myths about Surrogacy in India

So this afternoon I get a call from CBS News, who are working on a news story about surrogacy in India. As expected, they are fishing for stuff that could go wrong, though I guess if they didn't it wouldn't be a news story. So they went surfing the net and sure enough they found folks like me, though with everything that went wrong I still consider us a case gone right. 

I worry because I have seen so many poorly researched news stories that sensationalize a few well known problem situations or clinics without telling the whole story and being balanced. Recent isolated cases of DNA tests not matching the intended parents are indeed very concerning, but still isolated and could conceivably happen in other countries as well. Some other "gone wrong" cases have more to do with a couple going to a clinic without making sure they were established and well reputed, or not being careful about legal conflicts (and the laws of the home country were the problem instead of India to my recollection). I don't think rare and extreme examples should be the basis of a decision like this. You can find a horror story about any potential infertility solution, so take them with a grain of salt and use reasonable precautions. Nothing is guaranteed, especially when it comes to infertility.

While India could use some better regulation on surrogacy, I hope they never become over-regulated to the point places like England are where it becomes nigh on impossible to do surrogacy. See:  I find that the biggest roadblock to surrogacy is not only the cost, but the lack of legal recognition that it is a legitimate path to parenthood in so called "developed" countries. India was our land of opportunity partly because the regulations were not overbearing.

There are plenty of pros and cons to any solution to infertility, and surrogacy in India surely as any has a unique set. I hope that my blog and online presence has helped to educate others in their decisions. But the bottom line: I would do it all over again and recommend it to others. But you must DO YOUR RESEARCH and prepare yourself. Above all find a reputable clinic. Clinics and surrogates have been deceptive and taken advantage in many countries, and regulation can't always keep you safe. Be prepared for what could go wrong. But also be prepared to finally have your dream come true and become a parent 9 months later! (Our in our case 6 months!) I will try to give a brief summary, insomuch as someone like me can ever be brief!

1. The baby: You could finally become a parent! Finally having a child outweighs all the other pros by a mile, but you can't let it cloud your decision so that you don't do proper research and preparation or examine other reasonable/affordable alternatives for your unique situation.
2. The cost: A lot closer to $30K than the $100K+ you would pay in America. It takes 2.5 tries on average before successful implantation, so the cost for attempts is something to take into consideration.
3. The chances of success: If you are looking into surrogacy in India, you have likely looked at and tried other options but they have either failed, have low odds of success, or have cons that you are uncomfortable with. A proven gestational carrier combined with modern fertility medicine and the best prenatal care give you odds of success that other options may not have offered you. You could have equal chances of success for surrogacy elsewhere, so likely you are looking to India for the cost.
4. The betterment of many lives: The impact you will have on the surrogate and her family is beyond measure. The surrogate, her children, and her children's children will live a totally different life than they would have otherwise, with a home and education and life lifted out of poverty. Our clinic offered financial counseling and set up a trust in the surrogate's name to help them make sure to manage their windfall well for long term benefit.
5. Having the full experience: As a general pro to surrogacy anywhere, you get to to participate in a pregnancy, though in a limited sense when it is in India.  A big reason I chose surrogacy was that you get a child from their first day of life and experience infancy and all stages of development. Low cost adoption of older or challenged children, fostering to adopt where you can lose the child, or international adoption of an older infant or toddler were the only affordable options for us. While we intend to do that someday, each had an understandable downside with a process and paperwork that in my perception is a lot more intensive than surrogacy in India. If you can be a genetic donor, then you can also have the experience of a child that you are related to. It is not selfish to want that, anymore than it is selfish to want a healthy newborn that is lower risk for medical, developmental, and attachment problems.
6. Return on investment: While you can have failed attempts, you will be out a lot less money than you could potentially be from a failed adoption from what I understand. From my research I've seen more horror stories about failed adoptions and tremendous emotional pain and  loss of investment than I was comfortable with. I know an adoptive mother whose birth mother changed her mind in the several day waiting period after birth, and devastating does not even begin to describe it. An Indian surrogate not only does not want the baby, but they bear no relation or right to it. As long as your home country's regulations are also on board and you do the proper contract through a reputed clinic, this is YOUR child and it cannot be taken away from you.
7. Prenatal care: In India they will most likely choose to stay at communal surrogate housing, and you can choose that as a condition for your surrogate, though it could limit your selection. Some folks look at pics and see a room of cots and make negative judgements, but they have clearly never been to India. Trust me...a surrogate house is Shangri-la compared to other alternatives or where they have been living. Healthy food is prepared and educational classes are offered. There is air conditioning and on site medical care and close prenatal monitoring. They don't have to work and clean and endure the strain of caring for their own children during the pregnancy, though their families can visit frequently. These surrogates are not only happy about how their life and their family's lives are changing for the better and their comfortable accommodations, but many of them say the lifelong friendships they formed with other surrogates are the best part and lead them to do it again.
8. You have a greater chance of having twins. It's risky, but it is also AWESOME! This is a pro for surrogacy in general, and not exclusive to India.

1. Culture shock: If you haven't traveled, been to a third world country, and aren't familiar with Indian culture you are in for a shock. But if you open up your mind and prepare yourself it can be an amazing trip and a wonderfully life changing experience. I married into an Indian family and had spent a month there 8 years before we tried surrogacy so it was a lot easier for me and I knew what to expect. If you are borderline OCD and like everything antiseptically clean and hate crowds and traffic, India may not be for you. In my personal opinion things are much cleaner than they appear, but Westerners are used to everything being new and bright and shiny.
2. Communication: The language barrier, cultural differences, and time zone will pose definite challenges. As someone who has suffered from the pain of infertility, you are likely to have some control freakishness going on so the lack of clear communication will be hard to handle but can be well worth the frustration when the baby is finally in your arms.
3. Emotional connection: There will not be much of one, either with the surrogate or your baby. You are having a baby by email, and it may not feel like this is actually happening until there is a screaming infant being handed to you. You may connect with the surrogate, but since you don't have ether lifestyle or language in common it isn't likely. You will have the baby in common, and that is enough. It is primarily a business arrangement, and there is really nothing wrong with that. It's great if you can have a local surrogate in your home country and ya'll become besties and can share in every moment of the pregnancy, but it's not somehow morally wrong if that isn't your reality.
4. Medical standards: They do a great job at Indian NICU's. Don't get me wrong. But having experienced both I can confidently say that they cannot compete with American medical care, even if it is simply because of the available technology and not the doctor's skill level. Availability of experienced specialists is more limited. You have to hope you won't wind up in this boat, but you can do everything right and it can't always be prevented. They may be able to treat the symptoms pretty well but not give a solid diagnosis, and advanced therapies may not be available.  I've felt guilty that my daughter needed more medical care and expertise than was available, but the fact is my guilt is misguided because I would have done surrogacy in America if I could have afforded it and I've done everything in my power to give her the best care I can possibly provide.
5. Baby born premature or with medical problems: This can happen anywhere, even if you have a well screened egg or sperm donor and your surrogate does everything right and has no complications. But since this baby is in another country where you don't live, you could be in for a long and expensive ride. Your insurance may not cover out of country care or put up a fight about coverage, even though it is far less expensive there. You might have to live in India for many months, or wait to join your baby until they are discharged from the NICU. You may have to medivac your child out. (Check out the Rasta Less Traveled blog for what this can be like). This part of the journey did indeed suck, but we made it through to the other side and have two beautiful babies and have our happily ever after.
6. Death of the surrogate: Though not a risk exclusive to India it bears mentioning. I only know of this happening once, and it couldn't have been prevented or anticipated. It was an educated risk the surrogate or any woman takes on in a pregnancy, so your clinic should offer life insurance. In the case I know of the family was paid several times what she would have earned, and the baby did survive.
7. Surrogate risking their reputation: Education and scientific understanding is lacking in India, so many folks can't understand how surrogacy works without infidelity or genetic links to the offspring to the surrogate. This is one reason why surrogates travel from smaller villages and often choose to isolate themselves in communal surrogate housing, though often it is for the comfort and camaraderie. They just tell people it was for a job opportunity, which is very common and an easily believable ruse .An Indian woman takes on this risk, though they do it in part because they understand far better than most women in the world the pain and stigma of infertility because of how it is viewed in their culture. Our clinic helped local women at lower costs, and helped fake a pregnancy so the family will never judge the woman for not being able to bear a child.
8. You have a greater chance of having twins. It's awesome, but it is also risky no matter where you do surrogacy. You may have to do a reduction procedure if more than two implant. You stand a greater chance of loss of the pregnancy or one twin, complications, or prematurity. It will be more expensive to have twins in any country, but if done in India while you live elsewhere you could find yourself paying for double the extended NICU and exit fees like we did.
9. You won't know gender: It's annoying because gender neutral clothing is a myth in my experience. But if you really care about this so much then you probably shouldn't be having a child in the first place.

Please read my previous posts to see the many misconceptions about surrogacy in India.  and  
A couple of things I'd like to re-emphasize.
1. Indian surrogates are being exploited: Why is it assumed that they won't understand what they are doing but an American surrogate will? Do you have to have money in order to make a responsible decision for yourself? You don't have to be educated to be smart, and the tough lives these women have lived make me seem ignorant in comparison. They are perfectly capable adults who are counseled and aware of what they are doing, and selective reduction if necessary is done to ensure the health of the surrogate.  They have all been pregnant before, so that understanding of what it entails is a given.  Yes...being poor sucks in many ways. But it doesn't automatically make you less of a human being or less capable of making good decisions for yourself. And it doesn't mean that two women reaching across the world to help each other are engaging in exploitation just because one of them lives by what the other defines as poverty. Why is it that if you do it in America it is okay, but if you do it in a poorer country it is exploitation?
2. 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.


  1. Hey Emily, hope you and your family are well, beautifully written post. writers and readers alike forget there are many sides to a story. x

  2. Excellent post. This was my experience as well in India.

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  4. The procedure is identical to a frozen thaw embryo transfer ET cycle. For young women, we can transfer the embryos in a natural cycle, 2 days after ovulation. For older women, we need to downregulate with GnRH analog from Day 1, and then prepare the uterus to accept the embryo with exogenous estrogens and progesterone. The procedure is non-surgical, and there is no risk involved.
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  5. The procedure is identical to a frozen thaw embryo transfer ET cycle. For young women, we can transfer the embryos in a natural cycle, 2 days after ovulation. For older women, we need to downregulate with GnRH analog from Day 1, and then prepare the uterus to accept the embryo with exogenous estrogens and progesterone. The procedure is non-surgical, and there is no risk involved.
    What about confidentiality?
    In our clinic, we handle embryo donation like a closed adoption. There is no contact between the donating couple and the recipients, who never see each other. The recipient couple does not even need to inform their obstetrician that they achieved their pregnancy through embryo adoption.
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  7. I agree with you, but I'm curious: The most common objection I hear from people I know who are pro-life is that an impotent couple who wants a child can get the embryo implanted in herself. I maintain that it's wrong, but the recourse I fall back into is natural law theory when asked to explain (which is perfectly fine, but in my experience not that convincing). So are there any more concrete reasons to explain why that's wrong? Here i suggest peoples to go INDIA for IVF surrogacy, then you must search for Surrogacy India, Surrogate mother India, IVF India, IVF clinic India & IVF cost india. I found Go Surrogacy for this treatment in India. Hope you also like these.

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