Have you seen this program yet? I had a bit of free time this weekend and tuned to On Demand where I watched a documentary about IVF and gestational surrogacy in India. While I can see how this was “entertaining” for most of the world to watch, there were a few things that I found worthy of commenting on, both from the surrogacy standpoint as well as from the IVF overseas (cross-border fertility) aspect.

1. Gestational surrogacy

For those of you new to this world, surrogacy is a term that traditionally referred to a woman volunteering to receive an insemination of sperm, use her own eggs, and then carry the pregnancy to term and give the baby to another woman. Nowadays, traditional surrogacy is rarely practiced due to the maternal attachment that can occur for a woman who carries a baby conceived from her eggs. Most fertility physicians use gestational carriers, women NOT related genetically to the pregnancy they carry to term, where the baby is then given to the intended parent after birth through a legal contract. Some countries and some U.S. states do not recognize this as legal, but when performed in a state that allows it, the intended parents (most often the egg and sperm donors) are able to have a genetic child even when the mother does not have a uterus (or can’t manage to carry a pregnancy due to miscarriage, etc).

Using a gestational carrier is expensive–they need to be found, screened, tested, insured, contracted, and most importantly they then give of themselves nearly unconditionally while they go through fertility treatment, shots, and ultimately a nine month pregnancy. They spend time away from their own family, get morning sickness, are sometimes confined to bed rest or hospitalization, and risk surgery and potentially their own lives by carrying someone else’s pregnancy. This may not sound ideal to many of you, but a woman who can do this to help another woman share the joys of motherhood is a true hero in my book.

But something about Google… Baby–where they showed images of a downtrodden city in India with women who seemed to have little other options for advancement in life, who then lived in an infirmary-like setting with nine beds and no pillows for the entire pregnancy and were paid at best $6,000, this was disturbing. It brought to a head the complaints many have that gestational carriers are somehow coerced into a heart-wrenching choice that might forever alter the path of their lives in a negative fashion. Hard to say how it truly is perceived by the women in India who decide to do this – they appeared to have been counseled well by the doctor. The documentary only gave us a brief glimpse into these women and the effect this had on their families. But those of us with the power– that’s you as a patient and me as a physician – need to think long and hard about the rights of self-determination and how we can help all women make the right choices for their lives, never taking advantage of another. And to not even show up at your baby’s birth like one of the intended parents on the show? Amazing…..

2. IVF overseas

The second thing worth commenting on is how IVF is performed overseas, or even over on the other side of the freeway. Even my husband, who knows little about how an IVF laboratory should look, cringed at the dirty floors, the sloppy handling of sperm and embryos, and the chances for mistakes and mishandling (again, it was a TV show that was edited to portray certain viewpoints of the producers). If there were ever a time you wanted to make sure the counter tops were sterile, the identification labels were accurate, and the freezing temperature was stable, now is the time for your embryos. These are your most precious possession, your future, your legacy. How could you not be totally invested in making sure you choose a clinic you could trust–that you could observe- that you could feel confident you were getting the best?

I have seen patients that have spent their life savings on fertility treatment and feel that “outsourcing” to a cheaper IVF clinic overseas, may make sense. And some of those people actually do get pregnant. But how many? What are the odds? Do those clinics post statistics of their success rates? Do you trust those statistics? Please, for the sake of your embryos, caveat emptor (buyer beware!)

3. The parents

And finally, the one thing that the documentary gave way too little air time–the parents! The joy the moment they held their baby! The years of parenthood ahead! Nine months is a little time to suffer when you get that child for the rest of your life! If you could see what I see every day, the emailed photos of babies in the bathtub, on a swing, the birth announcements with pink bows tied around a bare bum, … oh they make my heart melt. And the smiles on their parents’ faces tell me that it was all worthwhile.