Clearing the confusion around surrogacy in India

You’d think an office full of women would know the different ways to get pregnant. No, we’re not talking about whipping out the Kama Sutra. IVF, miscarriages, freezing your eggs, surrogacy in india – the complexities involved in becoming a mother often get glossed over in a sea of baby showers and pregnancy photoshoots.

Fertility problems, in general, are still not openly discussed because the idea of someone (women, more than men) being infertile is considered a failure on their part. Surrogacy in India, in particular, is shrouded in mystery.

Dr. Nayana Patel, MD OBS and GYN, at Akanksha Hospital & Research Institute, urges people to see surrogacy as a mode of treatment.

“If you’re doing blood donation or a kidney donation, you are very open about it. But what about this? There are many well-educated couples who you’d think would be more aware who hide it from their own family because of the taboo.”

The conversation around surrogacy in India is not just taboo but riddled with strife with The Surrogacy (Regulation) Bill, 2019. But we’ll get to that later.

Understanding surrogacy in India

Simply put, surrogacy involved a woman agreeing to carry a non-biological child for another woman/couple.

Our understanding of surrogacy has been shaped by pop culture representations and celebrities opting for it. Whether it is Bollywood’s “Single parents club” or Phoebe Buffay in Friends.

One of the first arguments that happens over surrogacy is when it’s pitted against adoption. Adoption being the nobler cause (it is, no arguing that), prophesied as the way to control our increasing population instead of bringing more life into this world.

Well, effective population control would actually include sex education and access to contraceptives.

“If a couple wants a biological child, you can opt for surrogacy — there’s nothing wrong with it,” adds Patel.

In traditional surrogacy, intrauterine insemination (IUI) is used to artificially fertilise the surrogate’s eggs with the father’s sperm. The surrogate carries the baby to term, and after delivery, the child is handed over to the legal parents.

This method is now illegal in India, as third party eggs can only be availed from registered donors via authorised banks.

In gestational surrogacy, the surrogate acts as just the carrier or the oven for the baby bun. She has no genetic link to the child. In vitro fertilization (IVF) is employed to create an embryo using the genetic material of the couple, that is then placed inside the surrogate.

Is surrogacy the right path for you?

A fertility specialist might suggest surrogacy after determining that the prospective parents aren’t able to conceive themselves.

These can include medical conditions and ailments, says Patel, such as multiple fibroids in the uterus, cervical agenesis (no cervix since birth), Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome.

Other indications include hysterectomy, multiple miscarriages or excessive bleeding after childbirth, making another pregnancy a huge risk. “You come to a point where you have exhausted all the resources, physically, mentally and medically,” says Patel.

Becoming a surrogate to a couple unknown to you usually happens by word of mouth, adds Patel. It commonly involved women from lower-income backgrounds who were compensated for acting as surrogates.

This was put on hold by The Surrogacy (Regulation) Bill, 2019, where women can only act as surrogates out of altruism, and any payment is strictly restricted to covering her medical and other related expenses.

Regardless, Patel says that there have always been strict screening and medical requirements to become a surrogate.

You’ve chosen surrogacy, now what?

Once the prospective parents meet a surrogate and consensually agree to the process, they undergo a series of tests in preparation.

Counselling ensures that both parties involved understand each step clearly and agree to take things ahead. While Patel’s centre ensures counselling for all, the guidelines leave it up to the clinic to provide (or not).

Prospective parents: The embryo is created by a specialist using the egg harvested from the wife and fertilised with the husband’s sperm.

The biological mother may be given medication to help develop the eggs and undergo the retrieval process safely.

Sperm and oocytes can be sourced from donors if the biological material of the prospective parents is deemed unfit. That embryo is then planted into the surrogate.

Surrogate: The surrogate is medically prepared for implantation. “You have to ensure her uterine lining is healthy. They are screened and tested according to the ICMR guidelines through pap smears, blood tests and ultrasounds,” Patel explains.

She says that according to the ICMR, a surrogate cannot be over 45 years and should have a living child of their own. You can become a surrogate twice times. If you’ve previously had a C-section, then only once.

The embryo is planted into the surrogate. Follow-ups at the clinic can confirm a healthy pregnancy when a heartbeat is heard.

Surrogacy in India — the paper trail

Words only take you so far. Other than mutually agreeing on the process, the prospective parents and surrogate have a legal contract binding them to it too.

For example, it ensures that the medical needs of the surrogate are met, the parents cannot abandon the child once born and the surrogate cannot refuse to hand the child over to the parents.

There has to be a legal paper trail for each of the steps to keep a track of the progress. If donors are involved, they are required to relinquish their parental rights.

Where we stand right now with the Bill 

In an attempt to put an end to commercial surrogacy, India’s Surrogacy (Regulation) Bill, 2019 permits only legally married, heterosexual couples to use this method to start a family.

It also allows a woman to act as a surrogate purely out of ‘altruism’. Meaning a relative can serve as a surrogate for a couple that has been married for at least 5 years with medical proof of infertility.

Patel doesn’t necessarily agree with the new restraints, saying, “If someone doesn’t have a uterus, even after five years she’s not going to have a uterus. And after that time, her ovaries may not be in a condition to give her eggs.”

But there is still hope and a chance things will change. When the bill was presented to the Rajya Sabha, it was referred to a select committee. The recommendations of the committee were submitted in a report on February 5, 2020.

It changes the term ‘altruistic’ to “willing woman”, casting the surrogate net wider than just family members.

It also removed the need to demonstrate infertility for five years, increased the insurance coverage from 16 months, as proposed in the Bill, to 36 months.

Candidates were expanded to include widowed and divorced women choosing to have babies via surrogacy as well as Persons of Indian Origin (PIO) and Overseas Citizen of India (OCI).

The government is yet to decide on the recommendations by the committee, likely in the next session.

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