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SURROGACY

Surrogacy is a legal and ethical arrangement in which a woman (the surrogate mother) carries the baby of another couple (the genetic parents or commissioning couple – the egg and sperm belong to them). The commonest form of surrogacy is gestational surrogacy wherein the female partner of the infertile couple is treated with hormones to yield more eggs which are retrieved and fertilized with her husband's sperm in vitro (in the laboratory). The embryos thus formed are then transferred to the uterus of a surrogate mother who gets pregnant and hands over the baby to the infertile couple after delivery. Sometimes, if the female partner is of advanced age or has poor quality eggs it might be necessary to have an egg donor to improve the chances of pregnancy. The child thus born would be genetically related to both (husband and wife) or one parent (egg donor and husband).

Surrogacy is indicated in patients with repeated implantation failures at IVF, recurrent miscarriages owing to insufficiency or birth defects in the womb (absent uterus, some cases of bicornute uterus, intrauterine adhesion, cases of hysterectomy where the uterus has been surgically removed for cancer or other disorders such as severe hemorrhage and bleeding after delivery) or in cases where the mother suffers from some medical disorder such as hypertension or severe diabetes making it risky for both mother and child (increased maternal and perinatal morbidity and mortality).

Screening Criteria for Surrogates – We prefer to recruit young surrogates in the age group of 21-35. They may be single, married, widowed or divorced. Legal proof of their marital status is ensured. They are screened for any medical or health problems. A detailed history is taken for medical illnesses, past pregnancies, ease of normal or cesarean delivery, health of children born and previous attempts at surrogacy. We also subject them to a complete cardiologist screen with 2-D echocardiography to avoid unpleasant surprises during the pregnancy. Once they are certified fit by the cardiologist they are subjected to the complete pathology work up including: Hemoglobin, sugar, clotting profile, HIV, Hepatitis B and C, VDRL for syphilis, Hb electrophoresis for thalassemia and other special tests if requested by the couple. This is followed by a social and home screen (surprise visits by our social worker) to rule out homes which are unhygienic, signs of physical or domestic violence, alcoholism in the husband, etc. Also, detailed evaluation is done for alcohol, drug or nicotine abuse. Only after all the above criteria are fulfilled the surrogate is placed on a waiting list.

The clinic provides a comprehensive package for care of the surrogate mother during the tenure of the pregnancy and one month after delivery to ensure that all precautions and measures are in place for optimal safety of both the surrogate mother and the baby in equal priority. All medical check-ups, ultrasounds, admissions, delivery are monitored by an agency member who is totally dedicated to third party reproduction with help from her competent team members. We provide the following options for stay:
1. At her own home if patient and clinic is satisfied with the cleanliness and hygiene
2. At a surrogacy home if desired by patient (not recommended by clinic)
3. At a nursing home – one in western and one in central suburbs – as a superior option as patient can be admitted for the latter and crucial part of the pregnancy with complete and intensive monitoring of pregnancy, mother and child welfare.
4. At the patient's home – if they should so desire.

LEGAL ISSUES IN SURROGACY
The following are covered in the legal papers which are drawn up between the patient and the surrogate mother with a dedicated lawyer (different for domestic and international clients):
• Surrogacy Agreement as per ICMR guidelines
• Affidavit of Surrogate Mother's Husband relinquishing rights on the child
• Terms & Conditions of the Surrogacy as per ICMR guidelines
• Declaration of Intent
• Endorsement by the ART Clinic, details of IVF procedure, confirmation of gametes used by the IVF doctor (own eggs / donor eggs, husband's sperm / donor sperm)

The said agreements are signed by the respective parties and notorized Personal information required for the agreements includes name, age, address of the surrogate mother, her husband and their parents if mother is single, name, age, address of the genetic parents (infertile couples), name and address of the doctor and IVF clinic, name, age, address of the third party coordinator, witnesses and the lawyer.

As soon as the child is born, the records of the birth are sent by the Hospital to the Birth Certificate Issuing authority. The birth certificate is prepared in the name of the genetic parents (as per ICMR guidelines.

In case of foreign nationals, after the Birth Certificate is received, an Application is filed for Citizenship and issue of Passport at the respective Embassy along with required documents.

After the issuance of Passport, an Application is filed with Ministry of Home affairs (MHA) for Exit Visa and then with Foreign Regional Registration Office (FRRO) for exit clearance.

Finally after obtaining the Exit Visa, the Intended Parents can leave India for their respective country with their child(ren).

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