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The whole world's a delivery room: Israeli couples use gametes and surrogates from India and the US to have children - Haaretz

(9 July 2009)

It took seven years and trips to three continents before David Lumbroso-Gilad and his partner, Eli, finally held Rotem, their sweet five-month-old baby, born with the help of a surrogate in the United States.

Because the couple did not want to share their parenting with others, they did not opt for the inexpensive solution of arranging the birth of a child with an Israeli woman. Years of pursuing foreign adoption ended in a few "almost-babies" and a lot of futile back-and-forth dealings with adoption agencies. Surrogacy seemed to them "far away, futuristic and expensive," they say, but eventually, they understood it was their only alternative and they set their sights on India. "In those days there was no agency arranging surrogacy there. People would send out e-mails themselves, trying their luck," recalls David Lumbroso-Gilad, 42. "We even sent money over to place an ad, but got no replies; it reminded us of the tough times when we tried for adoption. That was when we decided to go with surrogacy in the United States, because we knew a couple that was in the middle of the process." Advertisement The process ultimately cost the two $120,000 - their entire savings - but in the best American tradition, was characterized by efficient, reliable service. Lumbroso-Gilad says: "In the U.S. there is no bureaucracy. Everything runs like clockwork. We had a wonderful surrogate, with whom we are still in touch, and parenthood is the most amazing thing that has ever happened to us and our families. It simply brought everyone together." With sophisticated communications and medical technology turning the world into one little delivery room, surrogacy abroad has become an increasingly popular solution for Israelis. Considering that in this country surrogacy is available only to heterosexual couples - who must also meet age requirements and be approved by a medical committee - arranging the procedure abroad, usually in India or the U.S. these days, is practically the only option for many would-be parents. It is hard to estimate how many Israelis have already employed surrogacy, since it can take different forms. Ron Poole-Dayan, an Israeli living in the U.S., is the Israeli spokesman and representative of Circle Surrogacy, and the proud father of twins born with the U.S. agency's help. He estimates that some 80-90 Israelis have been assisted by Circle since 2007 - compared to 500 surrogacy cases in Israel in the 13 years since the Surrogacy Law regulating the process was passed. He claims that about one-third of the Israelis who have contacted his agency in recent months were straight couples. However, it was mostly men who showed up at the introductory meeting Circle Surrogacy held at the gay community center in Gan Meir in Tel Aviv, preceding the city's gay pride parade a few weeks ago. Poole-Dayan and Circle Surrogacy president John Weltman - who has two children, born with the help of a surrogate, both of whom also attended that meeting - explained that their agency matches surrogate mothers and egg donors in the U.S. with couples or individuals who want a child. The most organized and liberal country in the world in this realm is the U.S., Weltman told potential parents: Anyone can have a child there via a surrogate - gay couples, unmarried or older people, even (under special circumstances) people who are HIV-positive. Moreover, the country's level of medical care and experience with these procedures has led to very impressive results: In his 14 years as president of Circle, Weltman claimed, only two couples did not have a baby after undergoing this process. He and Poole-Dayan attribute the high success rates to the organization's strict screening protocol: Egg donors, for example, must pass a battery of tests; usually only one in 10 is accepted. Only healthy women aged 20-29, with the right kind of family medical history, pass muster. The agency checks if they already have children, how their previous deliveries were, what their husbands think of the process, whether they intend to conceal their surrogacy, and what their financial situation is. "We don't accept women on welfare, and if in the interview the husband sits and scowls and says, 'She can do whatever she wants' - the couple is automatically disqualified," Poole-Dayan said. As Weltman put it, a poverty-stricken surrogate "doing it only for the money" may jeopardize the pregnancy if she juggles three jobs and eats unhealthy food; an unsupportive husband may leave the wife-surrogate, creating stress that is likewise bad for the unborn baby. Circle thus wants to know as much as possible in advance, because, Weltman explained, it has neither the ability nor the desire to monitor surrogates during their pregnancy, nor can they be forced to live away from home - as is sometimes done in India - both for moral reasons and out of consideration for the well-being of both mother and child. And appearances also matter: It is psychologically preferable to deal with a known donor - a woman who is willing to reveal herself to the couple. A child who will never know his birth mother may be troubled later in life. The candidate-screening process is thus lengthy and also costly for the couple: Circle Surrogacy takes between $40,000 and $130,000, depending on the medical procedures and insurance involved. Inconceivably costly While researching this article, we heard of a couple who paid as much as $200,000, for reasons Israelis might find a bit surprising: For example, a fertility clinic in New York is likely to be much more expensive than elsewhere, because of high operating costs there, or because the couple has special requests about the genetic outcome. The issue of whether the surrogate has health insurance is also crucial, since without it, her bills for medical tests, hospitalization and the delivery might reach hundreds of thousands of dollars. Therefore, would-be parents who do not use an agency or some other mediator familiar with the legal and administrative tangle may find themselves with an uninsured birth mother or infant - no small problem in a place where one day in the hospital costs $1,000 - or without a baby altogether. Circle offers several possible options: Its "guaranteed baby" plan, for example, involves a fixed fee for the entire process and promises a substantial refund if there is no baby in the end. Poole-Dayan is aware that the financial terminology is problematic. "A tension is created here that is hard to resolve," he admits, "but the fact that we try not to make it sound too commercial doesn't mean that the client shouldn't make a sound decision as a consumer. Just because this service has rates doesn't make it immoral." In France, the aversion to commercialized surrogacy is so intense that even after a two-hour meeting with an agency representative, prospective clients sometimes don't dare ask what the price will be, Poole-Dayan notes. The high cost of surrogacy in the U.S. is, of course, its greatest drawback: People who cannot afford to pay the price of a small Israeli apartment for a child will find that this path is simply not an option. That's what happened to Eyal (not his real name) and his partner, who tried to find a woman with whom to have a baby. After meeting some 120 would-be mothers, and going through three "almost pregnancies," they understood they had no choice but to pay. "The U.S. option was financially impossible," says Eyal. "Most couples I know who decided on it had to sell their apartment, and we couldn't do that." He and his partner then chose the other popular solution for Israelis - surrogacy in India - and are now expecting a child. Usually, Indian surrogates are in their 20s and married with children, from a low caste and in need of the money. Most do not want to meet their "clients"; in any case, an encounter is difficult due to cultural differences. "One thing about the culture is that people are much more obedient there," says Y., who is involved in the surrogacy business in India. "It's much more obvious that if smoking is forbidden [to surrogates], for example, then they won't smoke." This cultural tendency leads to a situation where, in some cases, surrogates are lodged far away from home during the pregnancy, so their behavior can be closely monitored - a practice that received publicity, and criticism, in the wake of Zippi Brand Frank's documentary "Google Baby," winner of the best Israeli film award at the recent DocAviv Festival. Y. says in response that this practice is typical of a particular clinic and is not widespread. The latest word in Indian surrogacy is a characteristic Israeli blend of East and West: The Tammuz International Surrogacy agency, run by Doron Mamet, offers a mix-and-match plan, involving fertilized eggs from an American donor - in other words, a woman who is Caucasian rather than Indian-looking - which are implanted in the womb of an Indian surrogate. That's the path that was chosen by Eyal and his partner, mentioned above. Intercontinental process While American donor eggs are costly, Indian surrogates are not, making the process cheaper. People willing to use an Indian egg donor will pay even less. Rates are $30,000-$60,000, not including travel and additional expenses. Eyal and his partner's baby, mentioned above, is one of two conceived with the assistance of Tammuz, out of failed attempts with 10 different women, which just shows how difficult the process is. Furthermore, in India "homosexuality is illegal, but local clinics are totally open about it. Of course, you don't see gay pride flags in the street," says Y. Using frozen embryos - which has been conceived in the U.S. and flown to India - can reduce the chance of a pregnancy. Then again, that process is relatively fast: Y. estimates that half the couples who approach his organization today are heterosexual, and simply do not want to wait the many months it will take for the Israeli committee to approve them: "In India, within two months you can already be at the phase of transferring the embryo to the uterus," he adds. Eyal and his partner have met neither the donor or the surrogate; they will take their first trip to India for the birth. Only then, if they arrive in time, will they meet the woman carrying their child. For Eyal, this whole situation has certain advantages: He does not need to take time off from work or pay for expensive airline tickets. His part of the process ended when he donated sperm at Sheba Medical Center, which was sent from one continent to another until a child was conceived. Now all he has to do is e-mails and phone calls that inform him of the pregnancy's progress. "For better or worse, it's a remote-control process," explains Eyal, "and you pay a price for it, which can be difficult sometimes. As much as they try to take pictures during the checkups and involve you in the process, it's not the same." Ada Atias and Mina Yulzari run the Parenthood Center, an Israeli organization that handles local surrogacy arrangements. Not surprisingly, Atias believes that conducting the whole process abroad is problematic. "An Israeli surrogate will not be willing to embark on the process without meeting the couple, and it's very important to her that they be involved in the pregnancy," she says. "I always say, 'Even if the birth mother feels the baby's first kick at 2 A.M., she should call the couple.' It gives them a sense of connection. I don't know how parents feel when they 'order' a baby and receive it. After all, pregnancy is part of the bonding process. Otherwise you have no idea what is happening - who is your surrogate? How is she feeling? You hope that everything will end well. And if the surrogate has a psychological crisis during the pregnancy or decides to extort more money, go find her in India." When one of Eyal's surrogate pregnancies ended in a miscarriage, he learned of it by phone on a Friday night. At the time he and his partner were "trying to get pregnant" with two surrogates, in the hopes of expediting the process after four failed attempts. In all likelihood, conception of multiple fetuses under such circumstances would not occur during a surrogacy process in Israel. "Today I think it wasn't smart, but we didn't think about it at all," Eyal admits. "All we thought about was the pregnancy. We wanted a child so badly, and when it's far away, there's a feeling that everything is permitted: You give your instructions, and it's done." Asked if he doesn't think the process is like some sort of outsourcing service, he explains: "I'm familiar with that claim, but we didn't think in those terms at all - maybe because Doron at Tammuz prepared us well, maybe because we knew about the situation in the U.S. In the end, it's not only true of India. On the contrary: In the U.S. the feeling of a technical process is even more pronounced." Unlike in Israel, in India, "the 'service mentality' is not as evident," Eyal says, and it's harder to get records of prenatal ultrasounds and other information about the pregnancy. In any case, Eyal and his partner have begun to prepare for the birth: They are working through the New Family organization to arrange legal status in Israel for the baby - a long, tedious business when Indian surrogacy is involved, requiring DNA tests in India that are sent for confirmation to the U.S. They've also started shopping for a crib, clothes and other baby gear, which is normal, only they will need to transport it to India, where they will stay for a few weeks until the baby gets an Israeli passport. They are also thinking of taking along baby formula, "since in India water quality is not a trivial matter." Eyal has already told his employers of the upcoming birth, and they responded to his news, happily, with encouragement and good wishes. A law passed a few years ago ensures that the National Insurance Institute will pay for his paternity leave. Now all that remains is to sit by the phone and wait. At the meeting at Gan Meir, some expressed concern about the realities of life after the birth. One of the men in the audience asked Weltman's children if they were ever teased at school for having two fathers. Thirteen-year-old Kyle answered that he is taunted now more than when he was little, but he claimed that the experience only makes him stronger. Zachary, 15, said he never encountered any problems: "I've never had a problem with having two fathers. When people asked me about it I answered honestly, without hiding anything, and I was never teased about it." It's not all about the money One of the interesting aspects of surrogacy is the type of women who agree to go through an entire pregnancy for someone else. In Israel, a surrogate receives NIS 120,000 - more if she is carrying twins or has a Caesarean section; there are additional costs for clothing and babysitters. The law requires that surrogates have had their own children, but they do not have to be married. In most cases, the women come from outlying parts of the country and are not well-to-do.Knowledgeable sources insist there is more than money involved. "The main motivation is financial, but not every mother wants to be a surrogate," says Ada Atias, of the Parenthood Center. "You also need to have the right personality profile. There is a capacity for giving that is part of the process, and for some of these women, the fact that they are not only needy but helping others is beneficial to their self-image. Without them, the couple won't have a child. It's very empowering."This feeling also depends, of course, on the bond formed with the couple; the better the relationship, the more sense of gratitude there is. The money also has an empowering effect. Atias recalls a mother of two daughters from an underprivileged town, who married at 17 and got divorced; she was a surrogate twice in four years, and is now finishing her training as an engineer."I met her in a tawdry little room, and now she lives in a spacious apartment. It's not that she could not have done it before, but she had no faith in herself, and the money also helped, of course."By contrast, Atias remembers a surrogate who also went through the procedure twice, but wasted all the money she was paid - NIS 250,000 - on shopping. "We sat down with her and said, 'Isn't it a shame?' And she said, 'Listen, from childhood I've suffered from the disease called poverty, and now I'm cured.'"Surrogacy can be both physically and emotionally demanding for the birth mother. It involves dealing with other people's questions and congratulations about being pregnant, but not raising the child. Atias notes that during the screening process the woman's surroundings are examined, to make sure she has a support system. Still, there is no way to prevent people from talking on the street. For this the center provides ongoing psychological support, Atias says.Ron Poole-Dayan of Circle Surrogacy agrees that carrying a baby for others involves more than financial payoff. Circle pays surrogates $20,000-$25,000 - not a very large sum in American terms, especially since the process lasts nine months. Therefore, the women are accepted only if their financial situation is stable."Because it is not a lot of money, relatively speaking, we get women for whom this is an amazing project, allowing them to change someone else's life," he notes. "It also, however, may allow them to spend a year at home with their own children or add to their college funds. Many of Circle's surrogates are very active in the process, and want information about the parents. In the end, even if they did it for money, it ultimately becomes one of the greatest things they've ever done."

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