logistics and costs of surrogacy in india

1. Logistics & Costs of Surrogacy in India By Dr. Samit Sekhar Kiran Infertility Centre Pvt. Ltd. Hyderabad/ Gurgaon/ Nepal

2. Planning a Child With help of Surrogacy

3. Why India for americans • World Class Medical Expertise & Medical Facilities • Clearly Defined Laws and Guidelines and Minimal Legal Complications • Abundance of English Speaking Population • Good Connectivity from Across the Globe • Good Infrastructure • Cost Advantage, much much affordable. • Safe and Friendly Country and people

4. Costs • Surrogacy Self cycle 32,000 US $ • Surrogacy Indian Donor 32,000 US $ • Surrogacy Caucasian Donor 45,000 US $

5. Who are eligible • Married Couples (Heterosexual) married for more than 2 Years • Citizens of countries which recognize Surrogacy such as USA,Canada,UK,Brasil,Singapore Etc..

6. Initial enquiry • Enquire through Internet, known successful parents, Forums about the hospitals providing services. • Ensuring that the Hospital is registered with I.C.M.R. (Indian Council of Medical Research) for providing Surrogacy Services. • Contacting Hospital in India through e-mail / phone/ Skype • Negotiate the terms and conditions • Sign Contract, can be done over email

7. Initial enquiry • Enquire through Internet, known successful parents, Forums about the hospitals providing services. It is always better to be double sure & best way is word of mouth by other successful parents in past and visiting the facility personally

8. Initial enquiry • Ensuring that the Hospital is registered with I.C.M.R. (Indian Council of Medical Research) for providing Surrogacy Services. Only hospitals registered with I.C.M.R. are allowed to treat patients of foreign origin.

9. Initial enquiry Mostly costs range around 32 K US$ to 45kUS$ depending on the Services being offered. Services offered include: 1) No of IVF and Embryo Transfer Attempts 2) Donor Type-Indian/Caucasian 3) Food & Accommodation 4) Concierge 5) Travel 6) Legal Assistance 7) Singleton or Twin Birth

10. Initial enquiry • Move Ahead Ready to Go Discuss with clinic appropriate timelines according to medical conditions and plan your itinerary accordingly at-least a month in advance to proceed further.

11. Logistics During Initial Visit Surrogacy/ ART Visa It is granted only if following conditions are met • To a Foreign Man & Woman duly married to each other for more than 2 Years • A letter from Embassy of country of origin of Intended Parents in India or from their Foreign Office stating that they recognize Surrogacy and will accept the child/ Children born as the biological child of Intended Parents • Affidavit by Parents assuring to take care of Child Born • Surrogacy should be commissioned only in registered clinics in I.C.M.R. • Duly Notarized Tri Party Agreement involving the Intended Parent, Surrogate Mother, and Clinic • Agreement can be done over email or post

14. http://hyderabad.usconsulate.gov/surrogacyinfo.html

15. Treatment cycle Initial Stay & Logistics • Your Initial Stay Duration depends on the genetic material you are intending to use. • in case of donor eggs the male partner is generally required to stay for not more than 4 days for Semen Extraction • In case you are using self eggs then you require to stay anywhere around 12-16 days per Egg Retrieval cycle depending upon the medical protocol prescribed by our doctor. • In case of Egg Donor, Intended Parents need only 4-5 days of initial stay • There is abundance of hotels providing world class stay and dining facilities around in major cities, charges per day for a couple on an average will not be more than 100$ US. • You need too register with FRRO, Foreigners regional registration officer which will require 1 day • stay and FRRO Process is also a part of the package offered to you by KIC • There are very rare indications of emergency situations in an IVF process, Almost all hospitals registered with ICMR are fully capable of handling such situations

16. Antagonist Protocol for In Vitro Fertilisation/ICSI • 1.Tablet Yasmin(or any other similar Oral Contraceptive pill) twice a day for 15 days • You will stop the pill 4 days before your departure for India and hence this way when you arrive here it will be day 1/2/3 of your menstrual cycle and we can begin treatment immediately • 2.Injection Recombinant FSH(300 units/day) or Highly Purified HMG from day 2 of the Menstrual cycle to be injected Sub Cutaneous/Intra muscular • 3.On day 4 of GonalF,the female partner will undergo Ultrasound to check for size and number of follicles • 4.if 2 or more follicles are 10 mm or more in size then Injection Cetrorelix(0.25 mg/day) will be added to the Gonal F on a daily basis • 5.Ultrasound will be repeated on day 6/8/10/12 to check for follicle growth

17. Antagonist Protocol for In Vitro Fertilisation/ICSI • 6.When 3 or more follicles reach a size of 18 mm or more ,Injection HCG(Human Chorionic Gonadotropin) will be given to trigger ovulation • 7.Egg retrieval under general Anaesthesia or Sedation is performed 36 hours after HCG injection • 8.Sperm from Male partner is used to fertilise the eggs from the female partner and embryos are cultured in the incubator for transfer on day 2/day3 or day 5 • 9. Egg donor stimulation is also similar to the steps mentioned above, she will also take the ovarian stimulation and Pills on the same dates as the Genetic parent • 10.if Embryo transfer needs to be done for the Surrogate mother then the Surrogate mother will also take medications on the same days as the egg donor or Genetic Parent but she will take medications to improve her Endometrial receptivity rather than medication to produce eggs

18. Time Lines A gist of timelines applicable in Surrogacy • Surrogacy Visa: To be applied at-least 4 weeks before you plan your travel • Duration of Stay with regards to Semen Collection: 4 Days • Duration of Stay with regards to Egg Retrieval: 12-15 Days • Time between Egg Retrieval and Embryo Transfer: 6 Days • Result Post Embryo Transfer: 10 to 15 Days • Interval between 2 Transfers: Approx. 15-21 Days

19. precautions at Birth Medical Aspects • In case of Singleton pregnancy the child may be required to be in Hospital for an average period of 3-4 Days • In case of Premature Delivery (Mostly applicable for Twin Births) the child is required to be Hospitalized for an average period of 7-14 Days Legal Aspects • Application for Citizenship and Passport for the child in US Consulate/ Embassy ( takes approx. 7-10 working days),our most recent case this weeek were issued passport without the DNA test in 3 days post birth. • US Consulate/ Embassy is available in all major cities across India including Hyderabad • Application in FRRO for Exit permit for Child -normally takes 3 days . • Costs involved in entire Legal Post Birth process included in package.

20. To-do list • Do not wait for the last week, be ready to fly anytime after 34 weeks • Pre-order and ship DNA kits in advance to nearest US Consulate/ Embassy • Pre-book your hotel in advance near the Pediatric Facility provided by your clinic to ensure easy access . in case the stay post birth is not included in your package) • Pediatric Hospitalization costs are not covered in the packages offered by Hospitals and is Approx. 60-100 US$ per day per child • Look out for a nanny for handling child (Important for 1st time to be parents). • Keep a timeline of approx 15-20 days of stay in India • All baby related items are available in India, you do not need to get it from abroad

21. Costs Not Covered in Package • Paediatric / NICU Approx 100 to 200 US $ • Stay If > 15 days • Eating Out • Sight seeing • AirFare • FRRO Exit for baby 100 US$

22. Thank you Dr. SamitSekhar Kiran Infertility Centre Pvt. Ltd. Hyderabad/ Gurgaon/ Nepal