Natalie Akoorie

Natalie Akoorie is a reporter at the NZ Herald based in Hamilton.

Fertility tourism: Couples desperate for a baby heading overseas

India has become a popular destination for families wanting to use a surrogate to have children. While leaving New Zealand allows them to avoid what can be a long wait, it's by no means an easy journey.

The Ashcrofts' twin daughters Nicole (left) and Peta in India shortly after they were born and Kali Ashari (left), their surrogate mother, feeding Peta.
The Ashcrofts' twin daughters Nicole (left) and Peta in India shortly after they were born and Kali Ashari (left), their surrogate mother, feeding Peta.

Paul and Angela Ashcroft were on a plane, flying somewhere over Australia, when their twin daughters Nicole and Peta were born.

"Paul and I looked at each other and the sun was just coming through the clouds and I said 'I've just got this funny feeling our babies are being born' and they were," recalls Mrs Ashcroft.

The Wellington couple, in their mid-40s at the time in June 2012, created the babies in India using in vitro fertilisation (IVF) and paid a gestational surrogate to carry the little girls.

Eight months later they got a call to say the surrogate was in labour, two weeks early. Unlike most expectant parents who head to hospital, they boarded a plane bound for Mumbai.


Kali Ashari, the twins surrogate mother, feeding Peta.

"We didn't find out our girls had been born until we checked into our hotel and we were in a state of shock."

The Ashcrofts were the first New Zealand couple to take advantage of commercial surrogacy laws in India, which is only one of a handful of countries that allow surrogates to be paid.

As a result of the 2002 law, lower costs, increasing medical infrastructure and the availability of surrogates, the country has emerged as a hotspot for this type of fertility tourism.

International surrogacy, also legal in the United States, Thailand, the Ukraine and at least one state in Mexico, is a growing trend for couples and singles, both gay and straight, seeking ways to overcome the hurdles biological, technological, financial, and legal of having children.

The subject was the hot topic at the fifth Congress of the Asia Pacific Initiative on Reproduction (ASPIRE Conference) in Brisbane this month. Closer to home members of the Law Society heard presentations from fertility specialists on the issue last week.

Fertility Associates group operations manager Dr John Peek says New Zealand had always aligned itself ethically with European standards but with the amount of reproductive technology exploding in Asia it could no longer be ignored.

"There's going to be a lot more reproductive tourism in this part of the world," Dr Peek says.

"The number of clinics and the number of treatments in India is growing by 25 per cent each year. I think in some ways we have to learn how to co-exist with some ethical things on our doorstep that are very different from our own without saying, 'Oh, we've got nothing to do with it'."

Medical visas are becoming commonplace and overseas governments are encouraging fertility tourism because of the economic benefits.

About 3000 clinics in India offer surrogacy services to foreigners, generating more than $400 million per year for the economy according to a study by Sama, a non-government group for women and health.

Dr Peek says New Zealanders are becoming more open to the fast-evolving fertility tourism market.

"What people are doing with their teeth and cosmetic surgery this decade they might think about doing in other more meaty areas of medicine such as reproduction in the future.

"As other countries improve their regulation and reliability and customer service then I think it's going to become more of a reality."

An estimated 2000 foreign babies are born to Indian surrogates each year but the industry is largely unregulated.

Two international incidents shone an embarrassing spotlight on surrogacy in India when two sets of parents did not complete the adoption process and were stopped at their home borders.

In both cases the Indian Government stepped in, resulting in the Indian Ministry of Home Affairs ruling in July 2012 that foreigners needed medical instead of tourist visas to engage a surrogate.

Only heterosexual couples who have been married at least two years and who come from countries that also permit surrogacy can now apply - amounting to a ban on single, gay, and unmarried people, and on those evading their home laws to have children.

The tighter restrictions have helped to popularise Thailand as another surrogacy destination but India is still the only country where the intended parents are recognised as the legal parents.

Fertility Associates group counsellor adviser Sue Saunders says a child cannot be "imported to New Zealand" without a huge amount of paperwork.

"They don't get passports and they don't get automatic immigration."

She tells a cautionary tale about a Kiwi couple who tried to returnhome with a baby born to a surrogate in Asia but who were stopped because they did not have the appropriate legal documents. "They thought it was like Australia where if you could prove a genetic link you'd be allowed to come in.

"The husband was working here and the mother and child were stuck in Australia."

It took 18 months before the couple could get their child into New Zealand.

The lesson for people considering overseas surrogacy is to hire a lawyer who specialises in international adoption, Mrs Saunders says.

Nerve-racking journeyWhen the Ashcrofts travelled to India it was on a tourist visa, before the new law was passed.

"It was very nerve-racking doing it because there was no proven way to come back to New Zealand at that time," Mrs Ashcroft says.

The couple spent months researching the legal requirements of the process, getting all the necessary paperwork in order to be able to bring the twins back before they embarked on the journey.

They had spent 10 years trying to conceive a baby themselves but fertility complications, health problems and limited finances almost ended their dream, until Mr Ashcroft inherited some money and Mrs Ashcroft's friend saw a documentary on surrogacy in India.

"The first time I went to India I was just so overwhelmed by the poverty," Mrs Ashcroft says.

"I just looked at my husband Paul and said can we even start a family in this situation?

"It was a culture shock.

"You don't think that this is what your life is going to come to, to have a family."

Clinic fees and surrogacy cost the couple $40,000 but that did not include legal fees, flights and accommodation for two trips to Mumbai - and time off work for up to seven weeks at a time.

They chose Corion Fertility Clinic to create their embryos, 19 in all.

Of those, four were inserted in their surrogate.

If more than two survived the Ashcrofts were contractually obliged to reduce to twins because of the health risks to the surrogate in the case of triplets or quadruplets.

But by putting four embryos in at once a couple's chance of "conceiving" is doubled and in the Ashcrofts' case only two embryos survived.

Their remaining embryos were eventually destroyed, under the terms of their contract.

Corion impregnates about two surrogates a week, who must be under the age of 30 and have completed their own family.

The surrogate can give birth to a total of only five children, including her own.

The women are then cared for, free of work commitments, in a surrogacy home where the clinic oversees medical attention, diet and hygiene to ensure a healthy live birth.

They may visit and receive visits from their families during the nine months before the baby is born at the top-quality Hiranandani Hospital.

The were no signs of coercion at Corion - when a woman is forced into surrogacy by poverty-stricken family members - according to Mrs Ashcroft.

Surrogates used by reputable clinics, such as Corion, are vetted through psychological testing before signing on.

With 80 per cent of India's 1.27 billion population "below the breadline" surrogacy provides a lifeline for some families, Mrs Ashcroft says.

"Our money is helping one family. At least that family has a better future or a future they're more in control of because of it."

The money is almost always used to pay for better education for the surrogate mother's own children.

She believes negative spin on surrogacy in India, dubbed "rent a womb" by some critics, has been propagated in the United States.

"They've lost a lot of money to the Indian market, particularly the fertility clinics."

She calls their surrogate a "wonderful caring person whose generous gift changed our life forever".

"We are so incredibly grateful for Nicole and Peta.

"It concerns me the debate in the media that diminishes this act of kindness.

"It takes away from the wonderful spirit of the Indian culture and their love of children that give them the understanding and empathy to help other couples such as ourselves."

New Zealand alternativeMrs Saunders says people don't have to go overseas to find a surrogate the option is available here but couples must get permission from the Ethics Committee on Assisted Reproductive Technology.

That process can take months and cost several thousand dollars depending on whether the couple are eligible for public funding.

Mrs Saunders says in some cases that could be an easier process to negotiate.

"Until New Zealand laws change and recognise births overseas it's a huge challenge for any couple to have a surrogate overseas. I think it's a bigger challenge for them to do that than to work their way through the clinic system."

The Ashcrofts made the decision to go public with their story when they launched a website to help other couples with international surrogacy.

"When we went through this process we were so incredibly private. We didn't tell anyone what we were doing because there is a bit of negativity about surrogacy in India and we didn't want to be judged."

Since they returned from India they have helped another four couples - one with twins, another who are expecting a single baby in July, a third who are expecting twins and a fourth who are currently undergoing IVF in India.

Their website, India Surrogacy New Zealand, has received 50 inquiries in the past year from couples wanting to know more about international surrogacy.

It's almost two years since the Ashcrofts made that trip to Mumbai to meet their daughters and bring them home.

Their girls are unaware of the momentous effort made to have them. For the 22-month-old toddlers, life is all about "tears and tiaras".

"When we're out with our girls in New Zealand, no one knows our journey," Mrs Ashcroft says. "We're just another couple at the playground or having lunch with our girls."

Pioneer calls for industry regulations

India's Akanksha Infertility Clinic is the country's most successful surrogate business, delivering more than 760 babies through surrogacy since 2002.

Medical director Dr Nayana Patel says infertile couples will continue to pursue international surrogacy as long as their home country allows only unpaid surrogacy.

Dr Patel said most couples felt uncomfortable or unwilling to engage a family member or friend for surrogacy.

A landmark case at Akanksha Infertility Clinic, in Anand, Gujarat, made headlines when a grandmother became a surrogate for her daughter, who had a congenital syndrome affecting her reproductive system.

The daughter's embryos were implanted in her mother's womb resulting in a live birth.

As with the Corion Clinic in Mumbai, the surrogates are vetted to make sure they are attending of their own free will.

Dr Patel has also developed a trust which educates the woman's children and supports her family while she is in a surrogate home for the pregnancy.

Couples seeking surrogacy at the Akanksha clinic pay about $26,000, covering medical services and the fee for the surrogate to become pregnant and carry a baby to a live birth.

Each surrogate receives about $10,000.

"It can change the lives of the surrogates because the money they earn may allow them to buy a home for their family, start a small business or educate their own children."

Once the baby is born the surrogate has no legal rights to the child. In India, the intended parents are recognised as the birth parents.

Dr Patel is urging all countries that recognise paid surrogacy to develop common rules to regulate it.

"This would make it easier for couples to make informed and safer choices about surrogacy and avoid any potential legal pitfalls," she says.

"At the same time, common rules would help to protect the rights of surrogates who are genuinely in the business of helping couples to achieve their dream of parenthood."

Using a surrogate

Surrogacy is where a woman, who cannot carry a baby, uses another woman to bear the child. An embryo, created using IVF, is transferred to the surrogate.

Commercial surrogacy, where women are paid to carry and deliver someone else's baby, is only available in a handful of countries including the US, Thailand and India.

Surrogacy is available in NZ but the time and cost to gain ethics committee approval, and the limited number of surrogates, mean some parents choose to pay an overseas surrogate.

India has become a hot spot for this type of fertility tourism, thought to generate the country $400 million a year.

About 3000 clinics offer surrogacy services and 2000 foreign babies are born annually in India to surrogates.

Five couples from New Zealand have pursued surrogacy in India, four with success while the other is still at the IVF treatment stage.

The costs, in the tens of thousands of dollars, vary considerably but India and Thailand are cheaper than the US.

In 2011-2012, there were eight applications for surrogacy in New Zealand, seven of which were approved.

Between 2005 and 2011, surrogacy applications approved by NZ's ethics committee resulted in 33 births.

nzherald.co.nz

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- NZ Herald

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