Fertility Tourism: Childless Couples Try India

When it comes to new ways to promote fertility, Bobby and Nikki Bains have been open-minded. They’ve tried herbal medicine, prayer, astrologers, soothsayers and babajis, the Hindu spiritual figures. They put a sign in their car windshield that read $18,000 FOR A SURROGATE TO CARRY OUR BABY. After five failed rounds of in vitro fertilization (IVF) treatment and two years of searching for a surrogate in Britain, the couple finally found an option they feel comfortable with: hiring an Indian woman to carry their child. Advertisements in several Indian newspapers led them to a willing surrogate whom Nikki describes as “very nice.” “She looked like the most compatible one for us,” she says, “She’s petite, and I’m petite, as well, and we have the same skin color.” The Bainses are part of a burgeoning fertility tourism trade. Cheaper prices, high-quality health care and the availability of donor eggs and surrogates are drawing an increasing number of couples to Thailand, Eastern Europe, Russia, China and India. In the English-speaking world, India has a big advantage because of the availability of English-speaking doctors. The number of surrogate births in India has more than doubled in the past three years, fertility clinics report. And Indian clinics are performing a growing number of IVF treatments for foreigners frustrated with disappointing results and soaring costs at home. By some counts, the industry brings more than $450 million a year into India. British and American couples in particular make up a big part of the recent influx of foreigners. The number of Brits and Americans coming to Malpani Infertility Clinic in Bombay has jumped dramatically in the past three years, says Dr. Anirruddha Malpani, the director. About 15 percent of his patients are now foreigners with no family connection to India.

Infertile couples are drawn to India largely because of the lower cost of treatments and lighter regulations. The British Human Fertilisation and Embryology Authority (HFEA) has outlawed payments to surrogates, but they can be (and usually are) reimbursed for expenses up to $18,000. On the other hand, the Indian Council of Medical Research allows Indian surrogates to claim monetary compensation, as well as expenses—but these usually don’t amount to more than $5,400. The cost of getting pregnant through IVF treatment in Britain is also pricey and so complex that the BBC has based a TV drama, “The Family Man,” on the adventures of an enigmatic fertility expert. At private clinics, which do 70 percent of all IVF treatment, costs can run to $18,000 a cycle. Indian clinics offer the same treatment for around $7,200—and they throw plane tickets and a hotel stay into the bargain. Whereas British clinics allow doctors to implant only two embryos into the uterus in a treatment, India allows six embryos at a time. Malpani also has experience treating women who have been deemed too old or overweight by the National Heath Service (NHS) for IVF treatment. “We would not discriminate against a woman based on her age or weight [because] guidelines may be useful when applied to a population but you cannot apply them mindlessly to individuals,” Dr. Malpani says. Bobby Bains says this kind of flexibility appealed to him and his wife: “The real benefit in India is the relaxed laws. We are allowed only two embryos to be implanted in Britain whereas in India, it is three times as much. So the odds of having a baby on the first go are higher.” Medical complications are also a factor for anyone implanted with six embryos. Malpani defends this practice by saying that if the technology were perfect, he would transfer only one embryo so they could all have one baby. “However, until we reach that stage of technological perfection, we feel patients should decide how many embryos they want transferred.” The danger with implanting so many embryos is multiple pregnancy which significantly raises the probability of premature birth, low birth weight, cerebral palsy, stillborn or death in infancy. Besides such health risks for surrogates, they also suffer from social stigma. “Nikki Two,” as Nikki calls her surrogate, has told the Bainses that her family is not happy with her decision to carry someone else’s child. Foreign couples also appreciate not having to wait long for an appointment, even if it means traveling to India. Rosa Tyser of Tennessee wanted to become pregnant using an Indian embryo so that she would give birth to a child that looked like her first two she and her husband had already adopted from India. After an unsuccessful search in the United States, she found Malpani. “Infertile couples are highly motivated,” says Malpani. “Infertility is like a chronic illness and couples invest a lot of time, energy and money to achieve their desire of building a family.” There are some ethical complications. Besides the health risks faced by surrogate mothers, the practice is also a legal minefield. Because the Indian Council of Medical Research has not issued any guidelines to deal with foreign clients using Indian surrogates, couples who take part in this procedure must adopt their child under Indian law. And because India does not fall under the Hague Convention on International Adoption, an adoption in India is not recognized under British law. This means the couple must readopt the child when back in Britain. This process, which involves a “home study” and requires the full approval of Social Services, can take up to two years. “The trend of couples traveling out to India to use Indian surrogates is increasingly worrying," says Carol O’Reilly of Surrogacy UK. “Most importantly, couples are not seeking the right legal advice before jumping into this.” The Baines’ are not worried by these complications. They plan to do whatever it takes to bring their baby home. Though their surrogate failed to get pregnant last year, she is now undergoing a second cycle of IVF treatment (using Bobby’s sperm and Nikki’s egg). They’ll find out in May if it succeeds. “We provide her with the money for her education, make sure she’s eating properly, taking her tablets and generally keep an eye on her. When she goes to hospital for checkups, they e-mail us to tell us she’s been,” says Nikki. The couple is paying her $720 for taking treatments and will pay her $9,000 for the delivery of the baby. If she agrees to deliver a second baby for them, they will pay her double. And if she fails to become pregnant? “We will consider a separate egg donor and or surrogate,” says Bobby. “But she will always remain in our hearts as a family member.” Indeed, the Baines’ are so confident that they have launched a Web site to share their story and to help other infertile couples connect with clinics in India. “It’s like gambling,” Nikki explains. “It’s like a habit, so you carry on until you achieve something.”

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