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Surrogacy Options – A World View – Chapter India

India is another option for some couples though it has been limited to hetrosexual couples who have been married for two years or more. This excludes same sex couples and single parents or couples married less than two years. It is important to know this before you get started as there is no work around for these regulations.

India – One of the best things about India is they has been doing surrogacy for almost as long as the US and they made history as being the first country other than the US to legalize commercialized surrogacy (http://www.tcog.in/articles/1/1/surrogacy-an-indian-perspective.html). India has many benefits including reduced costs, privacy, access to many willing surrogate candidates and straight forward legal practices making the exit process less frightening and faster than other international locations. 

Positives of India

 

  • India is substantially less expensive than the US. Surrogacy in India can cost from about 25k – 35k (http://www.wikihow.com/Decide-on-Surrogacy-in-India). This price is not inclusive of recipient travel costs, staying in the area preparing for exit, legal fees, embassy fees, passport fees or extraordinary costs relating to NICU expenses. I don’t have good information on the cost of NICU in India but from what I can find online, about 16,000 Rupees or approx $260 USD per day can be expected. Medical care in India is done differently than that in the US (as one might imagine). Doctors typically set their pay for services and insurance is not readily available. If someone with experience in NICU in India can comment, please let us know what we can expect. I do suspect that similarly with other international options, use of your own health insurance *should* cover your baby upon birth assuming no international exclusions. 
  • Privacy is ensured when using a surrogate in India. Due to privacy through the agency and with contracts and lack of general use of social media, your journey will be private. You will not find yourself in a position where you are reading about your journey on your surrogates’ Facebook. If you would like to keep your journey to yourself (as most do), you will be able to do this. 
  • Surrogates are readily available. While in the US you could wait months or even a year to find a suitable (medically, psychologically, and legally cleared) surrogate, in India, there are plenty of surrogates ready to start your process with you. The average time from agency agreements to a baby is about 12 months (3 months for the IVF process and 9 months of gestation). If your surrogate leaves the program or becomes ineligible for any reason, you can be easily matched with another suitable surrogate quickly so your process is not delayed. 
  • The exit process from India is pretty fast and simple. Because commercialized surrogacy was deemed legal in 2002, there are straightforward rules and regulations regarding surrogacy. You should expect to be heading home with your baby within 2 weeks from delivery with a passport and birth certificate. This assumes there is no need for a NICU stay. 
  • Your name will appear on the birth certificate. In some countries, you will need to do a post birth adoption of your child even if you are the genetic parents because the woman who delivered your baby is presumed to be the mother. India recognizes the Intended Parents as the true parents of a child born via surrogacy. This makes things much easier post birth. 
  • Your surrogate will likely be housed with the clinic. At this time (though this seems to be changing), surrogates and donors are generally contracted with particular clinics. This means the donors you will find with your agency are generally already screened and approved and the surrogates as well. Also, surrogates in India are generally housed with the clinic which makes your pregnancy more secure. You can feel safe that she has access to healthful food, prenatal vitamins, emotional support and medical care. 
Negatives of India
  • Lack of transparency is a common complaint in India. Consumers in the US expect a level of transparency not available in India. You should not expect constant or clear updates from the medical professionals on your case. To cycle in India you will need to “let go and let India”. If you require control over everything and constant and thorough updates, India might not be for you. This can be very frustrating for some. 
  • Stigma with international surrogacy can be overwhelming. People who do not understand surrogacy in third world countries (and yes, India is third world based on the level of poverty) might see utilization of services in places like this as taking advantage of poor women. While I don’t agree this is the case and many people who work with surrogates in India would refute this as they communicate openly with their surrogates and their family, it is something you should expect going into this process. 
  • You might miss the birth. If you feel strongly (most of us do) about attending the birth of your baby(ies) you should consider this before proceeding. Though most births are done via C-section in India (and most international surrogacy locations), an early delivery can mean you don’t have time to get there for that special moment. Some recipients have made the decision to go to India well before estimated due date to ensure they can be there when their special package is delivered. 
  • You are in a foreign country. While this might not seem like a big deal in theory, it is. Very basic things like access to premie diapers (they don’t have them easily accessible in India), the formula you have at home, foods you are used to, your community (friends and family) are all missing while you are waiting to come home. Though the exit process itself only takes about two weeks to complete, you will likely spend a couple of weeks waiting for delivery and your baby(ies) might need some extra time at the hospital. This could mean 4-6 weeks living in a foreign country. 
  • Entry to India for medical purposes isn’t easy. You will need a medical visa to come to India for any portion of your journey. The Indian government has the right to request your medical records and your finances when evaluating your application for a medical visa. They can not only decline you but it can take a great deal of time. This is especially problematic if you have time contains for your journey.
  • Multiples are very common. It used to be the practice for clinics in India to book you with two surrogates and transfer 4-5 embryos to each one (assuming sufficient embryos exist for this) and then they would reduce the pregnancy to the desired number once pregnancy occurred. After attending a recent conference, I heard Dr. Neeraj Pahlajani from a clinic in Raipur, India (http://www.raipurivf.com) speak and she indicates the current practice is transferring of two embryos to a single surrogate. As a general rule, you can assume a two embryo transfer has a 52% chance of twins if you are using a donor (http://www.shadygrovefertility.com/newsletter/how-many-embryos-should-i-transfer). This means transfers done in India (as they transfer two as a practice) will likely result in twins. I will review twin pregnancies in a posting a bit later on but suffice it to say, it leads to medical complications.
  • Triplets are not permitted. I personally see this as a positive as it increases the safety for the babies and the surrogate, it should be noted that a triplet pregnancy will be legally required to be reduced. This means if you transfer two embryo and one splits, you will be legally required to reduce the one that did not split (you can’t physically reduce a fetus sharing the same sac as another without reducing both. If you feel strongly about the idea of fetal reduction (abortion), you should take pause with this as it will not be your decision. 

There are more positives and negatives than what are listed I am sure but India is not one of my specialty areas so my hope is we will get some comments from people with more background in India to help expand this post. Also, I researched each of my comments but if something is outdated, PLEASE let me know and I will look into it. I am sharing the best data I can find but am very open to new information. 

Surrogacy Options – A World View – Chapter Thailand

thailand

While this country isn’t really much of an option anymore, many couples are still struggling with the fall out of this issue. I would like to make a place for people to share their process so far and also have a place of aggregated information. I will not use the same format as my other chapters as it is no longer a viable option.

Thailand, a History – It is hard to determine how long surrogacy has been commercialized in Thailand. From reviewing several clinic and agency sites, it seems the bulk of commercialized surrogacy started in 2007. Thailand became an attractive destination for surrogacy for other countries due to various loopholes allowing various surrogacy arraignments to proceed without legal interference. It is also hard to determine how many commercialized surrogacies have occurred in Thailand before the crackdown as these numbers don’t appear to be tracked or published but many clinics boast 500+ surrogacies since their inceptions. The lack of available information on hard numbers or time frames seem to stem from the lack of legality of this practice.

Thailand has been a very attractive venue for Intended Parents seeking surrogates as it did not close it’s doors to LGBT couples or singles. Thailand became the “go-to” location for most couples who found themselves restricted from India with the changes in 2011 by India restricting surrogacy to hetrosexual couples married for more than two years. Additionally, for European couples, Thailand is very attractive due to it’s proximity.

The cost of Thailand was similar to that of India and the access to donors was similar as well (most couples had access primarily to donors from that country). You could expect to pay approx. $25,000 for standard surrogacy and about $5,000 for the use of a donor.

Thailand surrogacy in general was structured very similarly to that of India with the number of embryo transfers, the surrogate and donor selection, housing of surrogates and general medical care and success rates. Where Thailand deviates from India is in a very important place. There were never any laws allowing for surrogacy in Thailand as there are in India. Due to this, the legal process was fairly convoluted and the process of exiting the country and obtaining a birth certificate was very different.

In Thailand, the surrogate mother’s name had to appear on the birth certificate. Your surrogate then had parental rights to the baby until they were formally and legally severed (in some cases this would happen upon the child’s 18th birthday). This could present issues for exit from the country and for any legal action in an Intended Parent’s home area. As a birth certificate is required for a number of things all over the world, the Thai surrogate would remain a legal part of your child’s life for quite awhile and all that entails.

Thailand, a breakdown – Things began to fall apart when it was found there was various unethical or ethically questionable events occurring. It is widely presumed these things occurred in part due to the lack of laws surrounding surrogacy. In India for example, it is illegal to not take any baby created by surrogacy home with you. You will be legally responsible for any child born in India through surrogacy. Because Thailand had no laws allowing surrogacy, it also had no laws relating to surrogacy. This made the area ripe for agencies and intended parents making ethically questionable decisions.

In the case of Thailand, there were several issues which all came out around the same time. I am sure most of you reading this are familiar with each but I have provided links to what I feel to be the best and most informed articles on each instance.

Baby Gammy – http://mashable.com/2014/08/12/baby-gammy-down-syndrome-surrogacy-case/ (I chose this one even though it is less mainstream because I think it gives a great overview).

Japanese Man Mitsutoki fathers 16 children – http://www.japantimes.co.jp/news/2014/09/02/national/surrogate-offers-clues-into-japanese-with-16-babies/#.VDnEo97gXzI (I chose this though the translation leaves one wanting because of the thorough explanation of the background).

Use of embryonic spinal fluid for use in cosmetics (gag) – http://www.eggdonor.com/blog/2014/08/07/thai-surrogates-harvest-embryonic-spinal-fluid-manufacture-cosmetics/ (I use this link as it is the best discussion on it I can find. I still can’t seem to determine if it was proven or not but it was a consideration swirling during the Thailand shut down).

Okay, so with the above, it becomes easier to understand why the militia which has taken over Thailand’s government would take steps to close those loopholes which allowed situations like this to occur. I will share my thoughts on each though please keep in mind, it is just my opinion.

Regarding the Baby Gammy issue, I think it is pretty hard to decipher exactly what occurred here. There is a great deal of “he said, she said” so it is hard to determine if these people were a horrible couple who rejected their child due to medical issues or if there was confusion and they were forced to take on a situation they had not agreed to. Now, I am a believer that if you create a child and that child makes it to birth, you are responsible for that child even if you didn’t want or expect to be. I hold the agency partially to blame for this because it doesn’t seem they protected the child or the surrogate as they should have. A couple should not have the choice to leave a child behind. I am not surprised they preferred not to take responsibility but it shouldn’t have been a choice they could make. They claim the surrogate told them lies but it is on the agencies shoulders to keep the Intended Parents informed with accurate information as soon as they are aware of it. The agency clearly knew about the Downs diagnosis early on (likely around 14 weeks but for sure by week 22). If their was a choice to be made, the agency needed to get involved to ensure everyone’s rights and responsibilities were being respected and enforced. Another issue with this case is it was later determined the Intended Father had multiple child molestation convictions. While I realize the inherent challenge to international background checks, some vetting of Intended Parents is equally as important as that of the surrogates they choose. The last issue making this situation challenging is Australia’s exclusion of Down’s Syndrome immigrants (http://www.watoday.com.au/wa-news/gammy-saga-australia-already-rejects-down-syndrome-immigrants-20140812-10373y.html). While in this case due to the nationality of the father Baby Gammy should have received citizenship it does cause pause to general views of Downs children. I don’t feel a law that unilaterally discriminates on basis of a medical condition is something we should have in this day and age.

While the issue of the 23 year old Japanese man fathering 16 children doesn’t seem to break any laws, it leaves me with the feeling of “yuck”. The man claims he only wanted a large family and had the resources to affect this. If someone were to attempt to do this in any country with surrogacy laws, I suspect it would be red flagged and the agencies and clinics, in an effort to adhere to ethical practices, would decline his request. Situations like this occur most often when there is no regulation. As much as I would love it if the customer were in fact, “always right”, sometimes it is the service providers job to be the ethical block to inappropriate requests. Just because you legally or financially can, doesn’t mean you should.

The embryonic fluid issue speaks for itself. If it is proven to be true, it will be beyond disgusting and sad. As I hear more on this (whether confirmed or proved false) I will post updates. Until then, no real reason to pontificate about it. Frankly, the idea makes me ill.

Thailand, what do we do now? – Unfortunately, there isn’t great news in this regard. There has been great effort from many to get embryos released. It does seem babies who are already born and couples who are already pregnant will face leniency from the militia currently in power in Thailand. The exit process will likely be more difficult and expensive and take longer but there doesn’t seem to be any indication they will prevent those babies from going home with their families. I have spoken with several attorneys and agencies who are trying to no avail to get their embryos out. I suspect this might let up a bit with increased pressure but I know many couples are just planning to start over. This is often because even if they are able to affect the release of the embryos, it is not clear the quality they will be or if they will get stuck on their way out. Transporting embryos in general is not easy without proper permits and permissions. One of the large stumbling blocks with this is that the doctor who created the embryos must sign several forms to generate the permit. As many surrogate clinics are in potential legal turmoil, it is questionable if those clinics will want official documents presently being signed admitting to surrogacy activity.

If we learn nothing else from Thailand, it should be to not enter into such an important process when there is zero legal framework to support your process. Also, it is important that all players (agencies, clinics, surrogates, donors, and recipient couples) are respectful of the process and act in a way that doesn’t ruin it for everyone else. The actions of few can poison it for the rest.

As the story unfolds, I will post updates. Please feel free to post comments, updates, new stories or questions. I will do my best to seek out answers with my resources.

Photo credit: Sam Ruaat / Foter / CC BY-SA

Surrogacy with your Own Embryos

SERVICES |  Surrogacy with your Own Embryos

Do you already have embryos that are genetically related to at least one parent? Surrogacy Beyond Borders is able to ship your embryos from virtually any IVF clinic in the world to our fertility clinic in Cancun, Mexico. As soon as you sign the embryo release forms with your IVF clinic, we will apply for an import certificate to bring your embryos into Mexico. Once we know your embryos are on their way we will begin preparing your surrogate. Our surrogates undergo strict medical and psychological screening to ensure you are receiving the most qualified surrogate possible.

We are constantly receiving inquiries from women who want to be surrogates. This is due in large part to the desirable location of Cancun for the first year of their process. Only the most qualified women make it into our program. We have used the same standards as in the US for surrogate selection including considerations for BMI, age, and prior pregnancies. We also screen out surrogates with questionable medical histories both in general health and their prior pregnancies. Our standards were created by a US physician specializing in high-risk pregnancies.


Prices range from $67,000 – $83,000 (prices subject to change) depending on surrogacy options selected.


surrogacy-with-your-own-embryos-pic

CONTACT US |  For Additional Information

Quality

Surrogacy Beyond Borders ensures the highest level of quality by choosing the best possible medical partners.

We work with Huntington Reproductive Center with Dr. Michael Feinman to handle medical services completed in the US. This includes optional embryo creation, semen treatments, semen testing, donor retrievals, consults and optional gender selection.

We work with Fertility Center Cancun in Cancun, Mexico with Dr. Jose Gaytan for embryo creation, donor retrievals, frozen embryo transfers, optional gender selection and prenatal care through month six or seven (depending on if a singleton or twin pregnancy).

We work with top physicians dealing with high-risk pregnancy in Villahermosa, Tabasco who handles our deliveries at Hospital Air.

You are welcome to speak with any of our medical providers at any time about your case. Reports are provided in English within 2-4 days from the time of appointments. Any potential complications are dealt with immediately and recipients are kept informed.

We boast some of the highest success rates for a Mexico program (or even US programs) with 72% success on first frozen embryo transfer*. We attribute this high success rate to great medical partners and the tight oversight on our surrogates throughout the process.

*Success rates are updated every three months and are accurate as of 12/15/2014

Affordable

Surrogacy is a very large investment no matter how it is done. US surrogacy can range in price for about $120,000 – $160,000 (for surrogate and donor) on average assuming things go right the first time.

Surrogacy Beyond Borders was founded with the desire to provide an affordable alternative to the US system. Our company is US based and has seven years of experience in surrogacy in the US. Surrogacy Beyond Borders uses the same screening, nutritional, qualification and prenatal care standards for their Mexico program as are used for US programs of two to three times the cost.

With Surrogacy Beyond Borders, you can expect to pay between $61,000 – $78,000 for surrogacy and egg donation services (if you already have embryos and just need a surrogate, you can expect to pay around $52,000). These prices are inclusive of agency fees, legal fees, medical fees, surrogate fees, donor fees, and most other fees needed to complete your cycle (with notable exceptions of your travel and embassy fees).

Please request an estimate for your particular situation. With a few simple answers (US vs. Mexico donor, one or two semen providers, HIV treatment, gender selection, etc) we are able to provide a quote for your process.