First impression of Bourn Hall clinic – it felt very western. Clean lines, nicely designed, lots of glass, large spaces…. very modern. In case you don’t know them, Bourn Hall is considered the ‘father of IVF’ and their main clinic is in England. Bourn Hall’s Indian locations have only been doing surrogacy for 1 1/2 years but what’s unique is they’ve created a specific agency devoted to upholding their high Western standards while also bridging the gap with Indian guidelines and ideals. Their surrogacy agency is called Ethical Surrogacy India and we truly found their whole outlook to be just that.. ethical. Going back to Bourn Hall, as we said their Indian IVF/surrogacy/egg donation clinics are part of the UK Bourn Hall clinic, well known and respected as the first place to have done IVF back in 1978, with their doctors winning the Nobel Prize. Quite an impressive association. Because their Indian fertility clinics (they have 2) are associated with Bourn Hall UK (there are 4 in the UK), the Indian clinics must adhere to UK fertility standards as well as follow Indian guidelines regarding surrogacy and egg donation. They pride themselves on the fact that they follow strict UK standards and that they are audited by UK fertility organizations. No other clinic in India can claim this
Bourn Hall runs their surrogacy program out of Kochi- which is about a 3 hour flight from Delhi . They said they did this because the air in Kochi is much less polluted and it is a beautiful city right on the water… more of a resort area in a sense. Definitely somewhere that helps put the ‘tourism’ in fertility tourism (though we’ve never really liked that expression… no one really ‘chooses’ to travel for fertility treatment.. it is usually out of necessity). Still the thought of a day or so in a ‘resort like’ city was appealing.. especially after the heavy smog and pollution in Delhi. So the minute we heard this, Kathryn and I looked at each other and realized we would be changing our plans… that now our travels would include a trip down to Kochi to see the facilities and their Indian surrogate housing facilities.
But while at Bourn Hall in Delhi, we met with the doctors and the facilitators and were very impressed with their modern and very ‘western’ approach. They really know how to appeal to the international market place and to put international Intended Parents at ease.
Because Indian regulations require that a fertility center not run a surrogacy agency, Bourn Hall has created a separate division to ‘run’ their surrogacy program. We immediately liked the name…ESI… Ethical Surrogacy India. The main contact for the surrogacy program is a young man named Brent – a South African with a warm personality and an easy laugh and Nidhi, a lovely young Indian woman. We liked both of them immediately and after speaking in depth, we felt that they were very ‘transparent’ in how they operated and that their claims of ethical treatment and management were sincere.
Bourn Hall follows two guiding principles : the welfare of the surrogate and the welfare of the baby. That’s not to say that the Intended Parents don’t matter… of course they do, but the perspective of Indian surrogacy and egg donation (especially at Bourne Hall) is a bit different than in the United States. In the United States, while the goal of course is a healthy baby, the Intended Parents have a lot more ‘control’ over the surrogate’s situation.. they can write very specific limitations or addendums in their contract that may change the surrogate’s typical lifestyle. They are able to have a say over the OB chosen and the hospital where the baby is delivered. It’s not to say that the IPs can’t ask for things regarding their surrogate in India, but in general, the surrogate’s well being and the baby’s health are the absolute priority. That takes a bit of perspective shifting for most Americans.. but as long as they know this going in, it won’t be so much of a shock. And in reality, it’s a good thing. A happy healthy surrogate makes a happy healthy baby.. and that is after all the goal.
The interesting thing we heard at Bourn Hall is that not only are the surrogates psychologically screened.. so are the Intended Parents. And Intended Parents can and will be turned away if they don’t meet qualifications… if they are single for instance and don’t have a strong enough support system (though this may no longer be an issue, the regulations in India regarding surrogacy have recently changed and single IPs and same sex IPs are no longer able to do surrogacy in India for the time being.. see our video excerpts from Indian fertility doctors regarding this which will be posted shortly on our Global IVF Series: Surrogacy in India) or if they have a life-threatening illness.
The surrogates are housed in Kochi and our first thought was ‘wow, that’s probably a long way from home.. so they’re separated from their families for the entire pregnancy?’ The answer is yes. If they have young children, maybe ages 2, 3 or 4, they will come stay with them. But as for older children and husbands, they generally stay home. As a mom myself (one through surrogacy and egg donation after years of repeat IVF failures and multiple miscarriage) the thought of being separated from my family for 9 months or so was unthinkable. But again, that is an example of seeing with American blinders on. In India most live with extended families… grandparents, aunts, uncles, cousins… so it’s not like leaving your children with a nanny for nine months while you ‘travel’ for a job. You know that your children are being well taken care of by people who love them.. and that they would feel more comfortable staying at home, staying in school, then being uprooted to live in surrogate housing with their pregnant mom. Quite often we are told the husbands are away from the home for extended periods of time anyway– if they are working in another city or even nearby country. And of course there is communication with their families, it is not like they are being jailed and all communication is shut off, the families come to visit and the visits are encouraged.
While Bourn Hall is an old established IVF group of clinics, their surrogacy program is relatively new. They currently have 12 surrogates pregnant with the first one due in April. (stay tuned – hopefully we will meet the surrogates during our visit to Kochi). They mostly do day 5 transfers (blastocysts) and will put back at maximum 2 embryos. If it’s a day 3 transfer, they will put back 3 or 4. Their current success rate is 60% with no twin pregnancies. (Personally i’m always happy to hear that since twin pregnancies are at significantly higher risk for premature birth and other complications).
The company strives to be transparent.. and a big goal of theirs is to keep the costs at what they say the costs are.. but of course, there’s always things that can happen … that is just the way surrogacy is. It’s the same for the U.S. – an approximate price can be quoted but until you know just how many transfer attempts it takes to get pregnant, whether you need an egg donor or not, whether your surrogate gets pregnant with twins or not, etc etc… it’s easy to see why additional charges can be put in place. In America as well as in India. But we know from talking with so many international IPs who have done surrogacy in India, their biggest complaint tends to be that they are quoted one overall price in the beginning and then six months into the pregnancy they are ‘held hostage’ for additional significant funds to continue the process. That was foremost on our minds as we discussed cost with all of the clinics. We found that generally they all of them are trying to be ‘transparent’ in their costs, some do a better job of it than others. Bourne Hall is one of the ones that is doing a better job. Their approximate cost for surrogacy + Indian egg donor is 33,000 US dollars. (again, if you want an educated donor that will cost you more, if you want to bring in a Caucasian donor from Ukraine, South Africa or America that will cost you even more). Their surrogates are paid 7000 which they claim is the highest amount that is being paid to surrogates in the country. The surrogates are paid about 25% at the beginning of the pregnancy and 75% towards the end… this seems to be the standard with Indian surrogacy (and very different than the US where the surrogate is generally paid monthly for her ongoing pregnancy.)
Intended Parents are allowed to have interaction with the surrogate throughout the pregnancy if they choose… they can skype with an interpretor, they can visit, again, transparency is the buzzword.. but more on the concept of ‘to bond or not to bond’ with your Indian surrogate in another blog. It’s worthy of a whole one There’s just so much to say about it.
Since Bourn Hall follows the Western model – the Intend Parents pay their surrogacy fees in 4 installments…
- 12000 upfront, increased if an egg donor is used
- 8000 at fetal heartbeat
- 5000 at completion of 1st trimester and
- final 5000 at completion of 32nd week.
Typically you use the same surrogate for 3 tries (which is not the common thing in India, but definitely is in the Western world). If you need to use a new surrogate after the 3 tries, there will be an additional 4000 start up fee for the new surrogate. Of course, the same thing happens in the US if you are working with one surrogate but for some reason do not have success and need to start again with a new surrogate (of course in the US the costs are higher).
Another interesting thing about India surrogacy programs is that we find many clinics will transfer into two surrogates at one time (there are even times when the doctor will not tell the IPs that he/she has done this.) We don’t believe it’s malevolent.. we truly think it stems from compassion .. they feel like the IPs have gone through so much to get to this point, that they just really want to increase their odds of success. (of course it increases the odds of success for the doctor as well – we’re not blind to that fact). This again, is probably more of a cultural difference than anything else. But I remember first hearing about this back in the US and the thought of transferring embryos into 2 surrogates without the IPs approval was shocking.. but now, being here, I find myself understanding the reasons why it might be done. However, at Bourn Hall this will never happen. They will not transfer into 2 surrogates at the same time and they will only transfer 2 embryos at a time, because that is ‘against’ the guidelines that are established in India (as well as the UK). I guess lots of the other clinics have loose interpretations of the Indian surrogacy guidelines… but we see that in the US as well. Some US clinics are strict about the age cutoffs, some are more flexible… some will work with HIV + IPs, others won’t… so interpretations of guidelines happen globally, we can’t be offended by what we don’t really understand. That is the beauty of education . and the main goal of GLOBAL IVF and our visit to India to explore low cost surrogacy and egg donation.
Finally we asked about the new regulation which just was announced.. that India is no longer allowed to do surrogacy with same sex IPs, single or married, and that any heterosexual married IPs must be married (and prove it) for at least 2 years. Everyone at the table sighed…so unfair, we were all in agreement. However, Bourn Hall reps generally felt confident that the ruling would be overturned.. hopefully that will be the case. They also mentioned that just in January a gay single IP from UK was able to secure a medical visa to do surrogacy. So their feeling is that if an IP can secure a medical visa and get the documents in place, then they will proceed with the surrogacy because they are not doing anything unethical. It’s just a question of whether single and same sex IPs from the US and Australia will be able to still get these medical visas (when we applied for our visa there was a very specific place for surrogacy — so we’re really not sure what to make of it). It’s really interesting how we’ve been getting mixed reactions regarding this new turnabout in India’s guidelines.. and we’ve been asking each and every doctor and advocate we meet their opinion… in fact, stay tuned for our our video ‘conversation’ regarding this issue soon to be posted upon our return.
Another day in Delhi comes to a close .. we say goodbye, ready to race back to the hotel to shuffle our flight plans to make room for a quick visit to Kochi.
The thought of a hot shower and a cool bed sounds great but instead we’re stuck in traffic.. so we settle for finding calm in the back of a cab a midst the hectic rush of zipping cars and hearing music in the ever constant cacophony of beeping horns.