By Janine Oakman
Smiling Teacher at Desk with TextbookIntended Parents requesting surrogacy come from all walks of life and each have different stories about how they came to this point -searching for a surrogate to carry their baby.

I have had couples who tried endless cycles of IVF without results, women born without a uterus or other medical conditions, women who have suffered multiple miscarriages or still-births, gay couples wanting a family of their own and even couples who lost their teenage children in accidents and are at an age where the Intended Mothers health is at risk if she were to carry.

It is never a journey embarked on lightly, and whilst many have family support, others face criticism or feel a sense of failure that they have not been able to produce a child themselves. Add to this the press about surrogacy being an exploitation of women in poorer countries and children that are waiting to be adopted, and we can often add guilt to the equation.

Whilst the decision to embark on surrogacy is a deeply personal one, I do not feel anyone has the right to impose their beliefs upon another. We cannot say ‘I deserve to be a parent but you do not’, nor can we claim this is ‘God’s plan/fate’ when we have the technology to help childless individuals become parents if they so wish.

Yes, paid surrogates often come from poorer economies, but in so-called first world countries such as the US or UK, women do offer to become surrogates as well. If a woman decides to do so out of compassion or for financial reasons, it is her decision and her body.

Intended Parents most often consider surrogacy abroad because of affordability or a lack of surrogates in their home countries. Self-surrogacy (using your own genetic material) starts at app 19,000 USD (total cost with baby handed over) at a reputable clinic in India, and anywhere from 22,000 USD to 38,000 USD using an egg donor with a surrogate in India, Georgia, Ukraine, Russia, South Africa or Armenia.

Knowing the costs is helpful, but how should you choose a clinic and who can you trust? How can you be sure that you can bring your baby home or that the egg donor you chose was actually used?

Research.

Don’t believe everything a clinic’s website tells you. There are honest clinics with a policy of transparency and then there are those promising a ‘guaranteed baby’ (impossible), with success rates that I’ve found to be, in reality, questionable. Support groups, blogs and chat forums are a great source of information from others that have personally experienced the clinics. A reputable clinic will have other parents who have used their service whom you can contact by email or phone. Written references are also available but be careful that these are legitimate.

Technology.

Make sure your clinic has well-trained staff and modern facilities. The doctor’s CV, details of the embryologist, etc should be available to you. Photos of the clinic can be reassuring- using a broom closet to collect the sperm sample does not inspire confidence. India in particular has some very affordable clinics, but these can be very basic compared to western facilities. Paying more in India can mean a modern, first class clinic.

Importantly, how many embryo’s are transferred? If they routinely transfer 6, you have to ask yourself -why? Is the embryologist so poorly trained? Are their success rates so low? Exactly how skilled is this doctor that would otherwise be risking multiple births? Not to mention that these additional embryos could be frozen and used for an additional cycle if required. How many embryos are normally transferred? Depending on the clinic and the quality of the embryos, a maximum of 4.

Legalities.

I strongly recommend pursuing surrogacy in a country where the Intended Parent/s are legally viewed as the rightful parent/s in a surrogacy birth- not the birth mother. Georgia, Armenia, Ukraine and South Africa have favorable legislation for the IP’s and protect your rights. India is also favorable although the legislation is not yet precise. Thailand has offered surrogacy in the past but is currently on-hold as the legislation may be changing.

Also make sure you can legally proceed in the country of your choice.  Some popular destinations include:

Ukraine– Married heterosexual couples only. If you do not meet the legal criteria, your rights may not be protected. Surrogacy laws in the Ukraine

Georgia– Married heterosexual couples only.

Armenia– Married couples, singles and gay couples.

India– The laws have changed since February 2013.  Please refer to this article for the latest updates: Exclusive Notes from the Latest Governmental Meeting Regarding Surrogacy Issues in India

South Africa– Couples. The female partner (if there is one) must not be able to carry herself. You must have South African residency, own property in South Africa and show intent to remain in the country.

Countries where Egg Donation is legal

Countries where Surrogacy is legal. 

Egg Donors.

If you require an egg donor, you are usually able to choose from photographs and are provided with her history. Most clinics do not permit meeting. This can be to protect the donor’s privacy or it may be a legal requirement. If your clinic is researched and reputable, you can trust that your selected donor is used. A clinic found to be substituting donors or operating unethically would be widely reported and both the clinic and doctor at risk of legal action.

Payments/contracts.

Payments are normally made in increments directly to the clinic. Your first payment will be to register and have your surrogate recruited, the second to pay for your IVF and your egg donor if you’re having one. After the fetal heart-beat is detected, monthly payments or the bulk of payment will be due.

The clinic should provide a clear payment schedule itemizing what each payment is for and when it is due.

You should have a contract with the clinic/surrogate and additionally with the egg donor. Copies of your passports will be required to ensure your identity.

Travelling.

Once you have decided on a clinic, make sure your passports are current or apply for a new one. The passport you use to sign the contracts should be the same one you travel with.

The clinics have a large number of IP’s from abroad, so there will be English speaking staff and recommended hotels for you.

Do read-up on your destination. Check for any visas and vaccinations required as these will need to be applied for/done in advance of travelling.

The Wait.

One of the most difficult aspects is waiting to hear if your surrogate is pregnant. There is a sense of having no control over the outcome, wondering if your surrogate is taking care of herself, dreading the news that the cycle might have been unsuccessful.

Here is my advice:

  • Surrogates are healthy women under 40 that have had successful pregnancies themselves or they wouldn’t meet the clinic’s criteria for acceptance. If she was able to carry her own children through a healthy pregnancy, why not yours?
  • She has chosen to be a surrogate for altruistic or financial reasons. She WANTS this pregnancy to be successful and you can be assured she is taking every measure to care for herself, follow the doctor’s instructions and is hoping for a positive test result. I have been at clinics where the surrogate has come in for her pregnancy test and left in tears at a negative result.
  • Be kind to yourself. It is out of your hands now and whilst you may feel powerless, stress will not influence the outcome. Stay positive.
  • Be prepared to try again. Some IP’s are successful the first time; others try 2 or even 4 times before succeeding. Using 2 surrogates with one IVF cycle does increase your chances dramatically, but also increases the risk of 2 babies or more.

Janine Oakman

International Patient Coordinator

janineoakman@gmail.com