The risky business of surrogacy

NEW DELHI: For many couples who are infertile, surrogacy is a boon as they can hope to become parents through this clinical method. But the next time couples opt for this procedure, they should spare a thought for the surrogates. These uneducated and poor women are lured into renting out their wombs for money without being explained the risks involved.
The doctors, driven mostly by commercial interest, are the ones who decide about the number of embryos to be transferred and the mode of delivery. This has been found in a year-long study of Delhi's fertility clinics by researchers from Delhi University, Jawaharlal Nehru University and Aarhus University in Denmark.

According to the study, which has been published in two international journals, Bioethical Inquiry and Acta Obstetricia et Gynecologica Scandinavica, doctors were willing to go to the greatest extent possible to fulfil the commissioning parents' demands. This includes putting multiple embryos, in one case seven of them, into the surrogate to ensure higher success rates.

The doctors' approach has been highlighted in their interviews which is a part of the study report.

One of them, herself a woman, states: "See, when they (the surrogate mothers) are signing the contract, they are giving a yes to all complications and risks associated with it— She cannot choose that I will be the mother of one child and I will not be carrying twins, I will not be carrying triplets. Doesn't happen that way— She has hired out her womb for nine months and seven days of her life to another woman, and we can assure only one thing, nothing will go wrong with you."

Sociologist Tulika Patel, one of the authors of the study, said unlike IVF treatment for couples and single women, where the woman bears her own children, surrogates rent their womb for money. "It is important to ensure they are not exploited for commercial interest, as has been seen in this study. One cannot depend on the doctor's assurance alone," said Patel, who teaches sociology at DU. Sunita Reddy from JNU participated in the study.

The study shows exploitation of surrogate mothers took place in many forms. First, the agents who picked them from poorer enclaves told them about the money they would get but not the risks involved.

When it came to transferring of embryos, most clinics preferred to put multiple embryos for better results. Even though medical guidelines suggest that transferring more than three embryos can pose a serious health risk to the mother and child, many clinics transferred four to seven of them. "In majority of clinics, doctors alone made decisions about the number of embryos to transfer. Some of them involved the commissioning parents, but few involved the mothers," said another researcher.

The ICMR guidelines state that commissioning parents (CPs) should not hire more than one surrogate mother simultaneously. But the researchers found one clinic which allowed two surrogates. "Recently, we had one couple who had four children; two children from each surrogate. But if CPs don't want to have more than one or two children, they might only let one surrogate continue the pregnancy and the other has to go for an abortion," one of the doctors at the clinic said.

The mode of delivery was also decided by the doctors and the CPs, study shows. The CPs, in one of the clinic, could reportedly directly decide the mode of delivery. For C-section, extra money was charged which was to be passed on to the surrogate.

According to the study, clinics used arguments like, "No one wants to risk a vaginal delivery when it is such a wanted child. We also leave very little to chance."