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.