Millie Mitchell and Hannah Wait, STP Reproductive Science Trainees, Salisbury Fertility Centre and Newcastle Fertility Centre
Five life changing weeks, eight In vitro fertilisation (IVF) clinics, five internal flights, three rail journeys, two Hindu festivals, one monsoon season thunderstorm and unimaginable hospitality and kindness! Our elective to India was a fully submersive experience through which we not only gained unique scientific knowledge but experienced ethical and cultural circumstances which would simply not be possible in the UK.
For those not from reproductive sciences, IVF in the UK is highly regulated by the Human Fertilisation and Embryology Authority (HFEA); our governing body. The governing of assisted conception in the UK, unlike many other countries, including developed western ones, is detailed in law (HFE Act 1990). This ensures appropriate care and consideration is applied to the treatment we give our patients, and ensures techniques are critically evaluated and validated before clinical use. This can impact the type of treatments patients receive and how frequently patients with certain needs come through our departments. For example, surrogacy treatment is rare in the UK due to the difficultly in negotiating the legal requirements as well as finding an altruistic surrogate.
Elective rotation in India 2
For our elective we decided to witness clinical circumstances which are rare in the UK – and where else better to choose than India. If you’re an avid news reader you’ll have seen that fertility treatment in India has made headlines in the last few years.From day one of our elective every embryologist and doctor was very open and honest. The techniques used in the laboratory are very similar to those in the UK, but it is the surrounding regulation and culture which differ so drastically. We learnt a great deal about the legal aspects of being a surrogate; egg or sperm donor in India. All egg and sperm donors are anonymous, unlike the UK where at 18 a donor conceived child can find out the name of the egg or sperm provider. Therefore there is an abundance of donated gametes in India. On the other hand, the UK is experiencing a shortage of donors as people potentially no longer want to come for donation with the prospect of not being anonymous. In India commercial surrogacy with financial payment of the surrogate is the norm. However, sourcing a surrogate in the UK can be hard to organise and arrange: the couple along with their surrogate must attend counselling appointments; fit certain medical criteria and a couple cannot pay a surrogate financially. These are potentially very difficult hurdles for couples to contend with.
We were able to spend time with Western couples who had travelled to India for treatment and hear about their journeys. With years of unsuccessful treatment in their home countries or illness preventing carrying their own child these poignant stories truly shone a light on how commercial surrogacy benefits these people. Quite amazing was the time we spent visiting a ‘surrogacy house’. These are buildings specifically used to house pregnant surrogates for nine months. There are as many as 25 surrogates in one house – and this particular IVF unit had four separate houses. As imagined, the surrogates often had to keep this a secret as they can be ostracised from their communities once they return home. As a surrogate the average pay, for delivering a live birth, is £3,500 and with the normal household income at just £40 a month, this is a very attractive thing to do – particularly if you want your children to be sent to a good (but costly) school or need to build a home. During the nine months spent in the surrogacy houses the women learn English language skills, embroidery and sewing so that they can start a business or produce products when they leave. Our five weeks in India was an ethically and emotionally difficult experience. We met couples absolutely desperate for a baby, and surrogates desperate for funds to support their own children.
Based upon our experience, we highly suggest using the time you have on the elective to truly push yourself. Our elective became an experience which was so much more than the learning objectives we set ourselves, our scientific practice will forever be influenced by what we experienced – and we guess that’s really what the NSHCS are aiming for when they made it part of our training. This experience will change our practice for the entirety of our careers. Start planning early, particularly if you are planning something elaborate or at multiple centres. Don’t be afraid to ask – you might just hear a yes! Finally, embrace it and if you ever get the chance – go to India.