Surrogacy and Adoption in India

Surrogacy 

Adoption and surrogacy are the two options to bring a child into the family.

The desire for a genetic link and increasing desire of prospective parents to monitor the child's prenatal care and medical history has made surrogacy a more preferred option.

The parents wanting a child through surrogacy need to go through a few steps,

1. Locating the surrogacy clinic,
2. Screening and working with an appropriate surrogate mother,
3. Medically and psychologically examination of surrogate,
4. Establishing a legal contract, and
5. Finally transferring embryos to the surrogate's uterus and confirming the pregnancy.

Adoption

For those parents who simply yearn for a child—genetically related or not—adoption can be both a compassionate and enriching experience. In fact, many parents choose adoption precisely so that they might provide a better family life not only for themselves, but also for the adopted child whose need, after all, is apparent.

Below are the seven stages of adoption in India as defined by Central Adoption Resource Authority, Ministry of Women and Child Development,

1.  Registration
2.  Pre-adoption Counselling and Preparation of the PAP(s)
3.  Home Study and Other requirements
4.  Referral and Acceptance
5.  Pre-adoption foster care
6.  Legal Procedure
7.  Follow up visits and post-adoption services

Dr Neeraj Pahlajani

Are You Willing to Become a Gestational Surrogate?

To become a gestational surrogate for a couple is a decision that requires huge amount of emotional investment. The whole phase of 10-12 months and even the period after that is life changing. For a woman, who wants to become a gestational surrogate, she might be surrounded with certain reservations. Some of those frequently asked questions are answered below,

1. Should a woman have had a previous pregnancy and delivery before becoming a gestational surrogate?

Yes. Before becoming a surrogate for someone else, you need to have gone through it once for yourself before you decide you are willing to go through same for someone else. Women who have healthy, strong, bodies that provide safe and nourishing places for an embryo to grow into a fetus and be delivered as a baby are selected for gestational surrogacy process. You would be medically examined and asked whether you have completed a pregnancy without any serious medical conditions.

2. Are gestational surrogates genetically related to the baby?

No. It is because the gametes, i.e., the egg and sperm used to make that embryo are of intended parents or donors and you are required to carry the embryo formed from those gametes. Therefore, the child would not be genetically related to the gestational surrogate.

3. What are the age requirements for gestational surrogates?

A woman must be at least 21 years of age and below 40.

4. Is there anything required from surrogate’s partner?

Yes. Your partners needs to assist you in,

• Emotional support

• Infectious Disease Testing. In medical screening (HIV, Hepatitis B and C, CMV, and any other sexually transmitted diseases or disorders) to avoid any high risk behaviors is also important for your partner (no tattoos with unsterile needles, new sexual partners, etc.).

• Participation in psychological meeting.

5. Are gestational surrogates allowed to have sex?

If you are sexually active, you can generally continue your intimate relationship without restrictions. A healthy sex life is beneficial to your relationship and can reduce stress. However, some IVF clinics may place restrictions on intercourse around the time of the embryo transfer or if you are pregnant and experiencing bleeding. The medical provider at the clinic would be the person to make the final recommendation about intercourse.

6. Does any part of the gestational surrogacy process hurt?

Becoming pregnant as a surrogate does involve a number of vaginal ultrasounds and speculum exams. These exams are not pleasant and if they are painful, you should let the medical provider seeing you. There are modifications that can be made to make the experience less uncomfortable.

The embryo transfer often requires the surrogate to have a full bladder. It may sound odd, but that is one of the most common things people complain about! The actual embryo transfer, at most would be a little bit crampy, for most clients.

7. Can I continue the medications I regularly take during the process?

Yes, most medications are safe during pregnancy. Pahlajani Surrogacy Care 

will review each medication you take and discuss it in the context of becoming pregnant. The fertility medical provider you will be seeing at the IVF clinic is the person who will make the final decision about which medications you can take, which ones may need to be switched, and if any medicines need to be stopped. Your health and well being is a top priority, so no changes will be made without your agreement.

As a gestational surrogate, you would be expected to take prenatal vitamins and possibly some supplements, based on the vitamin you are taking. These costs would be reimbursed, per your Gestational Surrogacy Agreement.

Your First Meeting With Surrogate - What You Need to Ask?

Your first meeting with a woman who would carry your baby for next nine months can be awkward. You might have spent meticulous efforts to form a massive checklist of questions, like:

“Do you smoke?”

“Are you sexually active?”

But these are not the right questions to be asked on first meeting. Don’t worry, your doubts would be cleared after the surrogate’s medical and psychological exams, and you’ll be made aware of them by a professional.

When you sit down face-to-face with a potential gestational carrier, try to empathize with what she’s going through. After a huge amount of deliberation and soul searching, she’s decided to do something incredibly generous, terrifically inconvenient, and more than a tiny bit risky, for a virtual stranger. She is also nervous about the meeting, you need to ease her.

1. Why did you become a surrogate?

Although her weak financial stability might be the reason, but it can never be the only reason. Yes, money is important but with all a surrogate goes through, she’s going to earn that cash, and it is a limited sum. No one’s getting rich as a gestational surrogate, so it’s a safe bet she has bigger motives.

2. What were your other pregnancies like?

You will know all the medical information about the surrogate and her previous pregnancies from her medical examination report. But by asking this question you show some curiosity and empathy towards her. It can be a good start to build a good relationship. By knowing small details about her cravings and small needs, you’ll know just what to put in her care package.

3. How do your friends and family feel about you being a surrogate?

Surrogate mother needs support as it is both physically and emotionally demanding. If you assure her of becoming a good support and appreciate what an amazing thing she’s doing, then she would be happy throughout her pregnancy.

4. Will you be comfortable if we assist you with doctor’s appointments and in delivery room?

Most surrogates will fully anticipate and welcome your participation in the process, but raising the issue in a polite and respectful manner will set the right tone for when those intimate moments inevitably arise.

5. What kind of communication would you like to maintain after the birth?

Some surrogates and intended parents want to stay in close touch. It’s important to reiterate that your surrogate will have no legal rights to your child. Once your baby is born, you are well within your rights to cut off all 

contact with the surrogate and never see her again.

Once your child is old enough to understand how he or she came into the world, they’ll likely be curious about who their surrogate was, so it helps if you’ve kept up the relationship.

6. What are your concerns about us or this process?

You never know what your surrogate may be thinking or how you may come across to her. She might have a special request that’s very important to her or a fear she’s working to get over.

Let her know that her concerns are important to you, and in case she does have a vastly different idea of how the birth should go, it’s better to find out now rather than a trimester or two into the pregnancy.

Dr Neeraj Pahlajani

Why Did Thailand Ban Commercial Surrogacy?

After the abandonment of a surrogate-born baby Gammy with Down’s syndrome by an Australian couple and as a case of nine surrogate babies allegedly with the same Japanese father hogged the limelight, Thailand banned commercial surrogacy on August 6.

Unregulated surrogacy industry flourished in Thailand without any resistance for years before discovery of the nine babies under the care of nannies in Bangkok soon after an Australian couple abandoned their surrogate-born boy with Down’s syndrome, while taking home their healthy twin sisters. For years, Thailand was a go-get destination for infertile couples in the highly unregulated market.

According to the draft, the new law would prohibit commercial surrogacy and those violating the law will face up to 10 years in prison and a fine of up to 200,000 baht ($6,200). Agencies, advertisers or recruiters of surrogate mothers will face up to five years in jail and a fine of up to 100,000 baht ($3,100).

The move came after surrogate-born baby Gammy, who is being raised by his surrogate mother in eastern Thailand. The surrogate woman’s allegation that his Australian biological parents took home their healthy daughter and abandoned the blond, brown-eyed boy with Down syndrome and a congenital heart condition sparked outrage worldwide. (Source: www.theguardian.com)

Another equally important snag with surrogacy industry in Thailand is Gender Section IVF. Gender selection is illegal in India, but a growing number of women are finding a way round the ban by going to Thailand where there are no laws against it. Doctors use preimplantation genetic diagnosis (PGD), a method that involves producing embryos through IVF and implanting only those of the desired gender into the womb.

Preimplantation genetic diagnosis (PGD) enables the identification of genetic diseases in the embryo before pregnancy is established, and eliminates the need for possible pregnancy termination after prenatal diagnosis of a genetically affected fetus. Determining the sex of the embryo to avoid X-linked disorders remains a common indication for PGD, and the vast majority of such cases are carried out using fluorescence in-situ hybridization (FISH) with DNA probes derived from the X and Y chromosomes.

Couples from around the world flock to Thailand for cheap, reliable gender selection treatment. But while half of them from the UK, Australia, Europe and the US are looking to have girls to balance their families, Indian couples have only one motivation as they want male heirs. 

Thailand has 42 clinics and medical institutes and 240 doctors licensed to use assisted reproductive technology. After tightening laws on commercial surrogacy, the gender identification is the major stumbling block to control unregulated surrogacy sector.

Dr Neeraj Pahlajani 

10 Must Read Books for Surrogates and Intended Parents

1.  Surrogate Motherhood and the Politics of Reproduction by Susan Markens (NON FICTION)

The book is about the social construction of surrogacy in the United States and debates surrounding two bills on surrogacy in 1992, one in California and one in New York, and at the way the feminist lobby and other factors shaped two very different outcomes. In New York surrogacy was eventually outlawed, while in California it is leniently practiced.

2.  Surrogate Motherhood: International Perspectives by Shelley Day Sclater (NON FICTION)

This edited collection takes an interdisciplinary approach to the subject of surrogacy, including perspectives from law, psychology, anthropology and social work.

3.  Surrogacy Was the Way: Twenty Intended Mothers Tell Their Stories by Zara Griswold (NON FICTION)

It is a collection of surrogacy journeys of mothers. Women becoming surrogates should read this book as it will be helpful in contracting a surrogate and even to those interested in becoming a surrogate for the insider perspective it provides.

4.  The Baby Business: How Money, Science, and Politics Drive the Commerce of Conception by Debora L. Spar (NON FICTION)

This book gives the facts about commercial surrogacy and some interesting insights into the global market.

5.  Birthing a Mother: The Surrogate Body and the Pregnant Self by Elly Teman (NON FICTION)

Book narrates the personal experiences of surrogates and intended mothers. It breaks many common myths about surrogacy and about relationship between participants in gestational surrogacy arrangements.

6.  Surrogate Motherhood: Conception In The Heart (Institutional Structures of Feeling) by Helena Ragoné (NON FICTION)

The writer looks at traditional surrogates-- women who use their own egg and are inseminated with the intended father's sperm. The analysis sheds light on the way surrogacy changes established notions of kinship, family, and motherhood.

7. Due Date by Nancy W. Wood (FICTION)

Surrogate mother Shelby McDougall just fell for the biggest con of all—a scam that risks her life and the lives of her unborn twins.

Shelby McDougall, recent college graduate, is facing a mountain of student debt and carting a burden she'd like to exorcise. But Jackson and Diane have their own secret agenda, one that has nothing to do with diapers and lullabies.

8. Womb for Rent by Amanda Brian (FICTION)

It is two books in one.  It has stories of a wealthy business tycoon Derek Cameron and his own resident pet sitter Talli Paxton, and Jenna McBay, who owns a bookstore and wants to wed a man of means.

9. Her Sister's Baby by Janice Kay Johnson (FICTION)

Colleen will do anything for her sister Sheila, including having her baby. Sheila's husband, Michael, wants a baby, too. When Colleen offers to be a surrogate for his wife, he's deeply grateful.

10. And Baby Makes More: Known Donors, Queer Parents, and Our Unexpected Families by Susan Goldberg, Chloë Brushwood Rose (FICTION)

(Courtesy: www.goodreads.com)

Dr Neeraj Pahlajani

Life of Surrogates in India

India is emerging as a leader in international surrogacy. Indian surrogates are becoming increasingly popular with couples from all over the world because surrogacy in India is much simpler as well as less costly. Few particular reasons are low cost surrogacy assistance, detachment of Indian females from drug and alcohol activities. 

Also, Indian IVF Clinics are becoming more competitive in low cost surrogacy assistance and hiring of Indian females as surrogates. Gestational surrogacy is very popular choice of infertile couples from abroad. A number of couples fly to India to get a baby of their own genes.

In India surrogacy was legalized in 2002, considering that it would be helpful for those women who are naturally not in a position to become a mother. At the same time, this practice helps those families with lack of financial stability and those families which are having the problem of lack of peace due to absence of child. Women in India, generally, become surrogates with dual aim, to assist the infertile couple and also to assist her family and children. Such women dream to give proper education to their children.

However, even after 12 years since the surrogacy was legalized, surrogate mothers face certain levels of social stigma and ostracism. As a practice surrogacy involves the bodies of poor women, which in India’s socially conservative culture, is cause enough for derision.

Butthe point is what the ethical issues are as to commercial surrogacy. Many argue that surrogate arrangements depersonalize reproduction and create a separation of genetic, gestational, and social parenthood. Others argue that there is a change in motives for creating children. According to them children are not conceived for their own sakes, but for another’s benefit.

Surrogates in India are bound around certain limitations. Few of those are no woman may act as a surrogate more than thrice in her lifetime, she and her husband has had no extramarital relationship in the last six months to ensure that the person would not come up with symptoms of HIV infection during the period of surrogacy, no drug abuse, and not undergo blood transfusion excepting of blood obtained through a certified blood bank.

Thus, commercial surrogacy continues to be highly stigmatized in India. Surrogates are spending the term of their pregnancy in surrogate homes in India and try to keep it a secret because reproduction is regarded as acceptable only within marriage; taken outside the domestic sphere of family, childbearing for economic achievement may be seen as ‘dirty work,’ ‘baby-selling’ or ‘womb-renting.’

People should know that the right to reproduce is a fundamental human right and surrogacy helps to conquer both biological and social infertility. It provides medically infertile couples to have a child of their own. Legalization of gestational surrogacy aims to protect the surrogate’s interests as well as those of the intended parents and the baby born after the surrogacy.

Dr Neeraj Pahlajani 

Does obesity reduce chance of getting pregnant with donor egg?

According to a new study conducted by Washington University of Medicine, women who use donor eggs to become pregnant through in vitro fertilization (IVF), those who are obese are just as likely to become pregnant as normal weight women. The study showed that these complications are restricted to women trying to conceive naturally. Obesity doesn't significantly affect women trying to conceive through in vitro fertilization (IVF).

However, the women are advised to reduce weight before pregnancy in any type of conception, including ovum donation. Being obese during pregnancy can have a major impact on your health and your baby's health. The best way to protect your health and your baby's wellbeing is to lose weight before you become pregnant. By reaching a healthy weight, you increase your chances of conceiving naturally and reduce your risk of the problems associated with being overweight in pregnancy.

Obesity is not an influential factor when it comes to analyzing the differences in the rates of miscarriages or live births among obese women who use donor eggs. Investigators aren’t sure whether the quality of a woman’s eggs or her uterus is most affected by obesity. As a result, several studies have focused on donor egg recipients to provide some clues.

Many IVF programs have arbitrary body mass index (BMI) restrictions that help them determine whether women can receive treatment. These cutoffs need to be re-examined.

In this analysis, obesity (defined as a BMI over 30) was not associated with a difference in pregnancy rates when compared with pregnancy rates in women with a normal BMI. The data from this study also indicates that obesity was not associated with differences in the rates of miscarriage or live birth among obese women who used donor eggs, when compared with women of normal weight. However, live births and miscarriages were not reported in all of the studies.

Previous studies have stated that obesity reduces chances of spontaneous pregnancy in women. Even if an obese woman gets pregnant, there are high possibilities of her suffering complications. Obesity was not found to be associated with differences in the rates of miscarriage or live birth among obese women who used donor eggs, when compared with women of normal weight.

However, reproductive outcome has affected female obesity. An analysis egg donation treatment shows that female obesity reduced the receptivity of uterus of embryo implantation and thereby compromises reproductive outcome.  

If you are very overweight and you are pregnant, don't try to lose weight during your pregnancy as this may not be safe. Although there are risks associated with being obese during pregnancy, there is no evidence that losing weight while you're pregnant will reduce these risks.

Dr Neeraj Pahlajani