Sunday, 15 February 2015

Couples are blessed with a baby through Surrogacy after 2 IUI and 14 IVF

Today I am sharing the story of my young patient, who was even ready to die  to fulfill her undying thirst to have a baby. (Names, places and picture have been changed to protect the real identity)

Nina had moved to the USA with her parents when she was 10 years of age. She was a brilliant student studying in a reputed school. At the age of 21 she got married to a Professor, both were healthy and happy. By the year 2007, 11 years had passed since the marriage, but still her dream of cuddling her own baby had not materialised. Now they started trying ART (Artificial Reproductive Techniques). In all they attempted  2 IUI  and 14 IVF  without any success.

The second attempt of IVF nearly cost her life. For the procedure of IVF, we need to retrieve the Oocyte (egg) from the ovaries, fertilise them with the husband’s sperm in a petridish (hence In-Vitro Fertilisation) and then transfer the embryo into the womb. To retrieve the egg, medications such as FSH, Clomiphene Citrate, etc.. are given to boost  the production of eggs and in very rare cases there would be a side effect of OHHS (Ovarian Hyper Stimulation). In Nina’s case it was a severe case of OHHS and protruded abdomen. Nina collapsed and was taken to the nearest hospital. She was put on a Ventilator in an Intensive Care Unit. Days passed even her parents lost all hope of her revival. After 21 days she came out of the ICU to an emotional reception of her husband Teddy and her parents. Teddy swore no more to children as he did not want to see her in this situation anymore and Nina decided to spend her life dedicated to her husband.

But as time passed by, she again started craving for a child and knowing her husband’s desire, Nina decided to try again and give a child to her husband, even at the cost of her life.

In the year 2008, against the doctor’s advice, Nina again started her journey through ART one after another without much side effect or for that matter any effect at all. She did successive 10 attempts unsuccessfully at various centers, fortunately without any issue of OHHS.

In 2009, Nina and Teddy came to India to take another attempt at IVF in Mumbai. Here again in the second attempt she showed symptoms of OHHS. Medications were given and symptoms subsided and she left back for the USA. One week later OHHS struck her seriously and this time it was worse than the first time – her lungs collapsed and she was put  on the ventilator, there was multiple organ failure and she was unconscious. It almost took a month to stabilize her conditions.

After she recovered she was found to be diabetic and pregnancy was ruled out. Through all this turmoil the couple stood together as per their vows – through thick and thin, through health and wealth and through all troubles and pleasures. Nina realized  that she can no longer bear a child and knowing how much her husband wanted a child,  advised him to get remarried. But her husband strongly declined and opposed any such thought.

By the year 2012 they came to know of the option of surrogacy. They came back to India and did their research in the Delhi and the Northern states, but was not happy and returned back to the states and kept searching for opportunities world over. In the year 2013, there was an International conference in Washington for which I had participated and it was here that I met this couple. We discussed many things and I was invited home for dinner. It was a palatial house in a big yard with a well groomed garden and all fineries of life, the only lacking was the heir – a progeny to carry on their legacy. They felt their life was meaningless and all their work futile. It was here that the discussions began and the plan for the process of surrogacy with a donor egg and Teddy’s sperm initiated. Within a short span of time, the plan became a reality  in our Hospital at Cochin.

36 weeks later there was an emotional scene when we handed over a beautiful baby girl to the loving couple who had waited for so long and had gone through so much of pain and trouble, nearly costing her life in an attempt to produce another – this was the culmination of their long cherished dream and the beginning of the true purpose of life. They just couldn’t take their eyes of the baby and the gratitude was overflowing. I myself felt so happy and felt as if I had fulfilled a part of my destiny.

Dr. Mani
Surrogacy specialist
GIFT IVF Centre (Director)

Saturday, 7 February 2015

The new cutting edge technique in IVF – “3-parent babies”

The recent developments in the UK can be landmark in the technology of IVF and a medical world first for Britain. Britain voted on Tuesday to become the first country to allow a pioneering "three-parent" IVF technique. After a furious debate, UK lawmakers vote overwhelmingly in favor of allowing the new IVF technique. But further vote must be held in the House of Lords before this become law.

Doctors say this technique will prevent some of the genetic incurable mitochondrial diseases. It is aimed to aid families with mitochondrial diseases, incurable conditions passed down the maternal line that affect around one in 6,500 children worldwide. The babies born from genetically modified embryos would have DNA from a mother, a father and a female donor.

Through this process, faulty mitochondria, which can cause inherited conditions such as fatal heart problems, liver failure, brain disorders, blindness and muscular dystrophy are removed and substituted with healthy mitochondrial DNA from the donor embryo. So the embryo will have biological parent’s nuclear DNA and the mitochondrial DNA from the donor embryo.

This technique will not change a child's physical characteristics like color, height or hair nor will it affect the child’s personality traits or intelligent levels. This procedure will make the baby healthy and prevent mitochondrial DNA from being passed on to the next generations.

Although this technology is path breaking to prevent mitochondrial diseases, it has raised several eyebrows. This law is vehemently opposed by the catholic and anglican church raising ethical issues.

The Bishops Conference of England and Wales said the Church opposed the destruction of human embryos as part of the process and hoped treatments for mitochondrial disease could be found.

"The human embryo is a new human life with potential; it should be respected and protected from the moment of conception and not used as disposable material," Bishop John Sherrington said in a statement.

"We have finally reached a milestone in giving women an invaluable choice, the choice to become a mother without fear of passing on a lifetime under the shadow of mitochondrial disease to their child," Robert Meadowcroft, chief executive of the Muscular Dystrophy Campaign, commented after the vote.

Lawmakers were given a free vote on the issue, and Prime Minister David Cameron's spokesman said the British leader had voted to support it, adding it was not "about playing God".

There are numerous supporters for 3 parent baby method, but critics are accusing that this is a step towards creating designer babies. We will have to wait and watch whether this will be passed as a law and what all implications this law is going to have.

Dr. Mani
Surrogacy specialist
GIFT IVF Centre (Director)

Wednesday, 4 February 2015

Testicular Feminisation Syndrome / Baby through surrogacy .

At Gift IVF, we are proud to have helped many intended parents realize their dream through IVF and Surrogacy. This is the unique story of a couple, whose aspiration to become parents were fulfilled at our clinic.  Well, this is not a story, it is a true happening however, the names and places have been changed to conceal the real identity.

Ram & Laxmi were childhood friends, they lived and studied in the same village and school. They used to walk along the same path near to the paddy fields, through the mango grooves to the school every day and soon they fell in love. Nobody took it seriously as everybody thought this was just another teenage infatuation. Years went by and these children grew to adolescence and into adulthood and their bond grew stronger with time. Ram grew to be a strong handsome young man and Laxmi turned to a beautiful curvaceous young lady. Little did they realize what was in waiting for them.

As Ram and Laxmi turned 27 and 25, it was time to get married as was the custom. There was no  obstacle, as the families knew each other and wedding went on smoothly with splendor and grandeur. Towards the end of the celebrations the young couple was led into their nuptial bedroom for their first night together with the traditional glass of milk. It was then that Ram came to a shocking realization that Laxmi was suffering from a disease called Testicular Feminisation Syndrome.

Testicular Feminisation Syndrome,  more appropriately called the complete Androgen insensitivity syndrome (AIS),  is a genetic disorder that makes XY (male) fetuses insensitive (unresponsive) to androgens (male hormones). When a baby is conceived the male gamete or sperm decides if the baby should be a boy or a girl. If the sperm  fertilizes the egg that has XY chromosome the baby is a boy and if it is with an XX chromosome the baby is a girl. It is in their adolescent stage the differentiation of males and females happen, till then boys and girls are very similar. In puberty they develop the Gonads (The primary sex organ) ovaries in girls and testicles in boys. The males, born with the XY Chromosome have testicles and starts to produce a hormone called the Androgen from the puberty stage which gives them the male characteristics – such as musculature, broad shoulders, facial hairs, bass voice etc… and the baby with XX Chromosome is born a girl and from puberty produces female hormones namely Estrogen and it is this hormone which gives women the feminine secondary sexual characters – curves, breasts, soft smooth skin, long hair, etc…

People with this syndrome cannot be diagnosed easily as they have no symptoms. They are born looking externally like normal girls, whereas geno typically they are males and are infertile. Socially they are considered as neither male nor female. Internally there is a short blind-pouch vagina and no uterus, fallopian tubes or ovaries. For some even the vaginal orifice is absent. There are testes in the abdomen or the inguinal canal which is usually mistaken for ovaries and during adolescence they produce high amount of Androgen but as the name of this syndrome signifies – the cells in the body are insensitive to Androgens and these get converted to Estrogen. Hence, a person with AIS will look externally like a beautiful woman, as in the case of Laxmi. As this is not a common condition and since discussing sex is considered a taboo in our culture, these conditions often go unnoticed and undiagnosed. The complete androgen insensitivity syndrome is usually detected only at puberty, when a girl should but does not begin to menstruate. Many of the girls diagnosed with this syndrome have no pubic or auxiliary (armpit) hair. They have luxuriant scalp hair without temporal (male-pattern) balding. As they do not have uterus or ovaries, they are sterile and cannot bear children.

Recorded descriptions of the effects of androgen insensitivity syndrome dates back to hundreds of years, although significant understanding of its underlying histopathology would not occur until the 1950s. This syndrome was formally identified in 1950. There are about 7,500 people affected with AIS in USA alone. The testicles in these patients produced a hormone that had a feminizing effect on the body, a phenomenon that is now understood to occur due to the inaction of androgens, and subsequent aromatization of testosterone into estrogen. In this condition, an organism is born with primary sex characteristics of one sex but develops the secondary sex characteristics that are different from what would be expected on the basis of the gonadal tissue (ovary or testis).

Coming back to our story, Laxmi had not disclosed this to anybody until now. Ram, who was truly in love with Laxmi, being a very kind hearted and understanding person, decided to face the consequences together. They visited various hospitals and clinics in India and in USA, where Ram was working. But they got the same reply everywhere that, Laxmi is a typical complete AIS candidate who did not even poses a vaginal orifice and they cannot have children. A vaginoplasty was done which improved their sex life, but they were not happy as they craved for a child. This was when they approached us. I was able to explain to them about surrogacy and availability of donor egg. This was a turning point in their life. Using Ram’s sperm and a donor egg, IVF was done and successfully the embryo was transferred to a surrogate mother. 36 weeks later a baby girl was born and their happiness cannot be described. Ram and Laxmi were shedding tears of happiness and she could not take her eyes off their baby and she was holding her close to her bosom for hours together.

These are the moments worth living for, to see the joy in the eyes of those who had lost all hopes of having their progeny. We are also content that we could aid in fulfilling their dreams, when they had no hope of completing their family. Now they have flown back to the USA, a happy and complete family.

All of us had a prayer on our lips “May they live happily ever after”……………………

Dr. Mani
Surrogacy Specialist
Director - GIFT IVF Centre

Tuesday, 3 February 2015


The NRI couple from USA  after failing  failed all attempts of ART finally came to us for surrogacy .
We did 8 attempts of ICSI over several months with donor egg, but as the sperms were of poor quality all the seven  attempts gave negative results .and finally in the eight attempt surrogacy was  successfully achieved.

The baby developed growth retardation from 28 weeks onward and we struggled to keep the baby safe, by various treatments and close surveillance.

We daily gave her heparin injections to increase blood circulation .She was also administered  protein as injections on drip daily along with a high protein diet combined with bed rest in the hospital .
Multivitamins along with IRON , Calcium and vitamin D were given from the starting.

 The heart beat was monitored every 2 hours with foetal movement chart . CTG was done 3 times daily, to check for foetal distress. Once in a week steroid injections were administered to enhance the lung maturity. When bilateral uterine artery notching was detected, we thought it may not go beyond 32 weeks , but we were determined to carry on .

The couple’s joy knew no bounds, when they held the precious baby.  As infertility specialists we often struggle to get results, although it is the problem with gametes  and we often repeat the procedure several times bearing the additional expenses , as they pay only for one procedure.

Medical tourism for surrogacy in kerala, India

Kerala, popularly known as the “God’s Own Country”  is  one of the most popular tourist destinations in India. It was rightly listed as one of the ten paradises of the world by National Geographic Traveler . You go to any prestigious hospital in any part of the world, you are sure to find an Indian doctor there and  some of the reputed  doctors worldwide are  from Kerala. The fact that the very same quality treatment is available at a substantially lower cost in Kerala is pulling medical tourists like magnets to this place. The low cost healthcare and high medical standard is boosting medical tourism in Kerala.
Advantages of medical treatment in Kerala are

1.      Reduced costs, highly competitive price package for treatments, surgeries and  Surrogacy
2.      Availability of latest medical technologies.
3.      Educated society, Foreigners  rarely face  language problems.
4.      Prospect  of combining tourism with treatment. Tourism industry is well developed with umpteen number
         of resorts and hotels
5.      Favorable policies of the government regarding the  medical visa regulations.
6.      Compliance on international quality standards.
7.      Govt  policies encourage medical tourism as many medical visa restrictions are removed.
8.      Low infant and child mortality rate.
9.      High life expectancy.
10.    Three international airports with good connectivity to all the major  cities of the world

11.     Pleasant weather and clean air with very less pollution, as there are  very  few industries

12.    Multi specialty Hospitals with international standards  
13.    One of the greenest states and growing hub for eco tourism
14.    Well qualified and well trained doctors and medical staff
15.   Clean and hygienic surroundings

Traditional treatments like Ayurvedic Therapies and massages are also immensely popular, attracting travelers from Europe, US, the Middle East and even countries like South Africa.

In India Commercial surrogacy is legal and it has become the haven for thousands of European, American and other overseas childless couples. Kerala is a favored destination for Fertility tourism or reproductive tourism. Numerous couples visit Kerala for fertility treatments because there are legal  regulations  in their home countries which doesn’t allow some types of fertility treatments. The high success rate, along with affordable cost and easy availability of surrogates has made Kerala a hot spot for couples from the developed industrialized nations, where the cost of fertility treatment is huge, about 5 to 6 times more . The remuneration paid to surrogates is also quite low compared to other countries, but they are provided medical, nutritional and overall health care through surrogacy agreements. IVF, ICSI,IUI and surrogacy are the  major  artificial reproductive techniques.

Lower treatment cost does not  mean that the  healthcare standards are also low. The  medical facilities & infrastructure in Kerala are at par with western and modern medical care in developed countries. India is the only place, which offers a comprehensive solution to all medical needs, with a  high level of service ,medical  facilities, and medical staff, without burning a hole in your pocket.

Surrogacy in Kerala

Surrogacy is becoming very popular in Kerala. Women who have difficulty in conceiving even after repeated treatments like IUI, laparoscopy, IVF and ICSI are opting for surrogacy .
In Surrogacy,the success is much higher than all other treatment combined, especially if donor egg is used.

At GiFT IVF center, Dr S. Mani along with Dr. Anitha Mani has been successfully carrying out Surrogacy for the last 7 years. Lately, numerous Malayalee couples settled abroad are coming for treatment, as we offer high standards in the services offered .

Treatment facilities include 9 month stay for surrogate mothers along with a  nutritious diet.
Foreign nationals are also equally interested in surrogacy in kerala, as they like to have a holiday along with the treatment and they have very high opinion about kerala to be very clean and hygienic, compared to other states of India.The low maternal and neonatal mortality along with the high rate of litteracyis an added attraction for  them.

The cost of surrogacy in Kerala is much less compared to the  western countries.

Antenatal care of surrogate mothers

Counselling and antenatal class 
Serial S.Bhcg
Weekly scan + NT(TVS) scan at 9 to 12 weeks 
Urine routine
Double Marker    test/Triple marker test
BP, wt weekly
NACE/ Materne T21 test- for fetal DNA Test if needed 
 Luteal support medicines, folic acid 



Regular Antenatal check up
Urine routine
20 weeks 3D/4D anomaly scan
24, 28 weeks-growth + Doppler scan
Iron and calcium supplements 
Protein supplements 

Regular Antenatal check up
Iron and calcium supplements 
Protein supplements 
Repeat FBS, RBS , Urine Routine
Growth + Doppler scan once in two week
CTG weekly once
Other tests as needed By clinical Judgment

Surrogate delivers baby for severe endometriosis patient

Today, the dreams of the 50 yr old couple came true , when the baby was handed over to them after Caesarian section of surrogate Mareeshwari.

They have been trying for a baby since the last 27 years. After 3 laparoscopic surgery for severe endometriosis and 10 failed IUI s and 2 failed IVF attempts, they had nearly given up hope.

A young smart lady working as journalist donated eggs. After IVF, the embryo was transferred to surrogate mother Mareeshwari , who stayed  in GIFT IVF center for 38 weeks .The couple could not believe their eyes and were overjoyed when they were handed over the beautiful baby girl.

Karthik waiting for mothers ( surrogate) delivery to start school

4 year old karthik is staying with mom in the hospital , waiting for her delivery soon.
She is a surrogate mother and the remuneration  that she receive is going to help her sent him to school . She could not sent him to nursery , as there was no income .

When he came with his mother to stay in hospital, he was a shy and a very thin boy. But now he is jumping around and playfully accompanies the nurses when they go on rounds to check on the  surrogate mothers ! 

legal documents required from hospital in surrogacy in India

All legal documents

1.     Letter from the hospital stating that you had undergone surrogacy treatment.

2.     Letter from the doctor regarding-

a.     IVF report

b.     Anti-natal check-ups – scan and blood report

c.     Delivery / Caesarean details

d.     Medical bills

e.     Agreement of financial terms

f.      Proof of payment to surrogate mother

g.     Surrogate agreement

h.     Consent of surrogate mother

i.      Affidavit of surrogate mother

j.      Copy of Baby’s birth certificate

Requirements for Exit Visa from FRRO (Foreigner Regional Registration Office)

1.       Surrogacy agreement
2.       Surrogate mother’s consent form
3.       Birth Certificate of the baby
4.       Citizenship of baby
5.       Flight tickets for the baby and the parents
6.       Residence proof in India
7.       Passport size photos as needed

Paper work required for the foreign national post delivery

1.       Birth Certificate

2.       DNA Report

3.       Passport

4.       Citizenship

5.       Exit Visa from FRRO Office

Requirements for Passport / Visa / Citizenship

6.       Marriage Certificate (Minimum 2 years of married life for surrogacy in India)

7.       Birth Certificate of both the parents

8.       Passports and Indian Medical Visa for both the parents

9.       Proof of address (Any Bills or Government documentation with the address mentioned on it)

10.     Bank Statement

11.     Pay slips / Tax return

12.     Some countries require police checks

13.     All legal documents, surrogacy contract, financial agreement, declaration of intent from the surrogate                    and affidavit from the surrogate’s husband, death certificate of late husband in case the surrogate                        mother is a widow.

14.    Completed application form from the respective embassy

15.    Photographs as required

16.    Completed application form for citizenship

All legal documents

1.       Letter from the hospital stating that you had undergone surrogacy treatment.

2.       Letter from the doctor regarding-

a.       IVF report

b.      Anti-natal check-ups – scan and blood report

c.       Delivery / Caesarean details

d.      Medical bills

e.      Agreement of financial terms

f.       Proof of payment to surrogate mother

g.      Surrogate agreement

h.      Consent of surrogate mother

i.       Affidavit of surrogate mother

j.       Copy of Baby’s birth certificate