In-Vitro fertilization (IVF) and Surrogacy are both methods of assisted reproductive technology (ART). Both procedures are aimed to help couples meet their dreams of parenthood.

Note: If mother’s own eggs are not healthy enough, the couple can pay some money another woman called “Egg Donor”  and then her eggs are fused with your husband’s sperms to form embryos. Those embryos are finally transferred to mother’s womb (not in the egg donor’s womb). Egg Donor has no rights over the baby since she sells her eggs to the intended parents.

Similarly if husband’s sperm quality is not good, a couple can opt for a male sperm donor as well.

The cost of basic IVF ranges between 1 to 1.8 Lakh Indian rupees. This includes medications and procedure cost.

Following is a more of a theoretical explanation of IVF, which you can skip and jump to Surrogacy directly.

What is IVF?

IVF or In-Vitro Fertilization is a process of fertilization, in which doctors combine the Female’s egg and Male’s sperm in a laboratory to form an embryo (also called Test Tube baby). Later, the embryo is transferred back into to a woman’s uterus/womb. This process was developed more than 30 years ago for women suffering with damaged Fallopian tubes.

How does IVF work?

IVF treatments start with a course hormone therapy on mother’s body to boost the development of several eggs/follicles in her ovary. When the eggs are collected, they are fertilized in a test tube to produce several embryos. After 2-4 days in the incubator, one or two embryos are transferred to the mother’s uterus where implantation may occur, assisting the mother to get pregnant.

However, not all embryo implants can result in a successful pregnancy that is why if any extra (healthy) embryos are still left, they are frozen for another attempt if needed.

Following is a more theoretical explanation of Surrogacy, which you can skip.

What is Surrogacy?

If the womb of mother is not fit for pregnancy, eggs are implanted into another woman who brings up the baby in her womb for 9 months. This other woman who rents out her womb to the intended parents is called a “Surrogate” and process is called “Surrogacy”. The surrogate mother agrees to give the child to the intended parents at the end of the pregnancy.

This is a complex process, which requires emotional and legal complex arrangements for both the parties. Medical, emotional, legal and financial are just some of the matters that need consideration before going with this procedure.

What are Two different Types of Surrogates?

There are two types of surrogate mothers: traditional surrogates and gestational surrogates.
With traditional surrogate, artificial insemination is performed. The egg of the surrogate woman is artificially inseminated with the father’s sperm. The artificial insemination occurs in the laboratory but you are using the eggs of the surrogate mother thus giving a genetic link between the surrogate mother and the baby. But the surrogate woman still carries the baby to full term and gives the baby to intended parents.

With gestational surrogate, it is the process of harvesting eggs from the mother and fertilizing them with the father’s sperms. For some reason, the mother cannot conceive thus the embryo is placed in the uterus of the gestational surrogate. The surrogate will then carry the baby for nine months and will give the baby to the intended recipients after the birth of the child.

How IVF and Surrogacy are Connected?

IVF and Surrogacy are different process however, IVF is needed in surrogacy process.

Through the gestational surrogate, IVF is now possible. The harvested eggs that are used in the gestational surrogate are not from the donor but from the mother and the sperm used to fertilize the eggs are from the father. When the eggs are fertilized, an embryo is formed and it is placed in the gestational surrogate.

A gestational mother has no genetic link to the child because it was not her egg that was used. Gestational surrogate is only the birth mother but she is not the biological mother.
Studies show that in the United States, gestational surrogacy is not a complex matter because both intended parents still have the genetic ties to the baby. Most couples now prefer to choose gestational surrogacy compared to traditional surrogate.

Difference between IVF and Surrogacy

IVF is the process of fertilizing an egg outside a woman’s body while surrogacy is the process when a woman agrees to carry a baby for intended recipients. The surrogate mother will have to surrender all the rights to the intended recipients.

If you used traditional surrogacy, the surrogate mother uses her own eggs. This method allows a genetic link between the surrogate and the child.

If you plan to use the gestational surrogacy, there is no genetic link between the surrogate mother and the child because the fertilization had taken place in a laboratory dish and the embryos were just transferred to the surrogate.

Even though every woman wants her child to carry forward her DNA, however due to aging or medical issues, her eggs might not be of such fine quality anymore to give birth to a child. If a woman goes for In-vitro Fertilization (IVF) or Surrogacy with donated eggs (eggs of a different lady fused with her husband’s sperms), for some women accepting a child who does not carry her genes can be overwhelming.

Honestly speaking, it does not matter. Once you have a child in your arms, it will be 100% yours, even legally. The birth certificate of the child will carry your and your husband’s name on it.

It is extremely important to find the right egg donor for you.

The Best Age Group

Not all women can qualify to be an egg donor for IVF/Surrogacy. The ideal age group is women between 21 to 30 years of age. Most agencies do not even consider women (egg donors) over 28 years of age.

The quality of the egg decreases rapidly as a woman gets older. The chance of producing good quality eggs decreases after 30 years of age and the possibility of having normal eggs falls sharply when a woman reaches 37 years of age. In foreign countries, a lot of working women get their eggs/embryo’s frozen at an early age and use them when they are ready for a child later in life when their own eggs may not remain as healthy as they were.

Women younger than 20 years of age are also not selected (usually) because they often do not understand the importance/depth of what they are agreeing to.

Proven Pregnancy Check

An egg donor should already have at least one child of her own to prove that she has the capability of producing fertile eggs.

Physical Features

If you are looking for an egg donor, it is advisable that you choose an egg donor whose features match yours, at least somewhat (height, complexion, hair and eye color).

Egg Count

Normally, only one egg is produced in the ovaries at a time when a woman is not under any medication. However, an egg donor is given medications so that she produces 10+ eggs at a time. Not all donated eggs are fit for use. Some eggs may not develop maturely while others may not fertilize for unknown reasons.

To ensure that maximum eggs are retrieved and they are healthy, it is best that you choose an egg donor who did not donate her eggs for another IVF/Surrogacy very recently (say in the last 4 months).

Number of Egg Donations

A woman is not allowed to give egg donations more than 5 times in her lifetime. The American Society for Reproductive Medicine has set this standard, this rule is usually followed by Indian doctors too.

Medical Screening

A physical examination is required before anyone becomes an egg donor. Blood tests are needed to check the hormone levels and medical history. Ultrasound is used to examine the pelvic organs, ovaries and uterus. These tests are completed to ensure that the egg donor is free from any existing health problems.

Likewise, egg donors are not smokers or should have stopped smoking for at least six months prior to the egg donation. Candidates with the history of drug use are also ruled out. Urine toxicology tests are required to determine abstinence from drug use.

Infectious Disease Screening

When tissue or blood is transferred from one individual to another, there is a risk of bacteria or virus. To reduce the risk of causing illness in the intended recipient, the egg donor is tested for any infections.

During the pelvic exam, a small scrape from the cervix is taken to test for Chlamydia and gonorrhea. Blood tests are also performed to test the egg donor for hepatitis B, hepatitis C, syphilis and HTLV-1. HTLV-1 is not common virus but it is associated with some forms of cancer.

Hormone Tests

Blood tests are done to measure estrogen, follicle-stimulating hormone (FSH), Luteinizing Hormone (LH), Antimullerian Hormone (AMH) and Thyroid Stimulating Hormone (TSH) levels to make sure that the hormone levels are normal. These tests are done during the first week of the menstrual cycle of the egg donor.

HIV/AIDS Testing

USA Law also requires that the egg donor should undergo an HIV test to make sure that she is not infected with HIV/AIDS. Indian doctors also perform these tests directly or rely on agencies to give them this report.

Partner Screening

The sexual partner of the egg donor should also undergo testing for sexually transmitted diseases and HIV.

Screening for Inherited Disease

To minimize the risk of birth defects in your child, the egg donor will undergo screening for inherited diseases.

In some cases, genetic counselor is accessible to make sure that certain genetic disorders like Huntington’s disease, Sickle cell anemia or Hemophilia are not present in the genetic history of the donor.

Psychological Screening

Egg donation is not a simple process. The whole journey of egg donation for IVF/Surrogacy is complex and may stir emotional, social and ethical issues. That is why psychological screening is vital.

An egg donor will have to take psychological tests. The main goal of psychological test is to make sure that the egg donor can fulfill the complex process of egg donation. Sometimes the partner will also have to undergo psychological evaluation.

Blood Type

Blood type matching is optional, but many doctors will recommend it. Consult your doctor regarding this.

Background Checks

For surrogacy, it is recommended that background checks should be done to ensure that  surrogate mother is a responsible person and if free from criminal background.

What if a Friend or Relative is your Egg Donor?

There are times when a friend or relative is the egg donor. Instead of choosing an anonymous egg donor, some intended parents prefer choosing someone they know like their sister or any relative to make sure that they have some resemblance to their baby.

Intended parents also feel more connected and secure knowing that they know the egg donor. However, even if you knew someone who would be willing to donate her egg for you, the usual medical screening, psychological screening, HIV screening tests should ideally be followed.

Other Factors to Consider

In recent years, recipient parties also chose egg donor that have recent high grades and good career. These documents may show the abilities of the egg donor. Aside from grades, physical looks also matter. Studies show egg donors that are beautiful and intelligent are more likely to be chosen as egg donors.

Trust me on this, the moment you enter any IVF clinic, their front end staff is fully trained to play with your emotions/dreams and sell their service to you. They will focus their emotional talk towards the wife due to obvious reasons. Within 15-20 minutes you will be almost convinced that this is the best place you can get the Surrogacy process done. They may even have newspaper and magazine cuttings boasting about their success (although I personally feel that some of them are paid publications too). They will fully convince you that how having a child (or a 2nd child) is more important than your money. Well, they need your money and you need a baby but there is a catch. The fact is Surrogacy/IVF is one of the safest industries where you pay even though there is no guarantee of success. Very true, no one can guarantee you of a baby but then you also need to ensure that.

Good, honest and experienced doctors/clinics are present. Therefore connecting with the right one is extremely important.

1. You are not being overcharged for the services .
2. You are actually getting good services from a knowledgeable and experienced team.
3. Decisions are not taken purely based on emotions.

Tips to find a good doctor or clinic for Surrogacy/IVF:

1. First thing first – Prepare yourself mentally:
Before you step out of your home, make yourself emotionally strong. Undoubtedly your decision to have a baby is correct and to achieve your target one needs to use their brain more than heart.

2. Do shop around for a  good Surrogacy/IVF center:
Go to at least 2-3 IVF/Surrogacy clinics (or more) before you make up your mind. Ask each one about their success rate and a BREAK-UP charges of their services. This will help you understanding not only what all steps are involved in IVF/Surrogacy, but if one center is overcharging for one step which another one is charging much less. It will later help you in negotiation.

3. Ask overhead/additional costs:
There may be tests like Semen Analysis, Blood tests, HIV tests, even cost of injections/medications which may not be mentioned in their package. Get a checklist complete out of pocket expenses.

4. Ask their policy if IVF/Surrogacy process fails for the first time:
Almost all clinics offer some discounts on 2nd or 3rd attempt if the previous attempt fails. See how much flexible they are in their repetition process.

5. Yes, you can negotiate to some extent:
If not much, there is always some room for negotiation. It is completely fine to leave your number and have the IVF/Surrogacy center to revert back to you with with some discounts or deals. Regardless of what these doctors/clinic staff tells you, they make a lot of money so they do not want to lose you easily.

6. Ask/Find References:
Ask for real references of parents for whom they have performed IVF/Surrogacy successfully. It is quite possible that they will simply not provide you because of privacy reasons, which is quite right. Still, there is no harm in asking. If any of your friend/relative had success with IVF/surrogacy process with particular a fertility doctor, it is better consider that clinic over others. You may be hesitant that your relative may get to know about your infertility issues and that you have been unsuccessfully trying to conceive for a while. Lets be practical, having a baby is more important than going with an unknown doctor. Infertility issues are so common these days that it is no more a taboo anymore. If nothing else, try to observe the presence of pregnancy ladies in the clinic. There may be other couples present in the clinic, try to get friendly with them and see what they have to say about the center.

7. Are doctors/clinics following the government norms.
In India sex-determination is completely illegal, and I would recommend you not to flirt around this rule or pressurize doctors over it. Additionally there are strict privacy and humanitarian laws surrounding these processes. If you try to bypass them, they may bite you back in case of any complication. If a center is ready to break rules privately with you could mean their business is actually struggling. There are IVF/surrogate lawyers if you have any doubts.

8. Will your doctor/clinic share the health record of your surrogate/egg donor?
Forcing your doctor to disclose the the name, religion or address of your surrogate might be illegal. But to other things like health records of your surrogate/egg donor and her history related to pregnancy is your legal right. IVF clinics/staff will often tell you “TRUST US” (on this or that), although it is very true that you do have to trust them many times during the process, but end of the day if you have some doubt, please do ask your doctor if they can provide you a proof.

9. Proven/experienced doctors are better:
Reputed clinics/big hospitals which can provide solid proof of they success or top of the line IVF/Surrogacy centers are usually 10-20% expensive over others. It is better to shell the extra cost if you are confused to go with a smaller setup or a bigger one.

10. Distance/Location selection:
In case of IVF/Surrogacy, traveling a little far from your home for a good doctor/clinic should not be an issue for you. Your local doctor may not be well qualified, may not have the best equipments/lab or the best legal team.

11. See if there is an unbiased agency which can assist you:
Although rare, there are IVF/Surrogate agencies who can act like a middleman and make sure that you get the best treatment. These agencies may be free for you (they may get a commission from the doctor) or they may directly charge you a fee. Again, see if this agency can provide referrals of their past cases.

12. Step by Step progression:
If just IVF is better for you, then why go for the expensive Surrogacy. Similarly if both of you are healthy, then why go for an egg/sperm donor.

My objective to make you aware about all these things is purely one-to-one and to help you make a mindful decision for your family.

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