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Roundtable                       Surrogacy in India                         A healthy controversy?                     The...
Roundtable       Dr Aniruddha Malpani       Medical Director, Malpani Infertility Clinic, Mumbai        Surrogacy is an ex...
Roundtable                  Dr Indira Hinduja                  Obstetrician, Gynaecologist & IVF Specialist, Jaslok Hospit...
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Surrogacy treatment in India


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Surrogacy in India. A roundtable discussion from Modern Medicare magazine featuring Dr Malpani from Malpani Infertility Clinic

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Surrogacy treatment in India

  1. 1. Roundtable Surrogacy in India A healthy controversy? The incidence of surrogacy is increasing in India, contributing to fertility tourism in the country. However, this still remains a contentious subject. Here are some expert opinions that clarify many of the questions about surrogacy in India. Dr Asma Mohd Yousuf T he term ‘surrogate’ was quite uncommon in the last decade, but this is not the case anymore. As a matter of fact, surrogacy was not uncommon in the past either, but was not much spoken about then. In India, commercial surrogacy was legalised in 2002 by the Supreme Court of India. Since then, India, besides tourism, has become a preferred destination for many to fulfill their parenthood dreams. However, the legal aspects surrounding surrogacy are complex. In some jurisdictions, the possibility of surrogacy has been allowed and intended parents are recognised as legal parents of the child since its birth. Yet, in many other countries, commercial surrogacy outside the country is considered illegal. Thus, children born through surrogacy to people belonging to these countries may land up ‘stateless’ due to divergent laws that may not grant them citizenship. Dr Alka Kumar Consultant Gynecologist, S L Raheja Hospital (A Fortis Associate), Mumbai Surrogacy is an arrangement in which a woman The birth certificate of the child would bear the carries and delivers a child for another couple names of the intended parents. In case of heterosexual or individual. Intended parents may arrange for couples with genetic contribution from both surrogacy in case of infertility or medical issues parents, their names go on the birth certificate. that make pregnancy risky in the female partner. In case of same sex couple (or single father), the genetic Other clients could be single parents or gay father’s name alone goes on the birth certificate. If couples. The parties that are usually involved donor egg In Vitro Fertilisation (IVF) is performed, the in the entire surrogacy process include the biological names of both partners in the heterosexual parents, surrogates, infertility specialists, lawyers and couple go on the birth certificate. There is no surrogacy agencies. mention of the egg donor or surrogate mother on A meticulous and stringent criterion is followed birth certificate. while screening for a surrogate. Once finalised, the Commercial surrogacy is legal in India and is financial & legal agreement is then made between the recognised by the Supreme Court of India. The surrogate and the commissioning couple. guidelines for surrogacy in India were laid down India is presently emerging as a leader in international by the Indian Council for Medical Research (ICMR) surrogacy and fertility tourism. Clinics charge anywhere in 2005. The success rate of surrogacy in India between ` 9 and 14 lakh ($ 22,00-35,000) for a complete can be expressed at about 45 per cent of carry- package, which includes fertilisation, surrogate’s fee, home baby in procedures using fresh embryos and delivery of infant at the hospital, medications, doctor’s 25 per cent in those using frozen embryos. fees and lawyer’s fees. Even after including the ticket Hong Kong and Taiwan are the other countries fares, cost of the medical procedures and hotel tariffs, the known for fertility tourism and where surrogacy is surrogacy expenditure to the intended parents comes to popular. In fact, many Indian women go to these a third of the amount that would have been spent on the countries for sex selection (especially for male child), same procedure in the UK. as gender determination is prohibited in India.30 I February 2011
  2. 2. Roundtable Dr Aniruddha Malpani Medical Director, Malpani Infertility Clinic, Mumbai Surrogacy is an expensive and complex treatment still not been enacted but is expected to happen soon. option, which is best reserved for women without This will give a major fillip to medical tourism, and a uterus. India has now become the preferred will also provide more clarity on appointment of destination for surrogacy, as several high-quality accredited authorities. IVF clinics are available here that provide excellent It is important that a legal contract be signed by an medical care with high success rates at economical expert legal consultant before the medical treatmentprices. Besides, there is a well-defined legal framework in starts. This ensures that everything is aboveboard, andIndia, with legal specialists to guide the intended parents that there are no legal hiccups later on. Taking shortcutsthroughout the process. can give rise to the tragedy of the birth of ‘stateless babies’, At present, each IVF clinic is governed by the local who do not have the citizenship of any nation. This canmedical authority (eg, local Municipal Corporation). cause irreparable harm to the surrogacy service industryThe Assisted Reproductive Technology (ART) Bill has in our country. Dr Duru Shah Chairman – Gynaecworld - The Center for Women’s Reproductive Health, Mumbai Couples with health problems or general Moreover, the success rate of surrogacy in India is inability to conceive still have the option about 60-80 per cent. Besides, there are fewer legal of experiencing parenthood with the help hassles involved because surrogacy agreement is legal of surrogacy. It also gives a chance to single in India. Indian clinics have also become competitive parents or couples with an alternate lifestyle not only in pricing but also in hiring and retention of to have a child of their own without going Indian females as surrogates. Also, in India, poverty through the adoption process. is the biggest and most important factor for women In India, the costs involved in the surrogacy choosing to be surrogates.process are approximately five times less as compared However, according to ICMR guidelines of ART Billthose in some other countries. The approximate and Rules 2008; 34(5), no woman shall act as a surrogatecost to the intended parent(s) is about ` 10-12 for more than three successful live births in her life. Thelakh, which includes screening of surrogate, IVF governing bodies in India for surrogacy and surrogacy-procedure, followed by antenatal check-up, related procedures are the ICMR, Ministry of Healthmonitoring and medications, hospitalisation & and Family Welfare and the guidelines issued accordingdelivery of surrogate. to ART (regulation) Bill & Rules – 2008. Dr Hrishikesh Pai Gynecologist & Infertility Specialist, Lilavati Hospital, Mumbai, and Fortis La Femme, New Delhi Indications for surrogacy include conditions the UK, Canada, Australia, the US and Israel. when a patient is unable to become pregnant There are about 40,000 IVF cycles done per year due to uterine problems like fibroids, in India, of which surrogacy constitutes 5 per cent. adenoids, repeated surgeries, cancer therapies, Foreign patients form only 5-10 per cent of the hysterectomy or conditions of poor general infertility treatment, whereas the Indian population health like in congenital heart, kidney and lung forms the bulk of patients with infertility problems. diseases. Surrogacy is also considered in dwarf As per the ICMR draft, the surrogate is paidpatients or single parents. 25 per cent of the money before pregnancy, There are two types of surrogacy – natural and 50 per cent during pregnancy and 25 per cent aftergestational. In India, natural surrogacy is not allowed, the child is born. However, arrangements can differwhere the surrogate is also the biological mother of as per individual settlements. The compensationthe child. provided to the surrogates is in terms of In India, there are 450 IVF units, third in the manpower involved and comes to aboutthe world after Japan and the US with 600 and ` 2-2.5 lakh. This compensation is offered in the form500 units, respectively. The nationalities that of a token of gratitude, as one cannot commodifyusually travel to India for surrogacy are from bearing a child. February 2011 I 31
  3. 3. Roundtable Dr Indira Hinduja Obstetrician, Gynaecologist & IVF Specialist, Jaslok Hospital, Mumbai, and Breach Candy Hospital, Mumbai In the past, traditional surrogacy was carried names of the genetic parents. The person(s) availing the out where, like a wife, a woman had intercourse services of a surrogate mother shall be legally bound to with the man to bear a child biologically accept the custody of the child and a refusal to do so shall related to her. Later, the artificial insemination constitute an offence. technique substituted the intercourse act. All information about the surrogate shall be kept In recent years, gestation surrogacy has confidential and information about the surrogate become more popular, wherein the surrogate shall not be disclosed anywhere other than the mother practically only lends her womb for carrying central database. the pregnancy to term. Here, conception takes place ICMR and National Academy of Medical Science in the clinic through IVF and embryo is transferred to (NAMS) guidelines have suggested formation of a State the surrogate mother. In this case, the commissioning Board and a National Board for regulating ART clinics. couple is the genetic parents of the child. The State Board shall have the responsibility of laying There are different kinds of surrogate depending down the policies and plans for assisted reproductive on the system of recruitment, eg, in non-commercial clinic in the state, taking into account the policies, surrogacy, the surrogate will usually be a family member recommendation and regulations of the National board. or friend, whereas in a commercial system, the surrogate The Director General of ICMR will chair the National is unrelated and has to be paid compensation. Board. These two authorities will monitor the functioning In countries like Japan, Hong Kong, Hungary and Italy, of the clinics, regularly inspect the premises and grant commercial surrogacy is banned and condemned, which is the licence. The licence will be renewed only after the also the case in Saudi Arabia. In India, the Supreme Court authorities are satisfied with the working of clinics. of India legalised the practice of surrogacy in 2002. As per Surrogacy stands as the pillar of hope for many the laws in India, a surrogate mother shall, in respect of infertile parents with the desire for a child. Taking up all medical treatments or procedures in relation to the surrogacy as an option is quite a dilemma and, if not concerned child, register at the hospital or such medical counselled properly, can come as an unexpected blow facility in her own name and shall clearly declare herself to the infertile couple. Other options like continuing to be a surrogate mother. The birth certificate issued in treatment or adoption should also be put forward to respect of a child born through surrogacy shall bear the the patient. Dr Shivani Sachdeva Gour Gynecologist & Infertility Expert, Phoenix Hospital, New Delhi A major advantage of surrogacy is that it the guidelines in India, surrogates have no legal allows one or both parents to be genetically rights on the child. Moreover, everybody wants related to the child. As against adoption, a healthy surrogate for their child. Women in surrogacy involves the intended parents at India are generally preferred as surrogates the time of conception as well as throughout because they are healthy and do not drink, smoke or the pregnancy. With a decline in the number do drugs. of newborn infants available for adoption, A surrogate can be selected by contacting an agency surrogacy offers childless couples another alternative that screens surrogates or an independent surrogate, to have a child of their own. who can provide her complete medical records. Individuals from foreign countries travel to India Tests results that rule out diseases like AIDS, hepatitis for medical care due to a number of reasons like lower B & C, STDs and rubella are very important. prices, less wait times and infrastructure equipped According to Indian guidelines, a surrogate can with advanced technological facilities. Besides, there deliver only three times in her lifetime. The governing are plans that offer complete travel packages in India, body that rules the clinics and hospitals carrying out including airfare, transfers and surgery costs, which these processes is based on certain guidelines in ICMR are less than the costs in the US. All these make in chapters 1-6. medical tourism more realistic for everyone, and not Another country that is attracting attention in just for celebrities. fertility tourism is Thailand. But the facilities there are In India, the approximate cost for a surrogacy more expensive as compared to in India. Besides, in procedure comes to $ 25,000 as compared to Thailand, people face language problems as English is $ 1,25,000-$ 1,50,000 in the US. Also, as per not widely spoken there.32 I February 2011