Surrogacy India Guide

With adoption becoming legally more difficult, and greater awareness of surrogacy as an option, many couples (and even individuals) that cannot otherwise bear children are increasingly turning to surrogacy as a possibility to fulfill their parenthood dreams. 

In general, couples first investigate surrogacy in their home country.  Some couples find that either the cost, or their country's legal environment, makes it very difficult to pursue surrogacy and then start investigating options for surrogacy abroad.  The most common overseas option is surrogacy in India, although there are other options.

Although India's first surrogate baby was delivered on June 23rd, 1994, the practice started receiving widespread international attention in 2004 when an Indian woman delivered a surrogate child for her daugther in the U.K.  Surrogacy in India gained more attention in 2007, when Oprah featured a U.S. couple pursuing surrogacy in India during her daytime television program. 

Surrogacy costs for a single successful round typically range from US$17,000 to US$25,000 with success rates as high as 50% depending on the age of the woman providing the eggs.  

In India, surrogacy as a medical process has matured to the point where some clinics specialize in surrogacy (which generally means they have IVF-egg transfer facilities, help identify surrogates, and assist in the legal/contractual process), generally giving them more experience and a greater understanding of the process than U.S. and European clinics that focus primarily on the more traditional IVF. 

In researching whether surrogacy India is right for you, this guide provides an overview for selecting a clinic, the process of working with a clinic, the pregnancy, birth and baby pick-up, and then post-baby birth issues

India Surrogacy Success Rates

While 2007 figures from the Society for Assisted Reproductive Technology reported 276 successful gestational surrogate pregnancies in the U.S. (with the patient's oocytes), India's clinics likely delivered 150 successful gestational pregnancies (with both patient's and donor oocytes).  This makes India the second most common location for gestational surrogacy.  However India, unlike the U.S. and Europe, has clinics that specialize in gestational surrogacy.

Each Indian clinic provides support for different types of surrogacy, with many support all types of surrogacy including:

For cycles with gestational carriers using patient's oocytes, SART figures for clinics in the U.S. show that fresh cycles in 2007 had the following results:

Of these cycles, 30% had twins, and almost 3% had triplets or more. 

Oocytes from younger women possess greater fertility potential, so if you are using a donor egg, the donor's age is one of the most significant factors for a successful birth.  

Clinics in India have not yet published such specific results, but individual clinics do claim success rates close to 50% (although it is difficult to verify these claims).  A summary of clinics, the number of births, and their claimed success rates, is included as part of the clinics overview

 

Selecting a Clinic

Surrogacy has rapidly become a mature medical process, with more and more clinics extending their IVF services, to include surrogacy.  While the medical procedures are very similar, the surrogacy process is far more complex, involving additional parties (the surrogate), legal agreements and citizenship paperwork (for the baby).  IVF clinics new to offering surrogacy services may not have experience in dealing with many of these issues.   

While going through the surrogacy process, you will usually need to make at least two trips to India , although some people visit more often.  Trips can include:

Of course, you may visit several times for the transfer process until you have a successful transfer. 

To learn more about whether surrogacy in India is right for you, there are several areas to understand, each covered in the following pages of this guide:

Aside from pursuing surrogacy in India, there are other choices.  Russia, Ukraine, Thailand and Malaysia also have clinics that assist in the surrogacy process - see the full list of surrogacy clinics if you are interested in exploring options beyond just India.  In general though, the Indian clinics have the most experience.  And most of the information you'll find, whether in news stories or blogs, are about India.  

Regardless of which clinic and country you use, do makes sure to investigate the legal issues (both who's names will be on the birth certificate and what your embassy requires to grant citizenship) as part of your due diligence, as this often becomes the most complicated issue in the entire process.

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:

Javascript is required to view this map.

 

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

 

Which clinic did you work with?

33% (3 votes)
33% (3 votes)
Surrogacy Centre India (Phoenix Hospital) (write-in)
11% (1 vote)
Surrogacy Centre India (write-in)
11% (1 vote)
WeeCare Surrogacy India (write-in)
11% (1 vote)
0% (0 votes)
Total voters: 9
Add your answer

 

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. 

What contract did you use with your surrogate?

Used contract provided by clinic, reviewed it myself, and signed it with no changes
83% (5 votes)
Used contract provided by clinic, reviewed it myself, and signed it with minor changes
17% (1 vote)
Worked with a lawyer and provided my own contract
0% (0 votes)
Used contract provided by clinic, had a lawyer review it, and signed it with no/minor changes
0% (0 votes)
Used contract provided by clinic, had a lawyer review it, and signed it with major changes
0% (0 votes)
Total voters: 6
Add your answer

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):

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 [email protected].  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. 

There are three phases at which one can choose to meet the surrogate:
  • 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
From an emotional perspective, the intended parents are often interested in understanding everything about their child, including the woman that will be carrying the child and everything about her and her family. Some areas of interest are related to the child, especially with regard to food and nutrition. Some are related to the family environment, especially with regard to safety. Others are more personal, with the surrogate even becoming like an aunt. If the clinic or agency you are working with is unproven or cannot reassure you about the surrogates living conditions, then there is more reason to consider meeting the surrogate and understanding her living conditions. 
 
From a commercial perspective, the surrogate and her family are seeing an immense amount of money from this transaction, and are some will wonder if they can get more. After all, if the intended parents can afford the costs of surrogacy, can’t they provide the surrogate just a bit more money?  A choice to make multiple international trips to visit the surrogate during the pregnancy is also an indication of wealth, and also an indication that maybe the surrogate can make more money.
 
Remember – Indian’s grow up in a culture with more bargaining and negotiation (and less fixed prices) than westerners are used to. In India, even overseas Indians who visit Mumbai get over-charged for taxi rides.   And more similar to the Chinese culture than the American culture, a signed contract is more like the start of the negotiating process rather than the end of the negotiating process.  So, you may get new requests during the surrogates pregnancy.   
 
Cases we’ve seen and heard of include:
  • 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) 
Some thoughts for cons recommendations:
  • 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

 

Did you meet your Indian surrogate?

Yes, before the transfer
67% (2 votes)
Yes, after the delivey
33% (1 vote)
No
0% (0 votes)
Yes, after the transfer but before the delivery
0% (0 votes)
Total voters: 3
Add your answer

 

[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:

Blog / Site Country Clinic(s) Used
..Un bébé en inde.. (French) India
Rotunda
Gynaecworld
2 Afro Dads - Our Journey to parenthood via surrogacy United Kingdom
Surrogacy India
A Distant Miracle United States
Surrogacy India, baby born February 2011
Amani and Bob's Indian Surrogacy Australia
Surrogacy India
Surrogacy Centre India (Phoenix Hospitals), baby born June 2010
Baby Dreams ... From India with Love! Canada
Akanksha Infertility and IVF Hospital (Anand), baby born October 2008
Baby Masala United States
Surrogacy India, baby born July 2009
Bollywood Road to Parenthood United States
Gynaecworld
Bonjour Parenthood! United States
Rotunda, baby born July 2009
Chai Baby Australia
Surrogacy Centre India (Phoenix Hospitals)
Christmas Eve Boys United States
Rotunda
Surrogacy Centre India (Phoenix Hospitals)


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)

Working with the Clinic: Preparation, Egg Retrieval and Egg Transfer

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.

Payments

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.

Phones

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. 

Egg Retrieval

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. 

Egg Transfer

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. 

Results

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.

Anand Hotels Page

Hotels
Laksh Hotel +91 2692 267897, 267898 Hotel web site
La Casa Inn +91 2692 264801 Hotel Web Site
Javascript is required to view this map.

Mumbai Hotels Page

There are many Mumbai hotel strategies.

One strategy is to not get sick - which means watching waht you eat. This strategy is better executed by either staying at a more expensive western hotel, or at least eating there often.

Another strategy is to stay at a more expensive hotel for the first few days, get used to the local environment, and then move to a more local hotel. It can be, however, psychologically difficult to downgrade.

A third strategy is to start at an economical hotel for the first trip, and then use a more expensive hotel when the baby arrives. For the first trip (egg transfer and retrieval) you probably won't spend as much time at the hotel anyway, and will probably spend more time visiting local sites.

Hotels
Residence Hotel +91-22 2857 5000 Hotel Web Site
Royal Inn Hotel +91 22 2649 5151 Hotel Web Site
Taj Lands End +91-22 6668 1234 Hotel Web Site
Renaissance Mumbai Hotel & Convention Centre +91 22 66927777 Hotel Web Site
Hotel Shubhangan +91-22-26460382 Hotel Web Site
Executive Enclave +91 (22) 6696 9000 Hotel Web Site
Ramada Powai +91 22 6777 2000 Hotel Web Site
HOTEL TAJ MAHAL | HOTEL PRESIDENT +91 022 6665 3366 Hotel Web Site
HOTEL EVEREST +91 022 22 152 784 Hotel Web Site
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The pregnancy

The pregnancy is an exciting time.  You'll find out whether the surrogate is pregnant about 2 weeks after the transfer.

Getting Updates

Keeping updated on your surrogates pregnancy may be difficult, especially when your surrogate may be illiterate, may not speak English, and in a different time zone.  Your main conduits will potentially be:

It's likely that the clinic's doctor will be your main point of contact.  When you are in India, discuss with the clinic how you'll get updates.  And then follow-up appropriately checking on planned appointments and request scans and faxes of hospital results.

To address this communication issue, Rotunda has recently launched a "Pregnancy Tracker Program" through a third party facilitation company called OGI.  For an (additional) fee of Rs. 100,000 (about US$2,300), OGI will provide regular health updates after every clinical examination, representing the intended parents during scans and tests.

Tests

The pregnancy will include normal checkups.  These include screening tests (like the double marker and triple marker tests) and diagnostic tests (like amniocentesis or CVS).  These tests check for common birth defects including Down syndrome, trisomy 18 and open neural tube defects.

Screening tests are designed to check whether there are any defects and they:

Women with “high risk” screening results are offered diagnostic testing. Women with a “low risk” result usually choose not to have diagnostic testing

Diagnostic tests are more accurate than screening tests, but also more invasive, and are performed on samples obtained by amniocentesis or chorionic villi sampling (CVS).  These tests:

The diagnostic and screening tests are not perfect; there is still a 3% chance of abnormalities even if the tests show negative results.

Routine Checkups

Check with your clinic on how often the gestational surrogate will have routine checkups.  These may be every month or every two weeks.  If anything is detected, additional medication or tests may be required. 

Additional Treatments

During check-ups, various medical issues that require treatment may be identified.  The doctor will identify and treat these as appropriate.  Typically, because of time zone differences, routine treatments will often be implemented without consulting the intended parents.  It may be worth discussing with the clinic which treatments will be completed with the intended parents consent and which ones will require consent.   

For peace of mind, you may want to brush up on the Food and Drug Administration (FDAs) system to rate the safety of drugs during pregnancy.  Many other countries have their own pregnancy categories for pharmaceutical agents.  The fact is that most medicines have not been studied in pregnant women to see if they cause damage to the growing fetus, but you can research any medication given to the surrogate to determine how it is classified.  The FDA's classifications include:

Note that the FDA requires more data than other agencies, so pharmaceuticals defined as pregnancy category A in other countries may be in the FDA's pregnancy category C .

Birth and Baby Pick-up

The surrogate process is different from the traditional baby birthing process.  Among other difference, you'll be flying to meet your child, your child will be born in a country with different standard operation procedures regarding newborns, you'll need to do extra paperwork for your child, and you'll have to carry everything you want/need for the baby on the air plane (or buy it in India). 

With a two to three hour feed schedule, the baby's first weeks are pretty sleepless for parents.  Prepare ahead and give yourself plenty of time.  The below articles should help.

The Baby - First Things First

What happens when the baby is born varies in cach country (and each state in the U.S.).  You may want to check with the hospital whether they routinely do the following, and if not, decide whether you want it done.

Antibiotics during labor:
Group B Strep (GBS) is a common bacteria that lives in mucous membranes including the bowel, bladder and vagina.  Estimates indicate that between 10 and 30 percent of western pregnant women carry GBS bacteria, and Indian doctors suggest the figures are likely higher for Indian surrogates.  Without treatment, 1% of babies born to GBS positive mothers can become infected and develop early-onset GBS disease which can cause sepsis (a blood infection), pneumonia or meningitis.  The two main preventative measures are to (a) have the surrogate screened between 35 and 37 weeks of pregnancy (much earlier if  you have multiples as they often deliver closer to 34 weeks), and, if the surrogate tests positive, provide antibiotic treatment during labor or (b) to have/schedule a caesarean delivery which then avoids exposure to bacteria in the vagina.  Because of the higher prevalence of GBS among Indian women, some Indian doctors give the antibiotics routinely.

Eye Drops
Babies are typically given medicated drops or antibiotic ointment in their eyes when they are born.  This protects their eyes from bacterial infections that can be contracted during delivery.

Vitamin K Shot
Immediately after birth, babies cannot produce their own vitamin K, which assists in blood clotting.  A Vitamin K shot will help prevent bleeding problems that can sometimes occur. 

Hepatitis B vaccine
In the U.S., this is often given before discharge.  It is a series of three shots, with the first given in the hospital.

Screening Tests
A newborn often receives a blood test to screen for disorders.  A few drops of blood are obtained by pricking the baby's heal.  In the U.S. most states screen for 21 life-threatening disorders, although some screen for more.  These include phenylketonuria (PKU) and hypothyroidism, both which are treatable but can cause mental retardation if left untreated. 

Hiranandani Hospital, where most babies from Rotunda are delivered, does offer optional newborn screening tests.  These are currently done through Preventine Life Care in Mumbai.  Comments from Dr. Shetty (suvin.shetty (at) hiranandanihospital.org) about these screening tests indicated:

  • Being a screening program, any test, which is positive, would need to be confirmed by further testing (charge would be additional as these tests are different) while treatment is being instilled.
  • In a newborn we prefer to collect sample in the 1st week (Day 3 – Day 5 preferably) as this period will give results for a number of disorders and help the pediatrician to take appropriate action wherever necessary.
  • The results are available in 3 working days (blood sample) and 8 – 10 working days (urine sample).
  • The newborn screening has been optional and hence not included in the package. Hence, there will a charge of Rs 6500/- (approx US$150) for the screening on OPD basis.

Hearing Test
This is typically done in U.S. hospitals as well.  The test measures how the baby responds to sounds by putting a small earphone/microphone in the baby's ear.  Without testing, hearing loss may not be diagnosed until the baby is 3 years old.  Diagnosing hearing loss earlier can help prevent speech development problems. 

Circumcision
If you have a boy, you'll have to decide whether you want him circumcised.  If so, check to confirm the hospital has facilities to support this.  

Cord blood banking
Cord blood can help treat a number of diseases, including leukemia and lymphoma.  Studies seem to show that the odds of requiring a stem cell transplant to treat such a disease during ones lifetime is 1 in 217.  India has private cord banking services available including from private companies like Cord Life India

 

List of items to bring to the Hospital

What you need depends entirely on the hospital you go to.  Hirinandani hospital in Mumbai has a small store that carries everything you'll need to take care of the baby.  That being said, it is nice to go prepared. 

Here's is what you can consider bringing:

  • Clothes (outfit, gloves, booties, hat (in case you go outside in the sun)) (more is better)
  • Blankets/wraps/towels (for drying the baby and/or swaddling the baby)
  • Diapers, wet wipes, cotton balls (for wiping the baby's eyes)
  • Food and accessories (formula, bottles, steamer, something to boil hot water, thermos to store hot water)
  • Medical accessories (check with your paediatrician)
  • Travel safety gear: car seat or baby carrier
  • Electrical Adapter (India is on 220 to 240 Volts)

At Hirinandani in Mumbai, the nurses can provide boiled water and can sterilize bottles.  But, once you've left the hospital and are in a hotel, you may be on your own.

The Paperwork - Prepare Ahead

This will be an exciting time.  But for you, it will be different than other births.  Not only will you need to take care of the baby, but you also have plenty of paper work that needs to be taken care of in order to bring your baby home. 

At the hospital: The Indian Birth Certificate

You'll be overcome with all kinds of emotions when you see your baby.  But you need to stay grounded - you need to remember to get paperwork for the birth certificate moving.  You'll need the birth certificate before you are able to visit the U.S. Consulate to get a passport, and likely for other country's consulates as well.  And you need the passport before you can get an exit visa. 

In Indian surrogacy births, the names of the genetic or intended parents are currently put on the Indian birth certificate. There has been some discussion about whether it is legal to put anything other than the gestational carrier's name on the birth certificate, particularly from one of the Mumbai IVF facilities that does not offer surrogacy. While I'm not a lawyer, several things seem certain. First, with the Baby Manji case, India's courts have tacitly acknowledged and accepted surrogacy. Second, the hospitals are putting the genetic/intended parents names on the birth certificates today, and have been for many years. That being said, India is also developing its own legislation on surrogacy, called the ICMR Guidelines. While these haven't been adopted yet (Nov 2009), as currently drafted they will explicitly allow the genetic/intended parents names to be put on the birth certificate. Until these are passed, current practice may be a bit of a grey area.

The Birth Certificate is issued once the local municipality receives the registration from from the Hospital.  In Mumbai, birth certificates are issued by the Municipal Corporation of Greater Mumbai, also known as the Brihanmumbai Municipal Corporation, or BMC.  At Hirinandani, on the day the baby is born, you will be asked to fill out a form in a giant book.  This is the form the BMC uses for the birth certificate.  Fill it out in capital letters and clearly - anything that causes confusion will delay the birth certificate.  The hospital will deliver this form to the BMC.  It is useful to get a copy of the form in case the BMC makes a mistake and you need to get the birth certificate corrected.   

You would expect that there would be a "normal speed" birth certificate, and an "accelerated speed" birth certificate, with published prices that you would pay extra to receive.  India doesn't work this way.  There is only a "normal speed" birth certificate which is quoted at 21 days, but is rumored to sometimes take longer.  To get the birth certificate accelerated, you pay "chai pani" (which is literally translated as "tea money").  This is a "facilitating payment" which some people also call a "bribe"; though there is a difference.  Facilitating payments accelerate an outcome while bribes change the outcome.  As a westerner, you don't know the right way to do this, so you hire someone to do it for you. 

Your choices to quickly get a birth certificate broadly include:

  1. Go through the public relations officer at the hospital.  At Hirinandani, the public relations office was working with a service and charged 5,000 Rupees (Aug 2009).  No guarantee on how long it would take to get the birth certificate, although they were expecting it would take around 7 days. 
  2. Go through a service/person who knows the process.  Many people seem to use Dilip, who was recently (August) charging 3,000 Rupees. 
  3. Goto the local municipal office (in Mumbai the BMC) and go through the process yourself. 

Several pieces of advice:

  1. Make sure you write all information very clearly on the hospital birth registration form and on the letter to the BMC so that the birth certificate is not printed incorrectly. It's an even bigger bureaucratic hassle to get it fixed.
  2. Make copies of the hospital registration form and the letter you send so that if there is an error, you can prove it wasn't yours.
  3. Don't ever base your plans on when you expect to get the birth certificate. Our experience is that India has not yet learned to “under-promise and over-deliver”, rather you are more likely to get “over-promised and under-delivered”. Leave some buffer time, you may need it.

 (This article was taken from a blog post on Peter's Surrogacy Blog)

Getting Australian citizenship for the baby

The Australian citizenship process is well defined (although the process is periodically changed), requiring a DNA test and additional documentation.  The Australian High Commission in India's web site state states:

Applications for Australian citizenship by descent for children born outside Australia as a result of surrogacy arrangements are assessed according to legal requirements set out in the Australian Citizenship Act 2007 (the Citizenship Act), and the policy guidelines set out in the Australian Citizenship Instructions. 

Under these guidelines, a child born overseas as a result of a surrogacy arrangement may be eligible for Australian citizenship by descent if at least one of the biological parents is an Australian citizen who has been granted full parental rights by a court of law. 

In addition to the general documents required for applications for Australian citizenship by descent, applications for Australian citizenship by descent for children born in India as a result of surrogacy arrangements need to be accompanied by:

- evidence that the child is the biological child of the intended parent; and
- evidence that this parent is also recognised as the legal parent of the child and that the surrogate mother and her husband or partner (if applicable) has relinquished all parental rights over the child.

Evidence of the above can be given in the form of:

(a) court documentation OR
(b) DNA testing and written advice confirming legal parentage

DNA testing is by far the quickest option (we don't know of anyone who has tried to prove parentage by court documentation) as citizenship will not be granted until this evidence is provided.  Passports will not be issued until citizenship is granted.

The full description with more details can be found at http://www.ausgovindia.com/ndli/vm_surrogacy.html  or  http://www.india.embassy.gov.au/ndli/vm_surrogacy.html.

As the details of the requirements do continue to evolve, it's a good idea to check the pages above.  Most people have also suggested contacting the consulate before traveling, so that they are familiar with your case when you do arrive.  

Other descriptions of the process include: 

Getting Canadian citizenship for the baby

A writeup on getting Canadian citizenship for a baby is in a Baby Dreams...From India with Love forum post.

Getting U.K. citizenship for the baby

Couples seeking U.K. citizenship for their babies have often spent 3 months in India before completing the necessary approvals and paperwork to bring their baby home.  It is important to understand the legal requirements to get your baby's citizenship. 

The London Evening Standard had a short Q&A on surrogacy which included the following:

What are the risks (of surrogacy abroad)?
Agreements are not legally enforceable and a surrogate mother has the right to refuse to hand over the baby if she changes her mind. Also, couples only gain parental rights over the child if they successfully apply for a parental order after six weeks. At this stage the surrogate relinquishes all her rights over the child. An additional complication with foreign surrogacy is that children born in another country could effectively be stateless.

Why would they be stateless?
They are neither recognised as Indian nor as British in the eyes of a court.

Has a British couple ever had problems?
Yes. Last December, a couple whose twins were carried by a surrogate in the Ukraine won a year-long battle over paternity.
Why did they have to go to court?

They had been unable to conceive so used a donor egg which was implanted into the Ukrainian surrogate. But only the husband was recognised as the parent, not his wife.

What happened?
Home Office officials allowed the babies entry to the UK and the couple were awarded parenthood. However the case is regarded by lawyers as a cautionary tale for anyone looking to “hire a womb” abroad.

The best description of requirements to get U.K. citizenship for a baby born through surrogacy in India is at http://1in640715.yuku.com/topic/382.  It states:

If you wish your baby to be a British Citizen you will need to apply to register your baby under section 3(1) of the British Nationality Act 1981. To do this you should contact the British Deputy High Commission in Mumbai who will be able to advise you on the application, including the documents you should include, provide the form (MN1) for you to fill in and forward the application to the Home Office in the UK.

Once your baby is born you will need to apply for a Parental Order (PO) under Section 30 of the Human Fertilisation & Embryology Act 1990. This transfers the legal rights to you as the intended parents. To qualify for a PO, you must be over 18, married to one other, domiciled in the UK and at least one of you must be genetically related to the baby. You can apply for a PO once your baby is 6 weeks old, and must apply before they are 6 months old. You may find it easier to employ a solicitor in the UK to assist you with this process. The website www.surrogacyuk.org has more details on applying for a PO.

Surrogacy UK also has a good description of the process required for U.K. citizens and some of the potential pitfalls.

If you are a UK couple considering conceiving with a foreign surrogate, you need to take care over conflicts of law on parenthood, and the rule against paying more than reasonable expenses.  Some foreign systems of law allow the intended parents to acquire parenthood status automatically, either through a foreign court process (such as a Californian pre-birth order) or simply by allowing them to be named on the birth certificate (as in India).  However, if you are domiciled here, English law will apply to you which means that you may not be regarded as your child’s legal parents (including for the purposes of entry clearance and citizenship, which can prevent you bringing your child home). 

The solution is for you to apply for a parental order, but if you have paid for a commercial surrogate, this may be difficult.  Most foreign surrogacy arrangements involve a commercial element, but under UK law this will mean that you will have to ask the court to authorise your payments before a parental order will be granted.  This is likely to involve an application to the High Court, and the court will weigh up very carefully the particular circumstances of your case in order to decide whether it should make an exception to the UK’s public policy against commercial surrogacy.

It is wise to seek legal advice before embarking on any international surrogacy arrangement.

The U.K. passed a new parenthood law effective April 6th, 2009.  The HFEA has a FAQ on the law here.   

How does the new parenthood law affect surrogacy arrangements?

The new parenthood law does not change the fact that the woman who gives birth to the child is the legal mother when the child is born.

If the surrogate is married or in a civil partnership, her husband or civil partner will be the legal father or second legal parent of any child born – unless it is shown that the he/she does not consent to the treatment.

If the surrogate has a partner with whom she is not married to or in a civil partnership, the partner must have consented to being the father/second parent of any child born as a result of treatment in order to be legally recognised as such. The surrogate must have also consented to her partner being recognised as the father/second parent.

If the surrogate is single or has a partner who does not wish to be the father/second parent, the new parenthood law makes it possible for the intended father/second parent to be the legal father/second parent upon birth of the child – but only where they have not provided sperm for the treatment. Both the surrogate and the intended father/second parent will need to consent to this.

As is currently the case, if the intended father has provided sperm for the treatment of the surrogate, he will need to register as a donor and therefore cannot be the father upon birth of the child. If the intended second parent has provided eggs for the treatment of the surrogate she will need to register as a donor but she can also become the legal second parent if the relevant consents are in place.

As is currently the case, the Parental Orders (Human Fertilisation and Embryology) Regulations 1994 and (in Scotland) the Parental Orders (Human Fertilisation and Embryology) (Scotland) Regulations 1994 provide that parental rights and obligations in respect of surrogacy arrangements may, provided certain conditions are met, be transferred from the birth parents to those who commissioned the surrogacy arrangement.

From April 2010 it will be possible for civil partners and two persons who are living as partners in an enduring family relationship (as well as married couples) to apply for a Parental Order (providing that certain conditions are met).

Patients seeking a surrogacy arrangement should seek legal advice.

Additionally:

Information about surrogacy arrangements where the child is not born in the UK.

In proposed surrogacy arrangements, the commissioning couple might not be able to apply for a Parental Order for a number of reasons e.g. they are not married to each other, or neither of them are domiciled in the UK. If the commissioning couple is ineligible for a Parental Order, then the only way in which they can acquire legal parenthood is through adoption.

If the child is born abroad, provided that the commissioning couple are domiciled in the UK, they
may apply for a Parental Order.

It is important that patients considering this an option seek their own legal advice before going ahead.

UK law treats everyone as having a domicile of origin from birth; where the parents are married this will be the domicile of the father. Domicile cannot be lost by going abroad for a holiday, or to stay for a period of time, unless there is no intention of returning to the country of domicile. A domicile of choice can be acquired through a combination of residence and intention to reside permanently in another country which will replace a person’s domicile of origin. If there is in any doubt as to whether this condition can be satisfied, a specialist immigration lawyer should be consulted or alternatively the Home Office may also be able to assist.

Immigration:

If the child is born abroad, the commissioning couple will need to apply for a visa to enable the child to enter the UK while the application for a Parental Order is being processed. Referral to the Home Office is necessary in all cases.

The InfertilityNetworkUK has a paper on Surrogacy in the U.K which states (this is geared more toward surrogacy carried out within the U.K., although it applies to births outside the U.K as well.):

In order to carry out a legal surrogacy in the UK you must be able to apply for a Parental Order.  Applying for a Parental Order a very simple process. Although you do not need a solicitor, some people like to have the peace of mind of employing one.
 
To be granted a Parental Order the Intended Parents must be:
·          Over 18
·          Married to one another (a civil ceremony is not classified in law as a marriage)
·          Domiciled in the UK
·          At least one of the applicants must be genetically related to the child
 
The Intended Parents can apply for a Parental Order once the child has reached 6 weeks of age, but must apply before the child reaches 6 months.

For the most current information about requirements and procedures, contact the British Deputy High Commission in Mumbai directly. 

Do your research and seek legal advice. 

 

Getting U.S. citizenship for the baby

You will have to make an appointment with the U.S. consulate to get your baby's passport.  During this process, you'll complete the following documentation:

  • Passport Application
  • Consular Report of Birth Abroad (CRBA) and
  • Affidavit of Presence in the U.S.
  • Social Security Number application (this can also be done after you get home)

The passport is required in order for the baby to get an exit Visa to leave the country and also to enter the U.S.

The CRBA is issued in lieu of a birth certificate to US citizens abroad. It is considered primary evidence of U.S. citizenship and can be used throughout the childs life for passport applications, school admissions, and other situations that require a U.S. birth certificate.

At present, it takes 7-10 days business after the U.S. consulate has approved the application to get the baby’s Consular Report of Birth Abroad (CRBA) and passport.  Approval can take additional time if the consulate requires more documentation than you bring to the appointment.

To understand the process, or to confirm any items that are unique to your situation, you can call or email the U.S. Consulate or Embassy before visiting India. Emails to the Mumbai consulate will get an automated response which, at the bottom, will include a note that says:

If these links do not help you find what you need, please resubmit your request using the phrase "Request for Specific Information" in the subject line of your e-mail. We will respond to your inquiry as quickly as possible.

This automated response email includes a link to information on how to obtain a "Consular Report of Birth Abroad" at http://mumbai.usconsulate.gov/birth_abroad.html. This information is a bit general and does not cover surrogacy.

That page lists additional information/requirements for babies born through Assisted Reproductive Technology - those requirements are http://travel.state.gov/visa/immigrants/info/info_1337.html. This information is also a bit general.

After you send an email with a subject line of "Request for Specific Information", you'll actually get a human response.  The consulate is also developing specific information for surrogacy, and will include the most recent versions. The email address is: MUMBAIACS at state.gov. Remember to put "Request for Specific Information" in the subject line if you want to get a human response.

Alternatively, you can call the Mumbai Consulate at +91 22 2363 3611 x4306 and ask for the American Citizen Services Unit.

After your baby has been born, you'll need to call the consulate to schedule your appointment.  If you don't call ahead, the consulate *might* let you come at the end of the day after all other scheduled appointments have been completed.  It's not worth it - make an appointment.  Also be aware of the consulate's holiday schedule - you won't be able to get an appointment on holidays (U.S. and Indian).

Mike and Mike write about their visit to the consulate here (scroll down a bit).  

Main recommendation is to have all your paperwork filled out when you arrive. 

Much of the information covered in the Consultea/embassy responses is included in the following pages, but it pays to request the most current information.  The two attachments the Mumbai embassy will send you are included below.  It seems that procedures do vary from consulate to consulate (Mumbai very strongly recommends DNA testing, Delhi does not - although these policies could evolve), so if you're working with the embassy in Delhi, or another consulate office, contact them directly for their most recent policies. 

AttachmentSize
DNAforwebsite__doc.docx15.26 KB
Standard_letter_for_CRBA_August2009.docx22.36 KB

Affidavit of Presence in the U.S.

The following is from http://mumbai.usconsulate.gov/transmission_requirements_.html and lists the transmission requirements for U.S. citizenship. Review it carefully to ensure you are eligible to transmit U.S. citizenship to your baby. This primarily applies to the Affidavit of Presence in the U.S., one of the documents you'll have to complete at the consulate.

Reports of Birth: Transmission requirements for U.S. citizenship

Children born abroad to U.S. citizen parents may have a claim to U.S. citizenship. The following is a brief description of the various circumstances under which a child born abroad acquires U.S. citizenship.

Child born in wedlock to two U.S. citizens: A child born outside of the United States or its outlying possessions to two U.S. citizen parents is entitled to citizenship, provided one of the parents had, prior to the birth of the child, been resident in the United States or one of its outlying possessions. (No specific period of time is required to establish residence.)

Child born in wedlock to one U.S. citizen parent and one non-U.S. citizen parent on or after November 14, 1986: A child born outside of the United States to one U.S. citizen parent and one non-U.S. citizen parent may be entitled to citizenship provided the U.S. citizen parent had been physically present in the United States or one of its outlying possessions for five years, at least two years of which were after s/he reached the age of fourteen. This period of physical presence must have taken place prior to the birth of the child. Click here for Affidavit of Physical Presence form.

Child born in wedlock to one U.S. citizen parent and one non-U.S. citizen parent between December 24, 1952, and November 13, 1986: A child born outside of the United States to one U.S. citizen parent and one non-U.S. citizen parent may be entitled to citizenship provided the U.S. citizen parent had, prior to the birth of the child, been physically present in the United States for a period of ten years, at least five years of which were after s/he reached the age of fourteen.

Child born out of wedlock to a U.S. citizen mother: A child born outside of the United States and out of wedlock to a U.S. citizen mother is entitled to U.S. citizenship provided the U.S. citizen mother had been physically present in the United States for a continuous period of at least one year at some time prior to the birth of her child. (NOTE: The U.S. citizen mother must have lived continuously for 1 year IN THE UNITED STATES OR ITS OUTLYING POSSESSIONS. Periods spent overseas with the U.S. government/military or as a government/military dependent, may NOT be computed as physical presence in the U.S.)

Child born out of wedlock to a U.S. citizen father: A child born outside of the United States to a U.S. citizen father who is not married to the non-U.S. citizen mother is entitled to U.S. citizenship provided the U.S. citizen father had been physically present in the United States for the period of time as specified in previous paragraphs for children born in wedlock to one U.S. citizen and one non-U.S. citizen parent, either before or after November 14, 1986; and

* a blood relationship between the applicant and the father is established by clear and convincing evidence; and
* the father signs a sworn statement agreeing to provide financial support for the child until s/he reaches the age of 18 years; and
* the father provides a written statement acknowledging paternity; or
* the child is legitimated under local law; or
* paternity is established by a competent court before the child attains the age of 18 years.

I believe that my child has claim to U.S. citizenship. What next?

If you believe that your child has a claim to U.S. citizenship, it will be necessary for the U.S. citizen parent to appear in person at this office in order to execute an application for a "Consular Report of Birth Abroad" before a consular officer. At that time, a passport application may also be executed.

What if I do not meet the requirements for transmission of citizenship to my child?

It may be possible for your child to apply for expeditious naturalization or an immigrant visa.

I am over the age of 18 and I believe I have a claim to U.S. citizenship. What next?

If your parent(s) had the prerequisite physical presence in the United States required by U.S. citizenship law in effect at that time, you should e-mail us at [email protected], giving as many details of your situation as possible. We will then let you know if there are any grounds for you to pursue your citizenship claim further.

In an email correspondence, the consulate indicated:

For the Affidavit of presence in the U.S.  I'm 40, have lived outside the U.S. half my life, and have traveled quite a bit.  Do I need to state the precise dates I lived in the U.S., excluding dates I was traveling?  Yes. 

Or can I provide documentation showing physical presence in the U.S. for some period of time?  Yes, we will also want this, to document those precise dates you will already have listed. 

If so, what period of time is required (1 year)?  Yes, if both you and your wife are proven to be genetic parents of the child – otherwise, 5 years, 2 of which are after the age of 14.  Transcripts are great proofs for this sort of thing, so consider having those on-hand for any education you did in the U.S. (yes, even high school). 

If so, what evidence is sufficient?  Use your judgment, but things like transcripts, W-2 forms, military records, etc – basically anything that proves you were in the U.S. for a given span of time.

To prove physical presence in the U.S., reports indicate that people have used school transcripts, tax returns with W-2s that indicate full-time employment in the U.S., earnings statements issued by the Social Security Administration, military records, leases, utility bills, etc. 

If you have questions about your situation, contact the consulate prior to traveling to India.  Starting in 2009, the consulate has become stricter in following these rules and verifying actual presence.

Passport for the baby

Once you know the discharge date of your baby, you need to call the Consulates Fraud Prevention Unit at 022-2363-3611 ext 4426/4431 to make your appointment.  If you are certain you will have the birth certificate by a given date, you can state simply you will have everything on the date of the appointment.  The lead time for appointments can take up to two weeks, so it is important to make this appointment as early as possible.  It's best to make one trip to the consulate to get your passport and DNA Swab complete to limit the exposure of your newborn. 

Once they confirm your appointment, they will send you an email with all the required documents you need to fill out. These documents will include:
- The Consular Report of Birth Abroad (CRBA),
- Passport Application and
- Affidavit of Presence in the US

The application for the baby’s social security card is at the embassy.

Please follow the link below if you desire to fill out the forms at home. The benefit is you will not need to do that in India at the last minute. http://mumbai.usconsulate.gov/reporting_birth_of_child_.html. The embassy can also provide you the forms when you arrive and you can fill them out then.  You will need to bring with you several documents.

1. Parents proof of U.S. citizenship.  Usually through your passport, but possibly through a naturalization certificate.
2. Baby's Birth Certificate that is issued by the Municipal office in Mumbai.
3.  Evidence of parents marriage: if applicable, this is usually via an original marriage certificate
4. Two identical 2x2 passport size photos with white background.  The Hospital can arrange for these photos to be taken. Please double check the size and background once you receive the photos.  There are certain requirements regarding the photo’s i.e. size and type. which can be found at: http://mumbai.usconsulate.gov/passportphoto.html
5. The discharge form from the Hospital. This is a report card outlining the babies birth and much unlike what you are used to in the states. We also recommend that you get copies of the babies medical records from the medical records department, the public relations department can help you with this process. The more information the Embassy has the better it is for your approval process. In addition it is good information for your pediatrician to have of what took place at the hospital.
6. A letter from your Fertility Clinic on official letterhead stating that they assisted you in becoming a parent. In the letter the details of the surrogate, the date of service and what has occurred will be spelled out in the letter
7. A letter from the hospital with their letterhead that outlines the birth of your child.
8. Your baby’s presence is required during these visits.

Address of the U.S. Consulate is:

American Consulate General
Fraud Prevention Unit
Lincoln House
78, Bhulabhai Desai Road
Mumbai, India 400026

Once you arrive at the embassy with your baby, you will be required to leave your cell phone and other electonics with the guard. They will allow you to bring the babies supplies in although you'll probably have to taste test an liquid formula. The entrance you want is to the left of where the guards allow your car to be dropped off.

Once inside the embassy you will confirm your appointment with the receptionist. You will then go into the room and take a number. You can approach the counter for your forms this time. Usually you are asked to be there at 9:15am. Appointments are traditionally made for Thursday’s. This process can take up to three hours, so make sure you bring your babies formula and pertinent supplies. They have bottled water at the embassy for you to mix the formula. Once your name is called you will hand over all of the documentation to the agent. The agent will ask for payment in Rupees. Please refer to the State Department website for the required amount. These amounts change from time to time. You should get the name of the American Official that assisted you, and if possible an email address, so the lab can notify them when the DNA test is complete and DNA results are on their way back to the Embassy. This alerts them to the package and help facilitate it’s movement through the security in the mail room.

At present, it takes 7-10 days business after the consulate has approved the application to get the baby’s CRBA and passport. Please be aware that surrogate situations are complex and frequently require additional documentation so the application may not be approved on the day of the appointment. Go prepared!

Some people (tangobaby, friend of HammockGuy) have reported success requesting an emergency passport without DNA results.  An emergency passport can be ready the same day.   It's not clear what criteria is required to qualify for an emergency passport. 

DNA verification

On clarifying the requirement for DNA testing, the U.S. consulate in Mumbai has recently indicated:

DNA testing may be recommended to support an application for an immigrant visa or to transmit U.S. citizenship.

This means DNA testing is not always required.  It is wise to clarify your situation with consulate or embassy before visiting.

The United States Government requires that you use an American Academy of Blood Bank approved lab.  Labs are added and removed, so you'll need to go directly to their approved list. This list can be found at http://www.aabb.org/About_the_AABB/Stds_and_Accred/aboutptlabs.htm.  Some labs confuse the INS guidelines with the Dept. of State guidelines and request a case number or even refuse to send the kit to you.  Start preprations early.

You’ll have to coordinate the shipping arrangements (both ways) directly with the lab.  You must have the kit sent to the consulate or embassy.  If you are having the kit sent to the embassy, it is wise to notify them that you have done so, so they can look out for the package and confirm receipt.  At the time of testing, you will need to provide a prepaid envelope for shipping the samples from Mumbai back to the lab for processing; the lab may include this for you - check with them.  The consulate will be the ones to actually initiate the shipment, but requires a prepaid return envelope for this.

In Mumbai, The DNA test must be done at Bridge Candy Hospital next to the US embassy.  Either on the day of your embassy appointment or during a separately scheduled DNA appointment (it's best to discuss your case with the consulate officers, as their recommendation on whether to do both these appointments on the same day or on separte days seems to change over time) you will meet with an Indian Physician at Bridge Candy Hospital. You need to go to a building across from the embassy, which is just a stones throw away from the hospital across the parking lot to the right of the hospital entrance. Here you will be asked to produce your baby’s birth certificate. You will then pay for the swabbing (350 Rupees per person) and they will hand you a slip for the test. When that process is complete you will be directed to the appropriate place in the hospital where the swab will be performed.

In an email, the consulate indicated:

Our current procedure is that the parent(s) and child appear together (at the same time) for a single appointment at a hospital near the consulate, where a cheek swab is taken for each person to be tested.  That way, there is no doubt as to from whom the contributions were collected.

A US embassy official will also be present. They will require a few items from you at that time.

1. The Original Birth Certificate and one additional copy.
2. A Copy of your passport
3. A 2x2 Photo of self
4. The DNA Kit (keep the kit in the Fedex envelope if you were the recipient of the kit)
5. DNA testing fee

Once the DNA Swab is done, the embassy official will seal it and place it in the return prepaid Fed Ex envelope provided by your lab. They will be responsible for shipment and will arrange for Fed Ex to pick up the package. Do get the tracking number so you can track the package. Once the DNA results are on their way back to the Embassy you can call them to let them know. They will notify the mailroom to expect your results.

Since this is often the most time consuming step, once the embassy receives the DNA test results, they'll contact you to come to the embassy to pick up the passport.

These procedures are all subject to change, so do contact the embassy or consulate to get an update on the most current procedures.

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The Exit Visa to leave India: Foreign Residents Registration Office

By Indian law, your baby requires an exit permit to leave the country. The exit permit is obtained from the Foreign Residents Registration Office (FRRO) in Mumbai or at the local Police Commissioner’s office if you are staying outside Mumbai.

The FRRO address in Mumbai is:

FRRO Office,
3rd Floor, Special Branch Bldg.,
Badruddin Tayabji Lane,
Behind St. Xaviers College,
Mumbai-400001.

The embassy will provide a letter of introduction and request for assistance that you can take to the FRRO when you pick up your passport. Exit permit applications at the Mumbai office are accepted between 10:00 a.m. and 2:00 p.m. For this appointment you will need:

  • Letter from consulate (they keep the original since it is addressed to them)
  • Surrogacy Agreement
  • Ticket (or print out of email confirmation) showing your departure date (that evening or next day is okay)
  • Passport for both parents and Visa for both parents (so copy both passport page and visa pages)
  • Copy of baby’s passport
  • Letter from Clinic
  • Letter from Hospital
  • Two 2x2 photos of the baby
  • US$80 worth of Rupees at prevailing exchange rates

Appointments are made on a first come first serve basis.  Get there early (maybe a half hour) to be first in line. When you enter you will sign a book on the first floor and take the elevator to the third floor. When you exit you will walk straight up to the desk, check in. You approach the attendant; they will look at your paperwork then send you into the door just to the left. You will then immediately go into the next set of doors on the left and too the back of the room where the computers are located. You then log on and fill out the form online for your exit visa. They will then hand you a chip with a number on it. When your number appears on the electronic board over the entrance door, you enter the set of doors on the left as you face the board. You will sit down with the official and they will review your documents and ask you to then wait to be called again, or to come back tomorrow. At that time they will hand you a slip for payment. Once you pay you will walk back to the official and get your visa.

They will give you the exit permit with the baby’s photo that you must present to the airport officials. You now have permission have to leave the country within the time they indicate. There is usually a three-day window but sometimes only a 1 day window.

Depending on the season, it may be very hot.  Electricity may be cut back due to load sharing, meaning the air conditioner will be turned off. 

The FRRO is a place where you may want to have someone help you navigate through the language differences (Hindi) and the cultural differences.  Some people have reported paying facilitating payments, others have not.  When speaking to the folks at the U.S. consulate, they were aware that facilitating payments were required for birth certificates, but did not think facilitating payment were required for the exit visa. 

The FRRO is a good example of the government bureaucracy you'll see in any country and folks have had mixed experiences.  Mike and Mike write about their FRRO experience in early 2009, BonjourParenthood write about their experience in July 2009, and Peter writes about Visting the FRRO in August 2009 (seemed to be the smoothest of the 3 experiences).

Baby Care / Sitters while in India

Learning how to take care of a baby is stressful enough.  Doing this while in a foreign country, and while having to navigate bureaucracy to leave quickly, can be even more stressful.  Fortunately, you have some options.  You can get baby sitters reasonably cheaply to help care for the baby during the day and during the evening.

Hirinandani Hospital:  If you are staying at the hospital, you can ask at the nursing station if they have sisters (nurses) that can stay with the baby either during the evening or during the day.  The hospital will bill you directly, about 600 Rupees for a 12 hour stint.  The sisters (nurses) are often the same nurses that work in the hospital, although sometimes the come from outside.  Either way, they are trained nurses.  They generally do not take tips.  Night nurses are not always available; availability seems better on weekends than week nights. 

Mumbai - Asha: Although there are certainly other nurses, Asha has worked with many couples, helping to care for their babies.  She's been to the Embassies and the FRRO, so she has unique knowledge of both taking care of babies and getting through the surrogacy process.  She really likes babies and tries to collect pictures of all the babies she's helped care for.  Ask her, and she'll show them to you.  Asha charges 2,000 Rupees (US$40) per 12 hours.  She can be reached at ashamj70 at gmail dot com or +91 97657 45028 or on Facebook (phone is probably the best). 

Know of other options?  Please add them in the comments below.

Check list of items you'll need

Suitcase with Baby products, ready six weeks in advance.  Mumbai does have stores available with reasonable ranges of baby products.  So you can buy most everything in Mumbai (Green Bell in Juhu Scheme, Mumbai, has at least some of everything - you're not in Kansas, you're not getting a Babies R Us).  The other consideration is whether or not you'll have access to laundry.  The better access you have to laundry, the less you need to bring.   

  • Formula
  • Baby Bottles (6)
  • Steam Sterilizer (or the microwaveable bags for sterlizing, if you'll have access to a microwave)
  • Oral Suspension (Oval), to buy over the counter (for babies with gas)
  • Clothes/onesies: 6 to 8  (may bring some premie clothes just in case)
  • Clothes/sleepers: 6 to 8  (may bring some premie clothes just in case)
  • Clothes/socks and booties: 4 to 6 pair
  • Receiving blankets: 4
  • Nappies/Diapers (about 70 per week)
  • Extra cloths (to clean the baby's mouth and/or bum)
  • Mittens (so baby doesn't scratch her face)
  • Diaper rash cream (or cornstarch)
  • Water...you'll have to decide if you trust bottled water.  If not, you'll need to boil it.  May need a kettle.
  • Carrier/car seat/rocker or sling.  India does not have car seat laws, so you can use your own judgement. 
  • Crib for the baby to sleep (check if your hotel will have one)
  • Washcloths and Towels (it's unlikely the hotel will have enough to keep up)

Other items you may want to bring

  • Digital thermometer
  • Pain reliever (non aspirin)
  • Rubbing alcohol to clean the umbilical cord stump
  • cotton swabs
  • infant nail clippers
  • suction bulb for nose

Other items

  • ATM Card
  • Indian Rupees (you can use ATM machines to get money)
  • Voltage converter if needed (India is 240V)
  • Camera

Paperwork you'll need (more copies is better, some of this you'll collect along the way)

  • Your passport with Indian Visa
  • Your passport photos
  • Two Copies of Surrogacy Agreement
  • Three Copies of Birth Certificate
  • Letter from Fertility Clinic
  • Letter from Hospital
  • Discharge Card from Hospital
  • Financial papers concerning payment to Clinic
  • Baby passport photos
  • - 1x1 for the FRO office
  • - 2x2 for the U.S. Embassy

 

After the baby is born

Okay, you have a brand new baby, now what?  There are plenty of baby guides out there already, so we'll focus below on issues that are unique to intended parents with surrogate babies born in India.

Bottle feed, or other options?

In terms of feeding a surrogate baby (both immediately after birth, and after bringing the baby home), there are many options.  Not all options are always available, and what is best will vary from baby to baby and intended parent to intended parent.  Nevertheless, the main options include:

  1. Bottle feed.  This is the easiest.  Note that formula doesn't digest as easily as breast milk, so formula babies tend to have more gas pain, resulting in more crying.
  2. Induced Lactation / Adoptive Breastfeeding.  Similar to an adoptive mother, a surrogate mother can induce lactation in order to feed the baby.  A google search on "adoptive breastfeeding" can provide much more information.  Inducing lactation takes time, effort, and often does not generate enough milk to feed the baby.  
  3. Use a wet nurse.  These are not widely available.  They are not available at Hirinandani hospital in Mumbai.   
  4. Ask the gestational carrier to nurse the child.  Rotunda generally does not have/allow babies to breastfeed, however Dr. Patel in Anand does allow (and support) this. 
  5. Ask the gestational carrier to express milk for the child.  If you want to pursue this, it's best to confirm with the gestational carrier before you select her.  If so, you may be able to get several days of colostrum and/or milk while the surrogate is still in the hospital recovering from the pregnancy.
  6. Use milk from a milk bank.  As of this writing Hiranandani does not have a milk bank available.
  7. Find a friend/acquiantance who expresses, freezes excess milk, but is expressing more milk than her child can consume.  Typically, this milk will be thrown out.  Note that many women do not produce extra milk, but some produce more than enough to have extra. 

Adoptive breastfeeding is the most likely alternative.  Two good sources for information on adoptive breastfeeding are http://www.fourfriends.com/abrw/ and http://breast-feeding.adoption.com/.

Flying home with the baby

You'll need to think about how to get the baby home, typically by plane.  Some issues to keep in mind include:

  • Seating: Until the baby is 2 years old, the baby can generally sit in your lap.  You can generally have 1 baby per lap.  If you have triplets, with two adults, you probably need to buy a third seat.  Do confirm with your airline.
  • Baby Food: You'll need to feed the baby.  If you're not breast feeding, you'll have to plan how to handle forumla.  You'll need sterilized bottles, formula and water.  You can pre-sterilize bottles and travel with them in platic bags.  You can pre-measure formula into either plastic bags or carrying containers.  Water is more complicated - check with your airline or airport.  Your choices come down to trying to carry water inside the bottles through security (say it's baby formula water - maybe you'll get through), purchase water after you've cleared security, or get water on the airplaine from the stewardesses.  
  • Changing the baby:  The onboard bathrooms have limited space for changing a baby, but you'll have to make do.  In addition to diapers, remember to carry extra baby wipes. 
  • Change of clothes for the baby: Bring the appropriate number for the flight.
  • Change of clothes for you: In case the baby throws up, goes to the bathroom, or does something else on you. 

Some other tips:

  • Ear Pressure: If the baby is breast feeding or formula feeding, you may consider feeding them during take-off and landing.  This can help alleviate any ear discomfort. 
  • Sick baby: Check with your doctor if the baby has a cold, cough, or ear infection. 

 Each airport seems to handle security differently - double check everything with your airline/airport before leaving.

Surrogacy (Surrogate): Tax Deductions

As a U.S. tax payer, I have the opportunity work through my taxes every year. This year I’m figuring out how much of our surrogacy expenses are deductible. After reading IRS Publication 502 (2009) Medical and Dental Expenses and multiple boards (1 ,2, 3, 4) this is what I’ve learned.
I’ll look at whose expenses can be deducted, how much can be deducted, and what can be deducted.

Throughout this document, italicized text is cut and pasted exactly from IRS Pub 502. For better or for worse, I made an editorial decision to provide more complete text when I’ve referred to publication 502. This does mean that I’ve included some portions of text that are not specifically relevant to surrogacy.

Whose expenses can you deduct?

You can generally include medical expenses you pay for yourself, as well as those you pay for someone who was your spouse or your dependent either when the services were provided or when you paid for them. (Publication 502)

A surrogate mother is, of course, neither the taxpayer nor the taxpayer's spouse, and typically is not a dependent of the taxpayers. Neither is a third party egg donor. Nor is an unborn child. Payments on behalf of any of these parties are not deductible.

However, expenses for the taxpayer, taxpayer’s spouse, or the child (once born), are deductible.

How much can you deduct?

First, you have to be itemizing your deductions in order to take a medical deduction. You’ll need to check whether the total of your itemized deductions is greater than the standard deduction. If so, it makes sense to itemize your deductions. That topic is outside the scope of this post.

There are many other expenses you can itemize and take as a deduction, the most common being mortgage interest.

With regard to medical expenses, you can only deduct medical expenses that exceed 7.5% of your adjusted gross income. So if medical expenses are equivalent to 5% of your adjusted gross income, you cannot deduct any medical expenses.

Which expenses can you deduct?

Payments to the Surrogate.

Prevailing views are that you cannot deduct these, but it hasn't been tested in court.

In cases were infertility is the cause of pursuing surrogacy, some could argue that infertility is a medical condition that requires treatment, and that the payment to the surrogate is part of this treatment.

This is a very grey area, but most tax advisors are not suggesting to deduct these fees. The closest advice seems to come from here:

In your letter of July 17, 2002, you asked whether medical and legal expenses incurred in connection with a surrogate mother and her unborn child are deductible under § 213 of the Internal Revenue Code. Although your request is not for a formal ruling, we are happy to provide you with general information.

Section 213(a) of the Internal Revenue Code allows a taxpayer to deduct the expenses paid during the taxable year, not compensated for by insurance or otherwise, for medical care of the taxpayer, the taxpayer's spouse, or the taxpayer's dependents (as defined in § 152), to the extent the expenses exceed 7.5 percent of adjusted gross income. Section 152(a) defines a dependent as (1) an individual listed in the section (2) for whom the taxpayer provided over half of the support for the taxable year.

A surrogate mother is, of course, neither the taxpayer nor the taxpayer's spouse, and typically is not a dependent of the taxpayers. Nor is an unborn child a dependent.

Cassman v. United States, 31 Fed. Cl. 121 (1994). Thus, medical expenses paid for a surrogate mother and her unborn child would not qualify for deduction under § 213(a).

Under very limited circumstances, legal fees may be allowable as medical care expenses. In Gerstacker v. Commissioner, 414 F.2d 448 (6th Cir. 1969), legal expenses incurred to create a guardianship in order to involuntarily hospitalize a medically ill taxpayer were held to be deductible medical expenses because the medical treatment could not otherwise have occurred. However, legal expenses incurred in connection with a surrogate mother are typically not in connection with otherwise-deductible medical care expenses. Thus, the legal expenses likewise would not be deductible under Section 213(a).

Medical Expenses:

If the sperm and egg donor is either the taxpayer or the taxpayer’s spouse, then any medical expenses for the egg donor and sperm donor are deductible. This would typically include all the IVF-like expenses including doctor visits, lab fees, and medication.

Medicines
You can include in medical expenses amounts you pay for prescribed medicines and drugs. A prescribed drug is one that requires a prescription by a doctor for its use by an individual. You can also include amounts you pay for insulin. Except for insulin, you cannot include in medical expenses amounts you pay for a drug that is not prescribed.

Imported medicines and drugs. If you imported medicines or drugs from other countries, see Medicines and Drugs From Other Countries , under What Expenses Are Not Includible, later.

There is additional language in Publication 502 that specifically references fertility treatment which says:

Fertility Enhancement
You can include in medical expenses the cost of the following procedures to overcome an inability to have children.
• Procedures such as in vitro fertilization (including temporary storage of eggs or sperm).
• Surgery, including an operation to reverse prior surgery that prevented the person operated on from having children.

Airfare/Transportation:

The airfare for egg transfer and sperm donation trip should be deductible for both travellers, as it seems to fall under the language below.

Whether the airfare to pick-up the baby can be deducted is probably open to debate, and whether it is deductible for both parents would be open to further debate. It would seem that it falls under “transportation expenses for a parent who must go with a child who needs medical care”. The language says “a parent”, so for the baby pick-up trip, airfare for one parent should be deductible. Airfare for the second parent may not be deductible.

This does not seem to have been tested in a court.  You may read the language below and make your own call.  The language in Publication 502 says:

Trips
You can include in medical expenses amounts you pay for transportation to another city if the trip is primarily for, and essential to, receiving medical services. You may be able to include up to $50 per night for lodging. See Lodging , earlier.

You cannot include in medical expenses a trip or vacation taken merely for a change in environment, improvement of morale, or general improvement of health, even if the trip is made on the advice of a doctor. However, see Medical Conferences , earlier.

Publication 502 also says:

Transportation
You can include in medical expenses amounts paid for transportation primarily for, and essential to, medical care.

You can include:

• Bus, taxi, train, or plane fares or ambulance service,
• Transportation expenses of a parent who must go with a child who needs medical care,
• Transportation expenses of a nurse or other person who can give injections, medications, or other treatment required by a patient who is traveling to get medical care and is unable to travel alone, and
• Transportation expenses for regular visits to see a mentally ill dependent, if these visits are recommended as a part of treatment

Transportation expenses you cannot include. You cannot include in medical expenses the cost of transportation in the following situations.
• Going to and from work, even if your condition requires an unusual means of transportation.
• Travel for purely personal reasons to another city for an operation or other medical care.
• Travel that is merely for the general improvement of one's health.
• The costs of operating a specially equipped car for other than medical reasons.

Lodging:

Next question is hotel costs for both trips. The language says that hotel lodging can be deducted if certain requirements are met. See below. The portion of lodging costs that are medical care related should be deductible, with a limit of $50 per person per day or $100 per couple per day. For the sperm donation/egg transfer trip lodging expenses for both partners should be deductible (you can include lodging for a person traveling with the person receiving medical care). The baby pick-up trip is slightly trickier, but the language does seem to allow up to $100 per day ($50 for one parent and $50 for the baby).

Lodging
You can include in medical expenses the cost of meals and lodging at a hospital or similar institution if a principal reason for being there is to receive medical care. See Nursing Home , later.
You may be able to include in medical expenses the cost of lodging not provided in a hospital or similar institution. You can include the cost of such lodging while away from home if all of the following requirements are met.
1. The lodging is primarily for and essential to medical care.
2. The medical care is provided by a doctor in a licensed hospital or in a medical care facility related to, or the equivalent of, a licensed hospital.
3. The lodging is not lavish or extravagant under the circumstances.
4. There is no significant element of personal pleasure, recreation, or vacation in the travel away from home.
The amount you include in medical expenses for lodging cannot be more than $50 for each night for each person. You can include lodging for a person traveling with the person receiving the medical care. For example, if a parent is traveling with a sick child, up to $100 per night can be included as a medical expense for lodging. Meals are not included.
Do not include the cost of lodging while away from home for medical treatment if that treatment is not received from a doctor in a licensed hospital or in a medical care facility related to, or the equivalent of, a licensed hospital or if that lodging is not primarily for or essential to the medical care received.

Legal fees:

The language here is less precise. Because signing a legal contract with the clinic is “necessary for the medical care”, it seems that the legal fees are deductible. Publication 502 says:

Legal Fees
You can include in medical expenses legal fees you paid that are necessary to authorize treatment for mental illness. However, you cannot include in medical expenses fees for the management of a guardianship estate, fees for conducting the affairs of the person being treated, or other fees that are not necessary for medical care.
Once the baby is born, any medical expenses for the baby (rather than the gestational surrogate) are tax deductible, as the baby is the taxpayer’s dependent. Thus, it is helpful to ask the clinic and/or hospital to separate expenses for the surrogate and expenses for the baby.

Keep this in mind...

To be tax efficient, you may try to bundle expenses (surrogacy as well as other medical expenses) into one year. That way you don’t have to reach the 7.5% threshold in two consecutive years, for example.

Surrogacy related expenses may take you over the 7.5% threshold, but keep in mind that ALL medical expenses are deductibles. So don’t forget your dental charges, prescription contacts, mileage for travel to the doctor’s offices, insurance premiums, deductibles, etc. Publication 502 includes a longer list of deductions that are includable here.

Baby sitting expenses, even from a qualified nurse, and even if your baby was in the NICU, are not deductible. Unless the baby sitter is providing nursing services as defined by the IRS, which generally means doing something the doctor specifically prescribed. (So, Asha's expenses are not tax deductible.)

Note that there are adoption related tax credits, but they do not apply to surrogacy.

Tax Advice

Now you see why taxes are not cut and dry. An aggressive interpretation would many of the deductions mentioned above and worry about an audit later. A conservative interpretation might not take some of the grayer deductions. While I’d love to give you the standard advice to talk to your tax preparer, the reality is that your tax preparer probably doesn't have experience in this area. 

If you have feedback from your tax preparer that references either the IRS publications or IRS rulings, please do send them in and we’ll update any of the above as appropriate.

 

Memories

We've not got 4+ years of baby photos.  Mostly on the computer where nobody ever sees them.

We've printed a few out.  Then we have to decide what to do with them.  

We really like the acrylic frames for showing off the ones we print out.  They're very contemporary looking and don't take any focus away from the subject.

See the magnetic acrylic frames at Solitary Rock.

Survey Questions

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Which clinic did you work with?


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Did you work through a medical tourism agency, or direct with the clinic?


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What contract did you use with your surrogate?


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Which clinic did you work with?


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Did you work through a medical tourism agency, or direct with the clinic?


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What contract did you use with your surrogate?


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Did you meet your Indian surrogate?


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Survey Results

Which clinic did you work with?

33% (3 votes)
33% (3 votes)
Surrogacy Centre India (Phoenix Hospital) (write-in)
11% (1 vote)
Surrogacy Centre India (write-in)
11% (1 vote)
WeeCare Surrogacy India (write-in)
11% (1 vote)
0% (0 votes)
Total voters: 9
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Did you work through a medical tourism agency, or direct with the clinic?

Directly with Clinic
67% (6 votes)
Medical Tourism Company
44% (4 votes)
Total voters: 9
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What contract did you use with your surrogate?

Used contract provided by clinic, reviewed it myself, and signed it with no changes
83% (5 votes)
Used contract provided by clinic, reviewed it myself, and signed it with minor changes
17% (1 vote)
Worked with a lawyer and provided my own contract
0% (0 votes)
Used contract provided by clinic, had a lawyer review it, and signed it with no/minor changes
0% (0 votes)
Used contract provided by clinic, had a lawyer review it, and signed it with major changes
0% (0 votes)
Total voters: 6
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Did you meet your Indian surrogate?

Yes, before the transfer
67% (2 votes)
Yes, after the delivey
33% (1 vote)
No
0% (0 votes)
Yes, after the transfer but before the delivery
0% (0 votes)
Total voters: 3
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