Monday, May 12, 2008

Leaving on a Jet Plane---to Rent a Womb in India

Customer service, tech support and face lifts...these days we outsource everything to India. So why not pregnancy?

Reproductive outsourcing is a new but rapidly expanding enterprise in India. Clinics that provide surrogate mothers for foreigners say they have been inundated with requests from the United States and Europe in recent months, as word spreads of India's combination of skilled medical professionals, relatively liberal laws and low prices. With opportunities for international adoption cut drastically, what about surrogacy? Despite the appearance of an innovative “quick fix,” surrogacy is still a complex and somewhat frightening way to achieve parenthood.

Commercial surrogacy, which is banned in some European countries and subject to a wide range of regulation in the US, was legalized in India in 2002. Surrogacy costs there average at around $12,000, including all medical expenses and the surrogate's fee of $5000 to $7000. In the U.S., the same procedure can cost up to $70,000---well out of reach of most infertile couples in the absence of excellent medical coverage. By the time one factors in air tickets and hotels for two trips to India (one for the fertilization and a second to collect the baby) the total comes to around $25,000, roughly a third of the typical price in the United States. According to some experts, Indian surrogacy is already a $445-million-a-year business---and growing.

What are the types of surrogacy?
The more common form is IVF / Gestational surrogacy, where a woman carries a pregnancy created by the egg and sperm of the genetic couple. The egg of the wife is fertilized in vitro by husband's sperms by IVF/ICSI procedure, embryo transfer is performed into the surrogate's uterus and the surrogate carries the pregnancy for nine months. The child is not genetically linked to the surrogate. The success rate (carry home baby) of surrogacy is around 45% in cases where fresh embryos are transferred. If frozen embryos are used, the success rate drops to about 20-25%.

Traditional Surrogacy is not new but it carries its own risks and rewards. Commonly an option for women who have no functioning ovaries due to premature ovarian failure, egg donation also can be an option. A woman who is at risk of passing a genetic disease to her offspring may also opt for traditional surrogacy. The surrogate is inseminated or an IVF/ICSI procedure is performed with sperm from the male partner of an infertile couple. The child that results is genetically related to the surrogate and to the male partner but not to the female partner. It is this form of surrogacy that carries the risk of the birth mother deciding to keep the child. And in many states the law is on her side.

What are the advantages of surrogacy? Surrogacy may be the only chance for some couples to have a child which is biologically completely their own (IVF surrogacy) or partly their own (gestational surrogacy). The genetic mother can bond with the baby better than in situations like adoption.

What are the disadvantages of surrogacy? Although surrogacy often attracts media attention when it succeeds, it is still a highly controversial and legally complex topic with several disadvantages to be considered. Some surrogates have a problem parting with the baby (remember the infamous “Baby Melissa” case in New Jersey several years ago where custody was fought long and hard in the courts before a less than amicable resolution?). The potential for medical / obstetric complications faced by a surrogate during pregnancy can put extra financial burden on the commissioning couple. While a couple has contracted with a surrogate who agrees to attend to her own health to help ensure the delivery of a healthy baby, there is no way to guarantee strict adherence to the terms of the contract. And what about cases the surrogacy technique may be 'misused' like career oriented women, figure conscious woman, models etc. may just 'hire' women on 'rent' to carry their biological child?

As interest in surrogacy grows here and abroad, so does the surrogacy business continue to grow in India. Yet it is not without risk. There is little regulation by the Indian Medical Council that oversees such practices. In the absence of clear rules women, often poor and illiterate, are vulnerable to exploitation. Meanwhile, as medical ethicists continue to debate the morality of the practice, couples from the United States and elsewhere are increasingly turning to India for the ultimate outsource — a rented womb.

For an interesting discussion on the reality of surrogacy from a doctor’s point of view, whether here or abroad, visit this blog: