Surrogacy in India: Boom or bane?

The Kiran Infertility Centre, in Hyderabad, India, recently announced what it called “a new milestone in Indian surrogacy:” the 200th baby born using Indian women as surrogates for American parents. The clinic claims to be “one of the most important clinics in the world [that] has helped thousands of infertile couples from across the world to have their own genetically related child through their IVF and surrogacy program.”

In a January press release, the Kiran Infertility Centre reports that the first baby born through surrogacy for Americans there was for a Kentucky couple in 2008. “Since then surrogacy in India for foreign infertile couples has become hugely popular,” the press release states. The clinic claims that it has been the birthplace for hundreds of babies through surrogacy and IVF for parents from UK, Brazil, Japan, Australia, Argentina, Uruguay, Singapore, Hong Kong, and Sri Lanka, among others.

The Kiran Infertility Centre is headed by Dr. Kiran D. Sekhar and Dr. Pratima Grover. The January press release quotes Dr. Grover as saying, “the feeling we get upon seeing an intended parent filled with joy after having a baby is unimaginable and invaluable, but this milestone also reminds us of the trust and faith bestowed by our patients on us.

“We are fully conscious of the fact that every milestone comes with an added responsibility, with every new successful birth there are several more hopes associated and we are thriving and working towards making that every dream and hope come true.”

The growing trend of overseas surrogacy is being covered by American news outlets and authors as a mostly positive development for infertile couples who may not be able to adopt or to use surrogates within the United States. A November 2013 ABCNews.com article states that Indian surrogacy is now one of the fastest-growing segments of the medical tourism business.¹ The article highlights the experience of one American couple whose three children were born using Indian surrogates. The Indian women who carried the pregnancies each received the equivalent of $6,000 to serve as surrogates.

Commentary by Laurie J. McKenzie, MD:

Gestational surrogacy in India is booming, driven largely by the decreased costs and the relative ease of finding an available surrogate. But is “reproductive tourism” in the best interests of the child, the intended parent(s), and the surrogate herself?

In 2011, more than 860 IVF cycles in the United States utilized a gestational surrogate (or gestational carrier).² Gestational carriers (GCs) can provide a means for an individual or a couple with reproductive challenges to have a child. Common indications for surrogacy include congenital absence of the uterus, hysterectomy, uterine scarring, and medical contraindications to pregnancy.

The use of a GC is regulated by the FDA in accordance with tissue donation, and only after the medical, psychological, and legal prerequisites are completed can treatment proceed. It is a complex road to travel even in the United States. Reproductive statutes vary from state to state, making it imperative to enlist the assistance of an attorney who specializes in reproductive issues and is familiar with the laws in one’s specific state. For example, in Texas a couple wishing to use a GC must be married, heterosexual, and have a documented medical need for a GC. In addition, the GC must be of proven fertility. If these specific conditions are not met, the intended parents will not be protected under the current reproductive statutes.

Utilizing a surrogate out of the country may only compound these issues and it raises additional concerns regarding the health screening of the surrogate and her medical care during the fertility treatment and pregnancy. What measures are in place to prevent exploitation of potential GCs? What protections are in place for the intended parents?

I congratulate the Kiran Clinic on their important milestone, and wish them continued success. Their announcement highlights the increasing utilization of gestational carrier arrangements and broaches the question: Is this best accomplished at home or abroad?

References

1. Donaldson James, S. Infertile Americans go to India for gestational surrogates. http://abcnews.go.com/Health/infertile-americans-india-gestational-surrogates/story?id=20808125. Accessed January 17, 2014.

2. Society for Assisted Reproductive Technology. www.sartcorsonline.com. Accessed January 17, 2014.
 

Dr. McKenzie is Director of Oncofertility, Houston IVF, and Director, Houston Oncofertility Preservation and Education (H.O.P.E.), Texas. She is also a member of the Contemporary OB/GYN editorial board.