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 the same two or three clinics, so they're not providing access to the clinic. Rather, they are providing a helping hand through the process. 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.
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.
Medical Records and tests
The clinic you work with will want to review your medical records. Check with them which records they want or need. You'll likely then schedule a phone appointment to review the medical records and to answer any questions you may have.
Selecting a Surrogate (or Surrogates)
In India, many of the clinics will find a gestational carrier for you. In general, they choose married women who already have their own children, and conduct a medical screening. These women have shown they can carry a baby.
On the issue of surrogates wanting to keep the baby: Since the surrogate has her own children already, she is less likely to want to keep the baby. Also, because the baby will be of another race, the surrogate is less likely to want to keep the baby. Finally, the Indian surrogate is often providing the service not just to help another couple, but really for the money she'll earn to help support her family.
The clinic will likely send you profiles of the potential surrogates, and you'll choose one of them. The information is pretty limited, and often describes the woman as a housewife, possibly illiterate, with several children of her own.
Payment will generally be done through your agency, or through international wire transfer. While wire transfers are quite common outside the U.S., they are not always as common inside the U.S. Make sure you talk to your bank to understand what they'll need in order to correctly transfer funds. Usually, you can visit your bank with the wire transfer instructions provided by the clinic, and complete the paperwork in a single visit.
The IVF process in your home country
If you are donating an egg to a gestational carrier, you will go through a standard IVF process. The main difference is that you can begin the process in your home country, and have the eggs retrieved and transferred while you are in India. You'll need to work with a local IVF specialist who is willing to participate in the process. If you are working with two different doctors, you'll want an agreement on the "lead" doctor (which should be the India doctor leading the surrogacy process), in order to avoid complications. The local doctor is mainly monitoring follicle growth and providing progress updates to the India doctor.
The Trip to India
Check with your doctor on immunizations. If you want them or your doctor recommends them, take them early enough so that they don't interfere with IVF medications. Depending on how and where you'll travel in India, (and more importantly, how and where you eat), you may not need immunizations.
If you start you IVF injections in your home country, you will likely need to carry them with you on the airplane to India - make sure you understand the airlines policies on this and abide by them in order to avoid travel complications. This will likely include carrying your prescription, keeping the medications cool and on ice, and avoiding exposure to light and the x-ray machine.
Also be prepared with enough extra medication in case your flights are delayed or you miss connections.
Check if you need a Visa to enter India. U.S. citizens do need a Visa. Ask your agency or travel agent whether they will help you get an Indian Visa.
Arriving in India is always an adventure. If you haven't travelled overseas, you'll be in for some culture shock. The easiest way to minimize this is to have a driver waiting to pick you up. Many of the Mumbai hotels offer free pick-up; check with them. They'll have a sign with the hotel name and your name to pick you up. Alternatively, just before you exit the terminal, there is a stand where you can pre-pay for a taxi into the city. (Note that taxi drivers don't make much money so they do almost invariably try to overcharge. Ask to see the rate card - if they claim not to have it, or claim the meter is broken, you can go to another taxi. Of course, even when you are overcharged, you'll pay less than you would in the U.S. or Europe.)
There have been a small number of reports where foreigners have been asked to pay customs duty on products brought into India. Indias Central Board of Excise and Customs web site says that "tourists" can bring in:
(i) used personal effects and travel souvenirs, if (a) these goods are for personal use of the tourist, and (b)these goods, other than those consumed during the stay in India, are re-exported when the tourist leaves India for a foreign destination.
(ii) articles upto a value of Rs.8000 for making gifts.
If you are traveling with products for your new baby, the key is to unwrap or take it out of its new packaging so that it qualifies as a "used personal effect". Otherwise you are subject to duty of about 35.7% (which may or may not make its way to the government).
Upon exiting the airport, people may ask to push your cart for you, whether you are walking alone or with your driver. They're mostly harmless, but will expect a tip from you. Most people firmly say "No thank you". They may be aggressive, and may walk with you for quite a while. Do get your drivers mobile phone number before you leave home (in case you can't find him when you arrive) and make sure you have global roaming on your phone (which will cost about US$3 per minute, so don't use it much).
Selecting a Hotel
India has a wide range of hotels. The 5 star hotels have better service than those in the U.S. You'll fin these types of hotels in major cities like Mumbai and Delhi. Anand, and smaller cities, will have 3 star hotels. You'll have to decide what type of hotel you want to stay at. Because you are going through a medical procedure, you may lean toward more stars in order to reduce risks of getting sick from the food. See the Mumbai hotels and Anand hotels pages for descriptions of some of the hotels that intended parents have stayed at in both those cities.
Check whether your existing phone plan has international roaming. If you do, use this to start. If you phone is unlocked and has a removable SIM card (less likely for U.S. phones, more likely in the rest of the world) you can just buy a SIM card when you get to India. Otherwise, you can just buy a cheap mobile phone when you get to India - it'll be cheaper than the International roaming charges. Usually your hotel will be able to direct you to a shop selling phones. Remember to negotiate the price of the phone and make sure it works before you leave. You should be able to get a basic phone for US$20 or so, the SIM card will be more depending on how many pre-paid minutes you buy.
The IVF process in India
You will likely visit the clinic every one or two days to review the progress of your follicle growth. The doctors may recommend changing the dosage of your medication in order to accelerate or decelerate the growth rate. India's doctor offices are neither efficient nor quick - bring reading material and don't make time sensitive plans.
The evening before the egg retrieval you'll need to take an injection. The clinic will provide the medication, but you'll likely self administer it. Make sure you are very clear about the steps required - it includes mixing ingredients!
The next day is egg retrieval day. Egg retrievals are typically scheduled in the morning, around 9:00 AM. The procedure is done under general anaesthesia. You'll likely stay in the clinic in the morning, and be awake and largely ready to leave by early afternoon. Keep your afternoon plans flexible - it's likely you'll be tired and won't be in the mood to do much but rest for the remainder of the day.
Anywhere from 1 to 30 or more eggs may be retreived.
The man will also produce his specimen at this time.
The eggs will be fertilized, possibly through ICSI. Similar to a standard IVF process, they'll be graded. The highest grade eggs will be selected for implantation in the surrogate.
It will take several days to hear early results on whether any of the embryos implanted (a chemical pregnancy) and two weeks to really get positive/negative results.