Surrogacy in India

One more reason to work with medical tourism agencies which have partnership with IVF clinics in countries with favorable laws.

India’s Rent-a-Womb Industry Faces New Restrictions

By HILLARY BRENHOUSE Hillary Brenhouse – Sat Jun 5, 6:50 pm ET

Since the day they were delivered more than two years ago, twin toddlers Nikolas and Leonard Balaz have been stateless and stranded in India. Their parents are German nationals, but the woman to whom the babies were born is a twentysomething Indian surrogate from Gujarat. The boys were refused German passports because the country does not recognize surrogacy as a legitimate means of parenthood. And India doesn’t typically confer citizenship on surrogate-born children conceived by foreigners. Last week Germany relented, turning over travel visas, and the entire Balaz family is finally going home – though only after a long legal battle that took them deep into the convoluted world of inter-country adoption.

“We can only wish them good luck,” India’s Supreme Court told local media. But it also reiterated the urgent need for legislation to regulate one of India’s fastest-growing industries. Hundreds of foreign tourists spill into the country every year to hire women to incubate their children. India has become the world capital of outsourced pregnancies, whereby surrogates are implanted with foreign embryos and paid to carry the resultant babies to term. In 2002 the country legalized commercial surrogacy in an effort to promote medical tourism, a sector the Confederation of Indian Industry predicts will generate $2.3 billion annually by 2012. Indian surrogate mothers are readily available and cheap. Unlike most countries in which surrogacy is lawful – and bucking the norm in heavily bureaucratic India – the procedure can take place without reams of government red tape. (Read ‘India’s Medical Emergency.’)

That may soon change. A draft bill to direct assisted reproductive technology (ART) is likely to be introduced this year in Parliament. The new legislation will beef up surrogacy guidelines authored by the Indian Council of Medical Research (ICMR) that have often gone unheeded by the few hundred Indian fertility clinics accustomed to writing their own rules. Among them is the Akanksha Infertility Clinic in the town of Anand, in the western state of Gujarat, where the Balazs found themselves. “We are lost when there are no laws,” says Akanksha medical director Dr. Nayna Patel, who has become the face of the industry abroad since being spotlighted on the Oprah Winfrey Show in 2007. “But the people drafting the bill have to remember to take care of the clinics, too.”

Patel chooses among the women who appear at the clinic, at least three a day, hoping to hire out their wombs. She pairs the surrogates with infertile couples, catering to an increasingly international clientele base – from 13 foreign couples in 2006 to 85 in 2009. And she oversees the negotiations between them. The entire process costs customers around $23,000 – less than one-fifth of the going rate in the U.S. – of which the surrogate mother usually receives about $7,500 in installments. Patel implants the women with embryos, using specimens from sperm or egg donors if necessary. Once pregnant, the surrogates are housed onsite until delivery, in a dormitory that was once a local tax office, so that they can be supervised. But under the new legislation, Patel will be permitted to supervise nothing but surgery. (Read ‘Can One Pill Tame the Illness No One Wants to Talk About?.’)

The new proposed government bill bans in-vitro fertilization (IVF) clinics from brokering surrogacy transactions. It also calls for the establishment of an “ART bank” that will be responsible for locating surrogate mothers, as well as reproductive donors. Fertility clinics will only come into contact with surrogates on the operating table. “We need to create a safe distance between the clinic and the surrogate to avoid unethical practices,” says Dr. R.S. Sharma, deputy director general of the ICMR and member-secretary of the bill’s drafting committee. “IVF clinics should only be concerning themselves with science.”

It’s a suggestion that has caused a stir in the medical community. Dr. Patel insists that she will not accept a surrogate sent to Akanksha unless she herself is permitted to perform medical and background checks. She maintains that ART banks will not have enough experience to determine whether a woman is fit for surrogacy, let alone to replicate the personal bonds she cultivates with her surrogates. “The trust they have with me is what makes the whole thing secure and safe,” she says. “And at the end, when they want to buy a house or a piece of land for farming, we get them the best deal. With this bill, we will not know what they are going to do with such a big amount of money.”

Indeed, surrogate mothers are likely to enjoy an unprecedented autonomy. They’ll have more freedom in negotiating their fee and receive mandatory health insurance from the couple or single employing them. Firm legal standards will ensure that medical professionals only be permitted to implant three embryos in a woman’s uterus per attempt. (The American Society for Reproductive Medicine advises doctors to implant just one; until recently, Dr. Patel routinely used five at a time, aborting anything more than two fetuses.) The legislation will only allow a woman to act as a surrogate up to five times, less if she has her own children, and will impose a 35-year age limit. That way, ladies motivated by desperation won’t be able to put themselves at risk.

In a push to avoid cases similar to the Balaz family debacle, the bill will also make things more challenging for foreign customers. The new legislation will require that the international couple’s home country guarantee the unborn infant citizenship before a surrogacy can even get off the ground. Such a stipulation will certainly not go over with Germany. “In fact, I’m not sure if any country will be ready to pledge citizenship before birth,” says Amit Karkhanis, a prominent Mumbai surrogacy lawyer. Countries accepting of surrogate-born children typically rely on DNA tests done post-delivery to determine the parentage of the baby.

Same-sex couples – a growing number of whom are relying on Indian surrogates – may not even make it as far as a plea for a government pledge. Just last year, Delhi’s High Court overturned a section of the penal code outlawing “carnal intercourse against the order of nature,” and the status of gays and lesbians in the country remains unclear. “Tomorrow, if the government outlaws gay relations,” says Sharma of the bill’s drafting committee, “then we will not allow gay couples to hire surrogates. The law of the land will be followed so far as this issue is concerned.”

When Australian partners Trevor Elwell and Peter West visited the country nearly two years ago, only one clinic was open to providing them surrogacy services. Now, with their surrogate-born twin girls a year old and their third baby incubating in Mumbai, Elwell estimates that a half-dozen Indian IVF clinics cater to homosexual couples. The men have found it uncomplicated to use Indian egg donors. They’ve made the switch to a facility where their new surrogate knows they are gay, and is comfortable with it. And they attained Australian citizenship for their children in a process that took no more than a few weeks. For them, as for most who flock to India hoping for a baby, informal surrogacy guidelines have been a blessing. “If the bill does complicate things, people will go to another country,” Elwell says. “There will always be somewhere this can be done. This is just the beginning.”

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Ask Our Fertility Doctors

IVF

Issues pertaining to infertility and fertility treatments are complex and certainly create a lot of questions in the minds of individuals who are either undergoing fertility treatments or seriously considering those. Since it would be impossible for us to provide answers to all the questions we receive on our website, we decided to set up a more appropriate venue for questions our clients may have. This is how this blog was born. Our fertility doctors (e.g. reproductive endocrinologists, OB/GYN doctors, embryologists, etc.) agreed to answer questions pertaining to infertility and fertility treatments.

In case you are wondering about qualifications of our doctors, during the selection process of our IVF clinics, we went an extra mile to ensure our clients will receive the same high quality IVF advice and/or treatments as those available in the U.S. Our partner clinics follow the standards of the American Society for Reproductive Medicine (ASRM) and are accredited in the U.S. Our partner doctors are board certified and often hold Ph.D. on top of their M.D. degrees.

Our hope is that this blog will serve as a professional, discrete environment where one can ask questions and hopefully find answers pertaining to fertility treatments. Our doctors agreed to answer questions concerning:

• General questions about infertility
• Questions in regards to effectiveness of Assisted Reproductive Technology (ART)
• Questions pertaining to tests (e.g. blood work, genetic testing, PGD etc.)
• Questions about the IVF process and what happens during specific treatments
• And of course questions pertaining to symptoms and problems during the course of the treatment

We hope we can answer most of your questions and in the process help you with starting or expanding your family. Feel free to email me with your questions (Darya.Mikhailova@theMedVacation.com).

Darya Mikhailova, MD

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I am concerned that my eggs may be of poor quality. How can one determine the quality of her eggs?

We can have some basic notion about the quality of eggs by examining the size of the follicle and the level of Estradiol in the middle of the cycle. However, as the woman ages, we often deal with such factors as thickening of the external wall/skin of the egg, which in turn makes it harder for sperm to penetrate the egg.

In reality, it is impossible to determine the quality of one’s eggs until we extract those from the follicles, examine them under the microscope and see the stage of their development. There are some easier methods of testing the ovarian reserve and the quality of eggs. These are chlomiphenom test, and the tests to determine the level of Follicle Stimulating Hormone (FSH) and Inhibin B. All these tests although helpful, are still not as effective as examining eggs under the microscope.

Do ovarian cysts affect my chances of getting pregnant?

The research shows that any ovarian cysts of 10 mm or larger reduce one’s chances of getting pregnant. For instance, studies show that women who underwent IVF treatments while they had 10 mm cyst in the beginning of the cycle were twice as unlikely to get pregnant as women who didn’t have cysts (all other factors being equal). Therefore, cysts will not prevent one from getting pregnant but will significantly reduce woman’s changes of doing so.

Can I fly and how long can I be in the air, after embryo transfer?
 
Yes, you may travel by plane. Air travel does not pose any danger to pregnancy as long as constant air pressure is maintained. Modern airplanes……….. as a rule…….. don’t have sudden air pressure changes.

We received a couple of inquiries about reversing tied tubes and getting pregnant after that.

Our doctors recommend IVF treatments, if you have your tubes tied and are thinking about getting pregnant. You may have heard this already from doctors in the U.S. or from research you’ve done. Getting pregnant a traditional way after reversing tied tubes may be a dangerous endeavor.

First, our IVF doctors say that reversing tide tubes is typically not an effective procedure. Moreover, even if the reversing tied tubes procedure is done, chances of having tubal pregnancy (situation when the fertilize egg implants itself outside uterus) are very high for that person. That is the reason why doctors recommend to have IVF in this case.

To summarize the recommended treatment course for women with tied tubes, our doctors would perform ovulation induction and egg extraction without reversing tied tubes for the patient.

Several individuals asked us how many eggs are typically harvested from a donor and what happens to the unused eggs.

On average, our clinics harvest 10 to 18 eggs per donor. As a rule, we fertilize all of the retrieved eggs with sperm. Certain number of fertilized eggs grow to become embryos. Our doctors transfer 1-2 embryos (more often two) in the transfer stage of the IVF process. In rare cases, in the situation of severe infertility, the doctors may recommend transferring 3 embryos.

The embryos which are left after the IVF cycle can be frozen. Our clinics use the latest cryopreservation approach, which dramatically increase cryosurvival (percentage of eggs/embryos that are alive after thawing) of embryos. Traditionally, IVF clinics used the slow freezing method that has been used since the 1980’s. Our clinics use rapid freezing technique recently developed in Japan called Vitrification. With Vitrification, the temperature is lowered at 23,000 degrees C° per minute. That is 70,000 times faster than in traditional approach. Such rapid cooling coupled with cryoprotactant fluids prevents formation of ice crystals in embryos.

You may be wondering why it is important to have as little ice crystal formation as possible. It is important in the embryology, because ice crystal formation is very damaging to frozen eggs and embryos. In other words, eggs do not fertilize well after thawing. The slow freezing approach produces disruption in the membrane, which causes a block to the conventional fusion and penetration of sperm with the egg surface.

Our IVF clinics do all of their embryo freezing at the blastocyst stage. Upon request from our clients, our clinics can also freeze eggs rather than embryos. We freeze embryos, because statistics show that pregnancy rates are just as high in properly frozen embryos as in fresh embryos which have never been frozen. The same cannot be said for frozen eggs; pregnancy rates for frozen eggs are 15-20 lower than those for frozen embryos.
You can email us your questions to info@theMedVacation.com

What is Medical Tourism?

Medical Tourism or Health Tourism is the term initially coined by travel agencies and mass media to describe the practice of traveling across international borders to obtain healthcare services. Today medical tourism is a rapidly growing industry that enables people residing in one country to travel to another country to receive medical, dental and surgical care of comparable quality to that available in their home countries for a fraction of the domestic cost. In addition, patients may choose to travel abroad because certain procedures are not available in their home countries, or because the wait is too long (e.g. Canadian cancer patients traveling across the border to the U.S.).

Contrary to popular belief, the concept of medical tourism is not a novel one. The first recorded instance of medical tourism dates back thousands of years to when Greek pilgrims traveled from all over the Mediterranean to the small territory in the Saronic Gulf called Epidauria. Also, Americans have been engaged in medical tourism, although they may not have called it that way. For decades, many Americans have traveled to such acclaimed medical institutions as the Mayo Clinic in Minnesota, MD Anderson Hospital in Texas, Memorial Sloan-Kettering Cancer Center in New York, and John Hopkins Hospital in Maryland.

Until recently, on the international scale, patient flow was mainly from less developed countries to developed countries. And not surprisingly, medical tourism to developed countries was a prerogative of the rich and the elite in the developing world. Recently, however, the skyrocketing costs of healthcare and long wait times for certain procedures, combined with the growing ease and affordability of international travel and tremendous improvements in both technology and standards of medical care in many countries began to change the face of medical tourism. In fact, the mechanism behind the growth of medical tourism was explained by Adam Smith in his monumental work The Wealth of Nations in 1776. According to Adam Smith, a country will “specialize in the manufacture and export of products [services] that can be produced most efficiently in that country.” Essentially, when we talk about medical tourism we are simply talking about outsourcing in the healthcare sector.

What have been the driving forces of this industry’s growth and why is medical tourism capturing so much attention in the media lately? In no particular order, below are the major factors exerting influence on the US society and fueling the growth of this industry:

  • Increasingly unsustainable health care costs in the U.S.
  • A growing number of Americans under the age of 65 who are uninsured or underinsured
  • Increasing life expectancy and an aging population
  • Rapidly rising insurance premiums paid by employers who are forced to pass a portion of those costs on to employees

It is estimated that in 2007 total spending on healthcare reached 2.4 trillion dollars. Nearly 46 million Americans, or 18% of the population under the age of 65, were without health insurance in 2007. This is a 4.9% increase from 2006. Moreover, some studies indicate that as many as 29% of people who had health insurance were “underinsured” with coverage so meager they were often forced to postpone medical care because of costs. In addition, as many as 120 million Americans lack dental coverage. Other sources purport that this number may be as high as 120 million.

Safety and quality is our first priority! We are almost certain that you have a burning question whether treatments in developing countries such as Mexico, Costa Rica, and Columbia are safe. So that you don’t lose your interest, here is a statistic from World Health Organization. In response to US providers who may tell you that all care in other countries is dangerous, we encourage you to ask them why the World Health Organization ranks the US healthcare system at number 37 globally, after Costa Rica, Columbia, and Chile? It’s possible to get excellent care overseas, provided patients do their homework or allow MedVacation to do that for them.

We would like to mention medical tourists’ satisfaction with services. According to results of the patient survey carried out by the Medical Tourism Association, when asked “How would you rate the hospital you received medical care at?” 70.7% responded “Excellent,” while 26.8% stated “Very Good.” Moreover, 63.4% of respondents indicated that they felt their overall medical experience was “better than it would have been in the USA, while 36.4% of respondents stated their experiences were “equal to what it would have been in the USA.”

www.theMedVacation.com