The Clinics: An Introduction

When we embarked on the surrogacy process, the first questions we had were "where can we find a clinic" and "what services can they provide".  Then we started wondering "what are the differences between the clinics."  There are more than we realized. 

As compared to other countries, finding a clinic in India is pretty straight forward.  In the U.S., for example, the intended parents need to source the clinic, gestational carrier and lawyer separately.  Intended Parents can can alternatively go through an agency, but recent reports of California surrogacy agencies running off with the prospective parent's money don't do much to inspire confidence.  In other countries, especially in Europe, intended parents find a legal system that is down right surrogacy-unfriendly.

India is surrogacy friendly, and the established clinics will find and oversee the gestational carrier and also provide standard contracts.  These clinics provide a one-stop shop.  And they have established track records.

A word about the legal contract: like any contract, if you get to the point where it is required, you're in trouble.  So while having a contract is smart, rely more on entering into a situation that you feel has a very high probability of coming out well.  (This is obviously not legal advice - it's personal advice.) 

There are a number of surrogacy clinics in India, although several seem to be really marketing and establishing theselves as surrogacy specialists for overseas patients.  These include:

Rotunda - The Center for Human Reproduction.  Rotunda was founded in 1963, specializing in treatment of male and female infertility.  It is located in Mumbai, with Dr. Allahbadia as its current Medical Director.  Dr. Allahbadia was an early pioneer in the surrogacy process.  While consulting with Hiranandani hospital in Mumbai, he and Dr. Yashodhara Mhatre delivered the first documented trans-ethnic surrogate baby in May of 2006.  It was delivered by an Indian surrogate for an ethnically Chinese couple from Singapore.  He is now the Medical Director at Rotunda.  According to its web site, in 2007 its chemical pregnancy rate for self cycles were about 33% and for recipient (egg donor) cycles about 50%, with over 300 clinical pregnancies since 2000.

Akanksha (Kaival) Infertility and IVF Hospital (Anand).  Akanksha is located in Anand, a small city by Indian standards, and is sometimes refered to as the Anand clinic.  Dr. Patel, who runs the clinic, began offering surrogacy services in 2004.  She supported a 43-year old woman, helping her act as a surrogate for her daughter and son-in-law, who were both living in the U.K. at the time.  This is the story really starting giving surrogacy international attention.  Later, in 2007, a couple that used the clinic was featured on Oprah.  Dr. Patel reports a 44% success rate, which is probably why she has a waiting list of over 200 intended parents with lead times of up to 7 months.   In October 2009, Dr. Patel reported 232 total surrogates that had given birth since she started offering surrogacy as a service.

Surrogacy India.  A relative newcomer but quickly establishing itself, Surrogacy India launched its services in 2008 with its first successful surrogacy delivery in May, 2009.   Surrogacy India has effectively used online channels to market itself and get the word out about its services - one can see this through the large number of blogs run by Surrogacy India clients. 

Surrogacy Centre India (Phoenix Hospital). Surrogacy Centre India is run by Dr. Shivani Sachdev Gour who received her medical qualifications in 2000 and now practices as a gynaecologist, obstretrician and IVF specialist.  While its informational brochure indicates that Dr. Sachdev Gour has delivered more than 25 babies through surrogacy, Surrogacy Centre India didn't really begin establishing it's online presence until 2009.  While the clinic offerred lower prices and enjoyed a price advantage in 2009, it has recently raised prices to be in line with other clinics, with first half 2010 prices quoted at 1,150,000 Rupees (approx. US$23,000).

Corion Fertility Clinic.  Although the Corion clinic itself is new, it's Medical Director and owner, Dr. Kadam, worked many years at Rotunda.  As the medical director and main point of contact for couples seeking surrogacy at Rotunda, she has taken many couples through the Surrogacy process and is very experienced with the surrogacy process.  She decided to go independent, and in 2010, opened her own clinic. 

Delhi IVF.  Located in India's capital, Delhi IVF claims delivering 200 to 250 surrogate procedures, and has been interviewed in multiple India press articles over the years.  Although these figures seem high, since blogs from overseas intended parents rarely mention Delhi IVF, they may reflect a high proportion of domestic Indian intended parents.  India bulletin board posters (1,2) seem somewhat negative on Delhi IVF.  At about US$17,000 for a successfull delivery, it is somewhat less expensive than Rotunda and Anand. 

Kiran Infertility Centre.  Kiran is now used by two agencies, and in an October 2009 interview Dr. Samit Sekhar, the clinic's embryologist, reported the clinic having delivered 24 surrogate babies.   Kiran claims a 65% success rate, mainly because it regularly uses two surrogates for transfers (some of the other clinics will do this upon request).  

GG Hospital.  Although it receives less publicity in the western press, GG Hospital's Doctor Kamala Selveraj was responsible for India's first surrogate born baby on June 23rd, 1994.  However, the hospital doesn't assist in finding or managing surrogates, making it difficult for westerners to work with.

To get an idea of which couples are using which services, visit the Other People's Experiences page, which lists blogs and the clinic the blog owners are working with.  Note the listings are based primarily on English language blogs, and some clinics (like Surrogacy India) have used the Internet marketing channel more widely than others to attract clients, as a result it has a relatively large number of blogs.  Some of the clinics that don't do much online marketing haven't attracting the blogging clients.  The blogs often outline, in varying levels of detail, peoples' experiences with the clinics they've cycled with.

 

There are an increasing number of facilities providing surrogacy services.  Some are more integrated than others.  The more integrated services will provide fertility/IFV services, identify a surrogate, manage the surrogate, and oversee the pregnancy.  Rotunda and Akanksha fall into this category.  Less integrated services will conduct the egg retreival/transfer, but may not help find a surrogate, manage the relationship with the surrogate, provide a contract for the surrogate.  GG Hospital currently falls into this category.  A broader list of India Surrogacy clinics, not all of which provide fully integrated services, includes:

 

Although they don't get as much publicity in the U.S., there are also surrogacy clinics in other countries. Some of these include:

 

 

What to Know, What to Ask

More difficult than finding clinics is actually understanding the similarities and differences between the clinics.  There is no "best" clinic.  Each clinic has a different approach to providing its services, and each intended parent needs to decide which approach they're most comfortable with.  In going through the process, and in discussions with other intended parents, these are the main differences we've identified (so far, the list keeps growing):

Cost: While there are differences in costs, it's probably more important to understand what is included in the published rates and what is not included.  Rotunda may be slightly more expensive, Delhi-IVF slightly less expensive.  Either way, you need to ask the clinics for their most recent prices, as they do change periodically. Being priced in Rupees, the price in your currency varies based on current exchange rates. The clinics will provide rates in advance, although there are many factors that are unknown. How much medication will be required to stimulate follicle growth? Will there be one baby or twins? Factors like these affect your final cost. In general, an unsuccessful try will cost less than US$10,000, while the successful delivery of a single baby without complications will cost between US$20,000 and US$25,000. You’ll need to add hotel and airfare on top of that.  See the India surrogacy costs section for more details.

Payment Terms:  Most clinics and agencies request you pay upon certain milestones.  For example, at the beginning of each trimester if the pregnancy is positive.  A smaller number of agencies request full payment up front (even before the egg transfer) and offer a refund if there is no pregnancy.  Unfortunately, when crossing international boundaries, it can be difficult to get money back that you are owed.   

Success Rates: The clinics do publish self-reported success rates. Rotunda, Kaival and Delhi-IVF all report success rates of around 50%.  Surrogacy India, being much newer, announced their first surrogacy birth on 1 May, 2009.  When asking about success rates, make sure you are clear about the definition of success.  What you care about is the "take home baby rate"; often this is not what the clinics use in their definition of success.  Questions you can ask about the definition include:
  - Is it based on a successful chemical pregnancy, clinical pregnancy (fetal heartbeat detected), or live birth (see this description of chemical pregnancy vs. clinical pregnancy)?    
  - Is it per cycle, or per person?  
  - Have any unsuccessful cases been excluded from the statistics for any reason? 
  - Does the clinic only work with younger couples more likely to be successful? 
  - Does this include self cycles, egg donor cycles (generally higher), or both?  
  - Does this include fresh cycles, frozen cycles or both?
  - Can this be broken down by age of the egg donor (older has lower success rates)?

Also, keep in mind that these success rates tend to be self reported and are not validated by any third parties.  So it's unwise to rely solely on them.  From very informal feedback and discussions with other couples, we suspect success rates (successful baby delivery per cycle) are certainly not above 50%, and more likely around 33%.  

Interestingly, the most effective way to improve success rates is, if one has enough embryos, to implant them into two surrogates in one cycle.  This does increase the odds of having multiple children, but can also reduce the odds of a multiple pregnancy depending on how many eggs are transferred.   

Location:  Rotunda and Surrogacy India are both located in Mumbai, a big city of 16,000,000 people. That means direct international flights, many embassies and consulates to get the baby's passport, international restaurants but also more expensive hotels and more traffic/pollution.  Kaival is located in the relatively small town of Anand, further from high volume international airports and with much more limited hotel and food options.  Being a small town, the staff tends to be friendlier than in big-city Mumbai or Delhi.  Delhi-IVF is located in Delhi which, as the nation's capital, is a big city with modern amenities available. 

Responsiveness:  India’s sense of time and sense of good responsiveness is different from the U.S. In India, it’s common to be 45 minutes late for a business appointment. It’s accepted and considered normal. This seems to flow over into email communications as well.  Because of this cultural difference, you need to follow-up frequently. Surrogacy India and Delhi-IVF seem to be the most responsive to questions and comments. Rotunda and Akshanka are okay.  In general, if you haven’t heard feedback within 2 or 3 days, follow-up. You may have to follow-up two or three times before you get feedback.  Also, Rotunda and Anand have become quite popular, and seem to have more queries than they are able to handle.  Don't take slow responses personally, just keep following-up.  Dr. Gupta from Delhi IVF was quoted as saying "There's so many inquiries now I've given up replying to them all".

Lead Time:  Many of the clinics are quite busy, the lead time to find a gestational carrier can be quite long.  Kaival tends to have longer lead times - up to 6 months - with Rotunda and Surrogacy India often having lead times of two or three months.  These lead times do vary quite a bit, so do check directly with the clinic.  

Selecting a Surrogate:  Some clinics/agencies allow more involvement in the surrogate selection process than others.  Regardless, the information available about the surrogates is relatively limited.  Rotunda lets you select your surrogate, informatoin available includes a photos, age, education, number of children and religion.  Dr. Patel in Anand selects the surrogates, but will send you photos. 

Surrogate Living Conditions:  Rotunda and Anand both provide a dormitory for the gestational carriers to live in, which allows for somewhat closer monitoring.  However, it is not compulsory for the carriers to use the dormitory.  Surrogacy India generally has gestational carriers to live at home, but requires the home have electricity, running water and a separate bathroom. 

Known egg donors:  India's guidelines for Accreditation, Supervision and Regulations of Assisted Reproductive Technology Clinics are just that - guidelines which have not yet passed into being law (as of mid 2009).  And they are still being discussed and modified.  One of the more controversial aspects is the prohibition on using known egg donors (such as a friend or relative).  Surrogacy India has been strictly following these rules, and does not allow known egg donors.  Rotunda has been allowing known egg donors and working to see whether this particular rule can be changed when/if the guidelines become law. 

Number of Embryos: Rotunda will implant up to 7 embryos into a gestational carrier.

Number of Surrogates:  If you plan in advance, and if you have enough embryos, Rotunda and Kiran will allow you to transfer embryos to two surrogates at the same time.  This is one of the few controllable factors that can materially improve success rates.   

Frozen Embryos:  Rotunda will allow you to freeze extra embryos (and will coordinate this process). Surrogacy India will use frozen embryos.  Akanksha does not freeze embryos, preferring to use fresh embryos for every cycle in order to maximize success rates (for both the intended parents and the gestational carrier).  There is an additional cost for this, so check and plan ahead. 

Meeting the Gestational Carriers: Whether or not to meet the gestational carrier is a very personal choice. Certainly there are language, cultural and economic differences that not everyone is prepared for. Rotunda generally does not encourage meeting the gestational carriers. Surrogacy India does encourage interaction between the two.

Gay/Lesbian/etc. Friendly:  Rotunda and Surrogacy India are both friendly and support surrogacy for non-traditional arrangements. Kaival is not friendly to gay couples or individuals.

Breast Feeding: Current literature indicates that colostrum, the initial milk generated after pregnancy, helps the baby’s immune system. Rotunda’s gestational carriers very rarely breast feed the baby after birth, often because the husbands won’t allow their wives to do this. Akanksha does encourage the gestational carrier to breast feed the baby for several days after birth. 

Some other things to keep in mind that can be true with any of the clinics:

Wire Transfers.  Some intended parents have reported that their wire transfers were lost.  Fill out the wire transfer paperwork very carefully.  You may consider wiring a small test sum in advance.  And if a wire transfer is lost, ask the clinic if you can pay by cash when you arrive (although this won't help in the recovery of a lost wire transfer) rather than continuing with more wire transfers.  Other alternatives are to overnight a cashiers check directly to the clinic and/or to pay by credit card (usually with a 2% for Visa/Mastercard to 4% for Amex surcharge.)

Medical Tests of donors and the surrogate: The reputable clinics conduct screening tests of the donors and surrogates including for STDs, hepatitis, chlamydia, etc.  Check with the clinic for their exact procedures. 

Baby's sex.  Due to infanticide issues, India has passed laws preventing doctors from disclosing the sex of the baby.  You'll learn your baby's sex at birth.

Multiple births.  In general, the biggest risk from assisted reproductive technology treatment is multiple births, including twins and triplets.  Multiple birth babies are:
 - more likely to be premature and have low birth weight
 - the risk of death before birth or within the first week is 4 times greater for twins and almost 7 times greater for triplets
 - the incidence of cerebral palsy is 5 times higher for twins and 18 times higher for triplets

In the U.K., 24% of IVF births in 2005 were twins or triplets, while the figure was close to 30% in the U.S.

Because it is dangerous for both the babies and surrogates health, many Indian clinics will conduct a "selective reduction" if the egg transfer results in three or more viable fetuses. 

Cost for failed attempts.  IVF success rates are generally around 35%.  Surrogacy may be higher because eggs are implanted in younger women, but probably not higher than 50% per cycle, no matter what an individual clinic may claim.  Realistically, you will likely require more than one try to become pregnant.  Make sure you understand your total cost of a failed try and the cost of a successful try.  Although this varies by clinic, a failed try (no positive pregnancy) is about 1/3 the cost of a successful pregnancy without complications.  Delhi IVF lists the price of a failed attempt at US$5,000 to US$6,000 with a successful attempt costing approximately US$17,000 to US$18,000. 

Extra costs.  If the baby has a difficult delivery, or the mother requires extra medical care, you will have to pay for extra costs incurred. See the costs section.

Contract / Legal Agreement with surrogate.  The clinics will generally have you enter into a legal agreement with the surrogate.  There have not yet been any reported cases of the surrogate wanting to keep the baby, so the legal agreements have not yet been tested by India's courts (that we are aware of).  Although the legal agreement may (or may not) stand up in an Indian court of law, India seems to have had many fewer surrogacy legal issues than other countries. 

Contract / Legal agreement with clinic.  Also be aware that the legal agreement provided by the clinic is typically between you and the surrogate; often there is no legal agreement between you and the clinic/hospital/agency.  Most people seem fine with this, but you should at least be aware of it.  There are attorneys who will help draft and oversee a "Service Provider Agreement" between the intended parents and the clinic; using such an attorney does add another party into the process but may provide peace of mind.  To date, most intended parents have not drafted separate service provider agreements. 

In an interview for the Wall Street Journal, Mike and Mike said:

...concerned that the agreements they were given to sign with the surrogate and the clinic were too vague, [Mike and Mike] spent $3,000 in legal fees to have a U.S. lawyer rewrite them. In retrospect, Mr. Aki, 43, wonders whether the revised contracts would have been honored in India's byzantine legal system anyway. Luckily, the process went smoothly.   

Your local IVF Doctor.  In order to minimize your time spent away from home, you will likely want to start your IVF cycle locally, and then fly to India just for the transfer.  This can help reduce the length of the trip from three weeks to a bit over a week.  Most local IVF specialists do not have experience operating in such a "satellite" capacity, where they are mainly monitoring progress and providing reports to the India doctors and clinics.  If you want to start your cycle locally, you'll have to get your local IVF specialist on board.   

Indias Assisted Reproductive Technology proposed laws:  India's guidelines for Accreditation, Supervision and Regulations of Assisted Reproductive Technology Clinics are just that - guidelines which have not yet passed into being law.  And they are still being discussed and modified.  There are two main areas to be aware of in these guidelines that are still being discussed, but could affect your surrogacy plans:
1) Using a donor egg from a relative is prohibited.  Some clinics are already following this rule.
2) Full payment must be made to the gestational surrogate before a pregnancy is confirmed.  This could significantly increase the cost of negative cycles. 

Birth Certificate:  The same guidelines also dictate the names to be put on the birth certificate.  Current practice is to put the intended parents name on the birth certificates, especially if they are both the genetic parents.  In the case of an anonymous egg donor, the name of the gentic father will be used with "unknown" as the mother.  However, a court case in Anand did direct that a surrogate mothers name be put on the birth certificate (this was with an egg donor, not an embryo from the intended parent) rather than "unknown".  For U.S. citizens, this generally doesn't cause a problem because U.S. law generally requires only one genetic parent to be a citizen - see later sections on getting a passport and consular report of birth abroad (the equivalent of a birth certificate for babies born overseas).  So, while the issue of which names to put on the birth certificate is generally not causing problems today, it is one to be watched, and one to then coordinate with your embassy before the baby's birth.

Citizenship:  Do work closely with your embassy, consulate and or legal professionals to establish what steps will be necessary to get your baby's passport and citizenship.  This is generally required before being able to leave India with the baby.  The U.S. has reasonably clear rules.  The U.K.'s rules seem to be getting clearer, but still seem to result in a two or three month stay in India before securing a passport for the baby.

As you can see, many factors affect which clinic is right for you.  Policies do change, so communicate with the clinics to confirm their current policies and then decide which you'd like to work with. 

If you are really cynical about surrogacy, and the possiblity of getting scammed, there are many ways clinics can take advantage of you.  This is unlikely to happen with reputable clinics, but one Ukranian web site, for example, states:

We regularly receive complaints from foreigners regarding scams involving surrogacy. Numerous foreigners have lost money to so called «surrogacy agencies» and individuals that claimed they could arrange for surrogacy services for comparatively low prices. Normally these «very competitive» firms are just swindlers. A quality service can not be cheap. Typically, the Ukrainian correspondent asks the foreigner to send money or credit card information for living expenses, travel expenses, or medical costs for the surrogate and then disappears or informs that the surrogate lost the pregnancy. It is not uncommon for foreigners to become victims of mistreatment and extortion by these criminal «agencies» after the pregnancy is confirmed. Sometimes even some medical doctors from reproduction clinics are also engaged in their criminal activities.

So if you prefer to take this risk and act on your own, please check twice all their identifications, all legal documents and certificates (including the clinic’s and your MD’s diploma). Always ask to show you the originals and keep a copy. Hire an independent interpreter, preferably a foreigner. Please check what’s included and what’s not in the contract. It should be explicitly mentioned in written form.

If you are informed that the surrogate gets pregnant, always ask for the original reports about her health with her name on it. It would be helpful in the court if she somehow «loses» her false pregnancy.

And of course always ask for an independent DNA test to prove that the child is really yours — it’s a wide-spread scam to pass off some stolen baby or a child who has been «refused» immediately after delivery by some adolescent or low-class mother as intended parents' after a false surrogate’s pregnancy. Please don’t hesitate to contact us should you need any legal assistance in case of any problems or an attorney to represent you in the court. Our lawyers have vast experience in such cases.

The key is, do your research.  If you are working with a newer clinic or agency, make sure you are comfortable with them.  If you can, get references.  And, if you can, make sure a reputable doctor is providing you updates of the process. 

 

If you have comments or updated information on any of the above, please leave them in the comments link below.   

India Surrogacy Costs

While surrogacy costs in India may be less expensive than in your home country, the process is still expensive. Be aware that there are significant costs beyond those typically quoted in a surrogacy package, including travel costs, medical costs not covered by the package, and especially the cost of multiple tries. Because the full cost of having a baby through surrogacy includes much more than just the payment to the clinic, it's worth being clear on the full surrogacy costs at the outset. Examples of what people have spent in their pursuit of surrogacy include:

• US$60,000 - Mike and Mike (of the Mike and Mike blog) indicated they incurred about US$60,000 in surrogacy costs through their surrogacy process (two children, two surrogates, with egg donors, both successful on first try) with Rotunda,
• US$128,000 - an anonymous 42 year old investment banker through three tries with her own eggs, multiple surrogates on each attempt, and successful on the third try
• US$50,000 - Rhonda and Gerry on three attempts through Surrogacy India, with success on the third attempt.
• £25,000 (US$42,000) - The Morrison's twins delivered in Mumbai, apparently after one try
• £50,000 (US$85,000) - Nikki and Mr. Bains with a baby girl conceived at Rotunda after 13 years of trying,
• AUS$50,000 (US$45,000) - Jojo reports having spent this amount on at least two surrogacy attempts without success yet and is still trying
• US$25,000 plus US$10,000 travel - Via this sites comment form, Stephanie reported "We used one surrogate, got luckly on the first attempt, and spent about $25,000 US (+ $10,000 travel costs). I thought it might be worth adding the best case/lowest intervention scenario to your list."

Clinic Costs

Listed below are approximate surrogacy costs at some of the clinics in India. In general, these costs assume a successful pregnancy without complications after once cycle and can be as high as US$25,000.

The price of surrogacy has been increasing. In 2005, Rotunda charged about US$12,000. Now it is about US$25,000. There are many factors driving the increased costs (life insurance for the surrogate, higher surrogate compensation, strengthening Rupee, Mumbai is India's most expensive city, etc.) and they are likely to keep going up.

Prevailing exchange rates also affect the cost, as most of the clinics charge in Rupees. Check with the clinic first to confirm current prices.

Typical Fee Structure

Each clinic quotes fees differently and can change their packages over time, so the fees listed may not be apples for apples comparisons. Use them as guidance only. Confirm with the clinic you select what is, and is not, included in the fees, and compare with other clinics. Often included (but to be confirmed) are the IVF procedure for the egg donor and surrogate, payment to the surrogate, the surrogates medical checks during pregnancy, any housing fees for the surrogate, and delivery fees. These fees are often structured as follows:

IVF Procedure
Rs25,000 to Rs 50,000 (US$1,000) Surrogate Recruitment
Rs100,000 (US$2,000) Surrogate endometrial preparation
Rs200,000 (US$4,000) IVF fees

Surrogate Pregnancy costs
Rs300,000 (US$6,000) Surrogate compensation
Rs50,000 (US$1,000) Antenatal care for surrogate
Rs75,000 (US$1,500) Surrogate caretaker
Rs50,000 (US$1,000) Surrogate housing
Rs50,000 (US$1,000) Deposit for any required antenatal hospital fees
Rs100,000 (US$2,000) 10,000,000 Rs life insurance policy for the surrogate
Rs50,000 (US$1,500) Delivery

Total cost = 1,000,000 Rs, or US$20,000.
(using an exchange rate of 50Rs = US$1)

Additional Fees:

During a cycle, there are many possible additional fees. Fees that may not be included in a standard price list include:

• egg donor fees, including housing for egg donors
• medication, especially if you start your cycle at home
• HIV/STD screening for you and our partner before starting the program,
• additional medication,
• additional ultrasounds,
• additional blood tests,
• ICSI,
• embryo freezing and thawing
• amniocentesis,
• surcharges for twins,
• selective reduction,
• termination,
• DNA testing,
• agency fees if a third party sources or assists in monitoring the surrogate,
• additional housing fees for the surrogate,
• hospital and medical charges for complications during delivery,
• neonatal care for premature delivery, etc.
• delivery charges (check whether these are included or not)

In order to avoid surprises, it is important to be very clear about which fees are, and are not, included in any quotation you receive. Newer clinics may not have as much experience in providing information about all the fees, and experienced clinics may not routinely provide them without being asked.

Legal Costs: While most of the clinics provide their own contract, and most people seem to use the clinic's contract, some people do have their own lawyer's review and amend the contracts. The Wall Street Journal article quotes Mike and Mike as spending US$3,000 on such a review. Traveling fees: In addition to this, you will also incur traveling fees. If you are successful in a single cycle, you will likely require:

• two trips (airfare),
• hotel stays, and

There are reports of some people using an Indian egg donor and shipping frozen semen so as to skip the first trip, although check the cost for shipping frozen semen or embryos - it may be more expensive than an airline ticket. The first trip is a bit over a week. The second trip, to meet your baby, can be from a week to several months - it really depends on how quickly your embassy is willing to process a passport for your baby. Check with your embassy and/or later sections of this guide for more information.

Picking up your baby: Finally, there are fees involved with picking up your baby including:

• Your consulate or embassy will probably charge for a passport.
• The U.S. consulate in Mumbai sometimes requires DNA testing, on a case-by-case basis (Oct 2009). Australian citizens are currently (Oct 2009) required to have DNA tests completed by an accredited lab in Australia (cost around AU$2,000).
• And you'll have to pay for an India exit visa for the baby.

As the clinics adjust their services for supply, demand and exchange rates, prices have been changing. Do check and confirm prices directly with the clinic.

If you have updated information about surrogacy costs, or information about clinics not listed here, please email it to us at:
info at GlobalDoctorOptions dot com

Go direct or use an Agency?

Agency or not?

You have a choice on whether or not to work with an agency.  Some people do, some people don't.  If you have experience travelling internationally and like doing things yourself, you can get through the process without an agency.  If you would like someone to help you through the process, you'll need to work with an agency.  All the agencies use clinics that you can work with directly, so they're not providing special access to a clinic.  Rather, they are providing a helping hand through the process.  Some of the advantages and disadvantages of using and Agency:

Advantages

• An agency generally understands the process and can help guide you through it, especially if you have never traveled internationally 
• An agency has generally narrowed clinic choices down to a small number of reputable clinics, saving you a fair amount of research time
• Some agencies claim they have special access to lower airfares, thereby potentially saving you money on travel costs
• Usually the agency is from your country, and therefore understands your cultural norms and expectations

Disadvantages

• Adds another person as an intermediary; many people find they end up working directly with the clinic much more than with the agency
• The agency typically has a smaller number of clinics it works with, which may limit your choice of clinics.  Some work with only one clinic. 
• Many clinics have their own interanational patient coordinator that generally provides services comprable to what an agency provides
• The agency has to make money too.  You can often work directly with the clinic, and bypass the agency fees.
• It's not often clear why an agency has chosen a specific clinic.  The most popular clinics don't need another intermediary and may choose not to work with agencies.  Agencies may also be selecting clinics that give them the largest commissions. 

You may ask your agency how they earn their living - some get paid by the clinic, some get paid by the patient, some by a combination of both.

Feedback on other blogs/posts on this topic includes:

• A survey run by Chai Baby showed that 5 respondents used a medical travel agency, and 16 did not.  The two respondents that provided additional comments said:  (1) This was helpful. We have had three attempts and used the agency in only the first one. The agency was helpful in that it helped us prepare for certain aspects of our first trip to India that the clinic doctor and staff did not have time to help us with. But we were disappointed overall with the help from the agency. They did not adequately help us with a medication dosage problem and they were not up-front about the cost of using the agency. They caused some confusion about the pricing with the clinic and (2) No help really, once we started, we communicated with the service.
• After having gone through the process with an agency, in their blog Mike and Mike say "if I knew then what I know now, we would have gone directly to our clinic" and not used an agency.
• Mixed feedback in this Yahoo Forum thread (registration required) from three posters who used agencies.  One poster recommends using an agency and the other "was not happy with the agency at all" and a third said "after we got to India we fired them".  All three referenced Planet Hospital.
• Comments on this article have very mixed feedback on Surrogacy Abroad, an agency with offices in Chicago and India.  One comment says "Surrogacy Abroad is just a middleman...who pads the real costs of surrogacy in India for his own gain. He knows very little about pregnancy himself. Contracts are vague and not adhered to. Promises are made and not adhered to" while another says "we opted to outsource to India choosing a wonderful agency we would highly recommend to anyone".
• This comment on a Newsweek article indicates that the agency (Planet Hospital) was "disorganized and incompetent" with a "lack of transparency" and that three months later the couple is still "waiting for the promised feedback from the clinic".  The agency's feedback to the comment indicates it may have come from a "rogue employee" who was "dismissed recently". 
• Communication with Rotunda has improved greatly now that we have direct contact instead of going through Planet Hospital.

Some of the agencies that provide surrogacy services (each of these have differing levels of experience; conduct your due dilligence before choosing to work with one):

• Planet Hospital (working with and Dr. Vega in Panama; had previously worked with Rotunda and Kiran)
• Surrogacy Abroad (previously worked with Kiran)
• Become Parents (works with (a different) Dr. Patel at Gynaecworld)
• We Care (currently working with Surrogacy Centre India - Phoenix and Origin)
• Visit and Care (multiple agencies listed)
• Karma of Baby (currently working with Surrogacy Centre India - Phoenix as well as other clinics in New Delhi)
• World of Surrogacy (currently working with Dr. Patel (Akashanka), Surrogacy Centre India - Phoenix and Dr. Banerjee)

The clinic-Agency relationships change quite often, so confirm the above.  For example, Dr. Sekhar at Kiran emailed us saying "As previously stated we do not work with either Planet Hospital or Surrogacy Abroad currently.  We stopped working with Surrogacy Abroad in August 2010 and with Planet Hospital in March 2011.  This we have also stated in our numerous emails to Info@globaldoctoroptions.com.  Kindly make the necessary changes as not doing so is harming our good name and reputation."

Selecting the Surrogate

Many of the clinics will allow you to select a surrugate, usually from profiles emailed to you.  If you are at the clinic, you may get a small book of profiles to review.  The information in the profiles themselves are rather limited and include age, religion, education, number of children and a photo.

Everyone will have different criteria, but below is a list of some of the criteria you may choose to include when selecting a surrogate:

1) Successful pregnancies.  In general, more is better.  Both the surrogate's own children and surrogate children.  Successful pregnancies show that the surrogate can carry a baby to term and also has experience doing so.

2) No unsuccessful pregnancies or complications in pregnancies.  On the one hand, successful previous pregnancies are a good sign.  On the other hand, they don't guarantee pregnancies were trouble free or that there weren't previous difficulties.  Unfortunately, it is almost impossible to get good information on whether there were complications in previous pregnancies - one possibility is to speak with the gynecologist that handled previous surrogate pregnancies to understand if there were any complications with those pregnancies.

3) Diet/Vegetarian.  India has a high percentage of vegetarians.  This can sometimes lead to low iodine levels which can also cause low T4 levels during pregnancy.  While this can be easily overcome with vitamins, one may consider a non-vegetarian surrogate.

4) Education level.  On the one hand, the education level one attains is really based on how one did in the lottery of birth.  If you're born in the U.S., you probably got an education.  If you are a woman born in the Indian countryside, you may not have had the good fortune of access to formal education.  From that perspective, education is irrelevant.  On the other hand, a higher education level may impart more knowledge that would help ensure a safe and successful pregnancy.  But trumping that is whether the surrogate has had past successful pregnancies. 

5) Previous transfers.  Some of the surrogates have had multiple previous unsuccessful transfer attempts.  It's valuable to ask how many unsuccessful transfer attempts a particular surrogate has had.  Medical science doesn't understand everything, and certainly doesn't understand what does and doesn't cause a successful transfer.

6) Religion.  Aside from any diet restrictions that religion may impose, religion is a non-issue for most people.

7) Age.  Age is most important for the eggs (if there is an egg donor), but not as important for the womb.  For many, age is secondary to successful pregnancies and limited unsuccessful transfers.  However, age in the mid to late 20s is probably in the sweet spot. 

8) Medical tests.  Clearly, standard medical tests to check for any infections or diseases should be undertaken.  Most of the reputable clinics seem to do this.

9) Height/weight/etc.  Some Indian women are more petite and some IPs may have genes that could result in bigger babies.  Some couples may want to pursue a "bigger" surrogate.  It would seem that a big baby in a little woman could increase risks during delivery, much as the larger babies caused by gestational diabetes can increase risks during delivery.

10) Choice of surrogates.  Even with the above, if the clinic has very limited choice, you're going to get what is available.  When choosing a clinic, you may try to understand the choice of surrogates (and possibly egg donors) they will provide.     

11) Colostrum/Breast Milk.  Colostrum is the initial milk produced for newborns and helps jump-start the baby's immune system.  If you would like the surogate to express colostrum or breast milk for some period of time, consider including this as part of the selection process and also include it in the contract with the surrogate.  Asking any time after the transfer leaves you at greater risk of the surrogate declining. 

12) Surrogate's living conditions.  This crosses over the issue of clinic selection and surrogate selection.  Some clinics (Rotunda, for example) have maternity houses for their surrogates where the surrogates can be more closely monitored during the pregnancy.  Others allow them to live with family or at home with periodic visits by a case worker and/or periodic visits to visit the gynecologist.

Of course, you have to trust that the clinic and surrogate are giving you accurate information.  While at Rotunda, Peter heard a conversation among the doctors about "no longer working with a surrogate that had complications in a transfer".  From that, it would appear that Rotunda has a high enough supply of surrogate candidates that it can be selective about which it offers for intended parents to work with. 

(This article was taken largely from Peter's blog post on Selecting a Surrogate)

Meeting the surrogate?

Meeting the surrogate is an intensely personal choice which sometimes brings out the clash between the intended parents emotional need to be involved in the pregnancy and the surrogate’s (and often her family’s) financial want for more money.   Remember, the surrogate’s aren’t doing this for emotional fulfilment, they’re doing it for the financial reward. It’s labor that they are getting paid for. 

• Before the surrogate is selected, as part of the surrogate selection process
• After the surrogate is carrying the child, but before she has delivered
• After the surrogate has delivered the baby

• The surrogate and family that were still calling the intended parents two years after the childs birth requesting money for things like their childrens school fees. 
• The surrogate’s sister who called the intended parents in the hotel after the birth and requested an additional monetary payment for the surrogate.
• The surrogates brother who spoke to the intended parents after the birth and requested more money so that the surrogate could have her own room in her home
• The surrogate and her husband who threatened to abort one of the twins in a multiple pregnancy unless they were compensated more money (even though the original contract between the clinic and the surrogate provided for additional payment in the case of twins) 

• If you want to meet the surrogate, do so after the baby is born and in your custody. This is the point at which the surrogate and her family have no negotiating leverage. While they still have the baby, they have negotiating leverage, should they choose to use it.
• Do not get involved in any negotiations. Refer all requests to your agency and/or doctor. 
• Do not give the surrogate your contact information. If she and her family can’t contact you, she can’t make additional requests or demands. 
• Don’t appear to be rich. This will be difficult, because as a westerner, and by being able to pay for the surrogacy process, you already appear richer than anyone the surrogate may know. But if you invite the surrogate and her family to an expensive restaurant or make multiple plane trips to visit her during her pregnancy, you’ll appear even more rich. Which makes you a more inviting target.
• If you do plan on meeting with your surrogate, coordinate closely with your clinic to understand what they might add to the above comments

 

 

[This article is reprinted from Peter's blog - To meet the surrogate?.]

Selecting an Egg Donor

There continue to be more and more choices for egg donors. Thanks to Janine, from Visit and Care, for providing the following summary of options (July 2010):

Dr Shivani SCI:

Offers two groups of egg donors. A list donors are University graduates or hold a Masters degree and charge an extra fee. D list donors are High school educated or uneducated donors. She can offer Hindu , Muslim and Christian donors for those that have specifications and will send photos of the donors to Intended Parents to select from.
She also works with Global Egg Donors to offer Caucasian, Asian and African American egg donors who will travel to India. Additionally she will coordinate with New Life Clinic in Ukraine and Georgia for Caucasian egg donors. These donors can be viewed on line with a password.  She accepts frozen shipped Embryos and Semen- IP's need to organise the shipping and she will provide all the necessary documentation.

Rotunda:

Have also introduced 2 categories of egg donors. Donors with high education again charge an additional fee. They will also coordinate with New Life Ukraine and Georgia for Caucasian egg donors. Photos of the donors are sent to IP's and they also offer Christian, Muslim and Hindu donors. Frozen Embryos and Sperm can be shipped and she will coordinate this for IP's with their cryoshipping service.

Akanksha:

Dr Patel prefers to match IP's with a donor available in their time frame with a matching blood group. If the donor agrees, she will send the donors photo to the IP's. If this is not possible, she will send the donor's details. Some donors are available with higher education and she also has a choice of religious groups. Caucasian egg donors are coordinated with New Life. She cannot accept shipped Embryos or Sperm.

Dr Kadam, Corion:

She has donors with Higher education available as well as various religious groups. Photos of the donors can be sent to IP's to select from and again she coordinates with New Life for Caucasian donors.  Frozen Embryos and Sperm can be shipped and she will coordinate this for IP's with their cryoshipping service.

All the clinics test and screen the donors and will provide IP's with copies of their medical reports as well as family history details and details of any previous cycles.
 

Video Interviews

There are a fair number of videos about Surrogacy.  Here are some of them.

1.  Rotunda featured, with interview of Dr. Kadam:

 

2. Dr. Patel's clinic in Anand featured on an episode of Oprah:

 

3. Phoenix Hospital mentioned, with quote from Dr. Gour, in an India news story about Surrogacy:

 

4. Dr. Patel at Anand investigative report, with a negative slant on commercial surrogacy, but informational nonetheless.  Embedding was disabled by the producers, but the video can be viewed here: http://www.youtube.com/watch?v=NqXZGM_sfvA.  The same story, with a slightly different editing, titled "The Baby Factory", was aired on Australia's Dateline in Feb, 2009.  Issues raised in the video include:

• costs were not well understood ahead of time - make sure you clearly understand costs ahead of time, and understand what is and is not included in the costs. 
• when should embryos be transferred - day 3 or day 5 (bastocysts).  Most surrogacy clinics seem to do day 3 transfers; the IVF doctor quoted in the video (and likely inexperienced in surrogate egg transfers) said they should be done on day 5
• genuine legal issues of whether a surrogacy contract would stand up in an Indian court of law, although no case of the Indian surrogate mother asking to keep the baby is known

5. Baby Manji: This is one of the cases that really brought surrogacy to the forefront of Indian debate in 2008.  The Japanese parents divorced before the baby was born in Dr. Patel's clinic.  The mothere didn't want the baby, but the father did.  However, at the time, Indian Law didn't allow for this.  The story ended well - the baby did end up getting a Japanese visa and going to Japan.  And, single fathers have since been successful in getting babies home from India, especially through Rotunda.  Dr. Patel doesn't work with single fathers, so she has less experience with these types of cases than Rotunda. 

 

6. Google Baby is a 2009 movie that features Dr. Patel and her clinic, has a 3.5 minute preview on IMDb.   No preview available.

7. Two Men and Two Babies is a 60 Minutes (Australia) piece on Peter and Trevor, two gay Australian dads who had twins through Rotunda, shown in May, 2009.  No preview available, but the full 13 minute show is  available on 60 the Minutes Australia site. 

8. Gay dads through surrogacy are bringing their babies home (although the surrogate was in the U.S.) - part 1/4

 

9.  Interview of the Switzers, who used Rotunda in 2008.

 

10) A Feb 2009 BBC World News report on Surrogacy in India (.wmv file will open in your media player).  Includes interview of Dr. Anoop Gupta of Delhi IVF.   

11) A three part series on Australia's Sunday Night Channel 7 TV chronicling Lisa and Nik's story (who used Surrogacy India).  The site makes it very difficult to link directly to videos.  The title of the story is "Babies for Sale" which is available either on the home page as a featured video or possibly in the archives.

12) Interview on Washington's NBC about Rob and Greg's pursuit of surrogacy, using Surrogacy India.
 

 

 

The Indian Surrogate - An Online Book

The Indian Surrogate is a photo journalist's view of Surrogacy in India - quite well done.  The site itself is tricky to navigate - to solve that, below is a table of contents.  You can also buy the eBook. 

The Indian Surrogate
Introduction
Editorial
Cradle of the World
Surrogacy 101
The Face of Surrogacy
Surrogacy Map of the World
Million Rupee Baby
India's Mother to Surrogacy
The Surrogate House
A Packaged Delivery
A Couples Last Resort
Surrogacy Goes Gay
Baby Miracle
Covering the Birth Beat
Singaporeans on Surrogacy
Surrogacy in Singapore
Appendix: More Photos

You can also buy the eBook here. 

Other People's experiences: Blogs, Forums and Articles

The Surrogacy India Guide covers many of the issues involved in pursuing surrogacy in India.  To build on the guide information (table of contents on the left), the blogs, forums and articles below cover various individual's more personal experiences in their journey to having a baby via surrogacy. 

Blogs from people pursuing surrogacy:

Other forums and support groups:

Most of these forums, even if they lean toward affiliation with a particular clinic, will allow anyone to join and participate in discussions.

Oneinsix forum (unaffiliated, tries at Rotunda and Akanksha)
Surrogacy in India Yahoo Groups (unaffiliated/independent Yahoo Groups surrogacy forum)
Surrogacy India Forum (affiliated forum, run by Surrogacy India; its heavy moderation causes controversy (1,2,3,4, 5, 6) but provides valuable information)
Dr. Patel Support Forum (unaffiliated, run by a Dr. Patel client that had a successful surrogacy, not run by Dr. Patel)
Pea in an Indian Pod (affiliated forum; run by case manager for Surrogacy Centre India (Dr. Shivani))
Us Proud Parents (affiliated forum; run by case managers for Surrogacy Centre India (Dr. Shivani))
Baby Dreams...From India with Love Forum  (unaffiliated, run by a successful Dr. Patel client)
Parents Pursuing Surrogacy
Surrogacy U.K. Message Board (registration and qualification required - U.K. citizens only)
Surrogacy101 (Blog covering surrogacy)
Surrogacy India on Wikihow

News Articles and Reports:

 

More Sites:
Society for Assisted Reproductive Technology: More IVF centric, but does include IVF outcomes, including for gestational surrogacy in the U.S.
National Guidelines for Accreditation, Supervision & Regulation of ART Clinics in India

Paid:
OurIndiaIVF (40 page booklet of surrogacy experience with Dr. Patel; US$20)
Two Flew Over a Cuckoo's Nest (eBook of Nikki and Bobbi's experiences, requires donation, outlines experiences with their 10 clinical surrogacy attempts)