*Note: This blog entry remains here for archival purposes. Please see my comment below re: the current international surrogacy landscape.*
Ever since DJ and MJ arrived home, I have been formulating my thoughts about our unique experience and the purpose of this blog moving forward. Having gone through the process twice, both domestically and internationally, Josh and I have a unique perspective and ability to compare and contrast two major options in assisted reproduction. Thus, I present here some of my collected thoughts looking at domestic vs. international surrogacy head to head. I hope this post will help people that are curious about these options, and possibly interested in exploring one of these avenues as intended parents themselves.
I am breaking down the comparison under several headings based on factors that may be important in deciding between the two. I should add that some of this is specific to our experience with a particular agency in California, USA and an IVF clinic in Mumbai, India, and may not be exactly the same as all the domestic and international options currently available.
When we pursued domestic surrogacy in 2006, we went to one of the first and biggest agencies at the time. Located in Los Angeles, California along Wilshire Boulevard, this agency presents itself as a one stop shop for all of your surrogacy needs. They have a large staff with a psychologist that locate potential surrogates and match them with the perfect intended parents. They work closely with the best Beverly Hills fertility Doctors to make the pregnancy happen. They have lawyers ready to get the legal situation sorted out before the birth even occurs. And they have case managers that are assigned to each case coordinating communicating between all the different parts of the process like a well oiled machine.
Compared to our domestic experience, our surrogacy abroad was a much more a la carte affair. We had a contact person in Michigan that referred us to an IVF clinic in Mumbai. We were matched with a surrogate through the clinic. From there, the clinic outsourced embryology labs, OB/GYN Doctors, and hospitals scattered around Mumbai to do their parts at different points in the process. Because there was no case manager per se coordinating all these different players and because we were relying on email alone without frequent phone calls, we felt rather uninformed at times and felt that the process was less organized.
The surrogacy agency in California did a marvelous job of matching us with the perfect surrogate. They carefully screened potential surrogates for medical issues and did psychological testing to ensure that they are mentally prepared for the process. They had the surrogate and us both complete extensive questionnaires about our expectations, and then presented the surrogate with profiles of hopeful parents with compatible preferences for the surrogate to choose. Our surrogate Marie told us she was presented with another profile initially that she declined before she was given ours. She liked what she saw in our profile, and when we met in the Fall of 2006 a lifelong friendship was made. We visited Marie frequently during the pregnancy in California and got to know her whole family. Since AJ and JJ were born, we have remained close even though Marie has moved several times since and now resides in Alaska. Even though she is far away, we still keep each other frequently updated and she is always the first to like Facebook photos of the boys as they grow up!
The IVF clinic in India had many women seeking to become involved in surrogacy. Whenever we visited Dr. M, we waded through a group of not yet pregnant women waiting in the lobby. They all stared at us with a hopeful look in their eyes because being chosen to work with us could mean a huge boost in their family’s socio-economic standing. We were presented with a couple different surrogate profiles that were screened medically and were prepared for the IVF procedure, but I do not have the sense that they were as carefully informed about the emotional aspect of carrying someone else’s baby in their womb. Therefore, we chose the surrogate that had done surrogacy once before and knew exactly what she was getting herself into. After we made our choice, we know that we made our surrogate very happy because she was smiling like she won the lottery the next day. Because of language barriers and less frequent contact, however, we knew that our relationship with Pavitra wasn’t going to be nearly as close as the one we maintain with Marie.
The surrogacy agency in California had their own database of potential egg donors that they compiled on an internet website. We were able to peruse profiles of many young woman and we found the variety of candidates from different ethnicities to be helpful given that we were seeking to have children that were half Asian and half Caucasian. We sometimes felt looking at questionnaire answers, video clips and smiling headshots like we were looking at an online dating website rather than seeking an egg donor to help create our family!
The selection in India was understandably more limited. There was some racial heterogeneity in the egg donor pool, but not a lot. Nevertheless, we were able to find the egg donor that suited our goals, and moved forward making the complementary genetic contribution on our end to make the children we hoped for.
As I have mentioned previously, the agency in California had lawyers that specialized in family law working with us during the pregnancy prior to the birth. The lawyers attended a hearing in California family court during the latter half of the pregnancy. Because the surrogate was not genetically related to the babies she was carrying, and because the egg donor was anonymous and had already signed away any parental rights, maternity of the babies was deemed by the family court Judge to be “in doubt” and the Judge issued the order before the birth that birth certificates be recorded with both our names as Intended Parents alone. The babies were automatically considered US Citizens at the time of their birth.
In contrast, India listed only one of us as the genetic father of the twins, and the space for the mother on birth certificates was left blank. The babies spent a few weeks in India after their birth as we proved to the US Consulate that they were US Citizens, and we obtained exit visas allowing them to leave the country. Now that we are home, we are working with our own lawyer to get a second parent adoption in Florida that will allow both of our names to appear on important documents.
IVF Success Rate
In the US, most reputable IVF doctors are happy to discuss their success rates while marketing their services. Some of the IVF clinics in India appear to keep this information closer to the hip, but not necessarily because they are any less effective. I think another reason for this may be is cultural. Being of Chinese descent myself, I know that being overly forward and boastful about your success is something that is frowned upon in many Asian cultures.
Being healthy gay men with no infertility issues other than our lack of uterus, we feel very blessed that both IVF processes were successful on our first attempts. In the US we transferred three embryos and two took resulting in a twin pregnancy, and in India we transferred two embryos hoping for one more child and both took anyway, giving us our second set of twins.
Quality of Medical Care
In the US, the quality of the medical care for the surrogate and the babies is pretty uniformly good due to healthcare regulation.
In India, high quality medical care is also available as long as you have the money to pay for it! DJ and MJ were born at Hiranandani Hospital in Mumbai. We found this private teaching hospital to have very well trained doctors. They even had cord blood banking services available just like in the US. We paid a bit extra (still reasonable by US standards) and ended up staying with the babies in the Presidential Suite with dedicated 24/7 Nurse and a Butler preparing our meals. For a moment I felt like how JLo, Celine or Mariah must have felt right after their twins were born!
Up until this point, it appears that US surrogacy is equal or superior to options abroad in most areas. But let’s face it. An important deciding factor is the bottom line. Surrogacy in California through a premium agency cost us well into the six figures USD, while surrogacy in India was a fraction of the cost. If we had decided to try and save as much as possible in India, we probably could have spent about a third of what we spent the first time around in the US. Instead, we decided to treat ourselves to some luxury amenities in the hotels and hospital because we don’t have the opportunity to travel much anymore after AJ and JJ arrived. Even treating ourselves, we estimate our costs in India are still less than half of our expenses in California.
In summary, we went on two different journeys because those were our best options at different times in our life. Obviously, we are very happy with the similar outcomes for each – two sets of healthy twins of our own. For people considering gestational surrogacy in the US or abroad, the decision may ultimately boil down to what is important to you, and what you can afford. If certain things like choice egg donors, ideal surrogate, constant communication and legal protections are things that you are not willing to compromise on, you may want to take out a loan and pay for the premium service closer to home. On the other hand, if you have a taste for adventure, are a pragmatist, and simply want a healthy baby without worrying about too many other details you consider trivial, an international destination may offer you the family of your dreams at a cost within your financial means.
In trying to present a fair overview of domestic and international surrogacy for future intended parents, I have deliberately left out specific names of agencies and other details particular to our own process. I did this because I don’t want to be viewed as wholeheartedly endorsing or advertising for anybody in particular. To any readers who have any more curiosity or seek more unfiltered commentary, please feel free to contact me privately with the form below.
Or you can leave a general public comment below. Feedback is appreciated!