Surrogacy Practical steps to avail Surrogacy

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• Former Asst. Professor PGIMER, Chandigarh.
• Former fellow University of Washington, Seattle
  RSA Kansas city, USA.
• Pioneer in ART in Chandigarh. Over 22 years
  experience in IVF. First To Start IVF, ICSI,
  Vitrification, And PGT In Chandigarh And Northern
  Region
• Vice President Of Indian Fertility Society Year
  2016-18
• Instrumental In Starting The IFS ART Diploma
  Course In 2014(first Batch In 2015)
• Section Editor (Clinical ART) Journal Fertility
  Science and Research
• Organizing Secretary on National Conferences
  ISAR 2007, Fertivision 2008, Fertiprotect
  2019, Organizing Chairperson LOC Fertivision
  2020, Vive chair North Zone, Yuva FOGSI 2020
• Member of ASRM, ESHRE, FOGSI, ISAR, IFS, IMA,
  ISOPRAB, FPS(I), IAGE
• Founder Secretary for Greater Chandigarh Chapter
  for IFS.
• Centre won the best integrated IVF team 2021,
  Best Ivf Centre 2020 and ICON of year 2019 of
  Northern Region By Et Health World 2020.
• Madhurima Editors Choice Bhaskar Women Of Year
  Award 2011
• National 35, International 15 And Book Chapters
  10

Dr Umesh Jindal Director Jindal IVF, Chandigarh.
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SurrogacyPractical steps to avail Surrogacy

• Umesh Jindal
• Jindal IVF and Sant memorial Nursing Home
  Chandigarh
• Fertivision 23

Disclaimer Most of the steps which are mentioned
are based on my personal interpretation and
sequence building based on various available
documents. The actual process once streamlined
may be little different or not as cumbersome as
it seems today.
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Important Gazetted documents

• Three are important
• The Surrogacy Regulation Act 2021
• The Surrogacy Rules 21.6.2022
• Notification 14th March 23 regarding both gametes
• Some smaller notifications have come from time to
  time
• Surrogacy regulations March never published in
  Gazette. It had all the forms required

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The Official Hierarchy
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Steps to Avail Surrogacy

• Centre registered
• Check basic requirements
• Eligibility Requirements - couple/woman,
  surrogate
• Fitness, medical and psychological- -
  couple/woman, surrogate and surrogates child
  health
• Documents
• Consent between couple and surrogate
• Medical board clearance
• Insurance
• Court order of parentage and affidavit
• From AA Certificate for Essentiality for couple
  and eligibility for surrogate
• Application to state board
• Permission from state board
• Start case

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Home work at Surrogacy centre
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Step1 Centre Registered

• Apply to national registry and copy to AA
• Fee of Rs2,00,000/- for three years
• Staff , equipment and other requirements as per
  ART/Surrogacy Act
• Staff can be common
• No need to run as separate entity as ART Bank
• Certificate of registration

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Step2 Basic Requirements

• Intending Couple / woman has one of the
  indications necessitating gestational surrogacy
• The surrogate is arranged by the Couple/woman
  Surrogacy Act section 4. (iii) (b) (II)
• Willing for altruistic surrogacy (in which no
  charges, expenses, fees, remuneration or monetary
  incentive of whatever nature, except the medical
  expenses and such other prescribed expenses
  incurred on surrogate mother and the insurance
  coverage for the surrogate mother, are given to
  the surrogate mother or her dependents or her
  representative)

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3.a Check eligibility of couple

• (As per clause 4.iii.c, surrogacy Act 2021,
• Couple is of Indian Origin (Both husband (male)
  and wife (female) are Overseas Citizens of India
  cardholders in accordance Acts/Rules/Instructions/
  Guidelines being followed by the Ministry of Home
  Affairs, subject to fulfilment of various
  criteria as per the Surrogacy (Regulation) Act
• Couple is married
• Female age is between 23 50 Male age is
  between 26 55 on the day of registration ( keep
  adequate margin of 5-6 months as it may take that
  long)
• Couple do not have any surviving child
  biologically/ through adoption / through
  surrogacy earlier or have a child who is mentally
  or physically challenged or suffers from life
  threatening disorder or fatal illness with no
  permanent cure (affidavit for infertility/
  disability for existing children)

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3.b Eligibility Requirement Single Woman

• (As per clause 4.iii.c, surrogacy Act 2021, )
• Is of Indian origin (Aadhar, address
  proof/POI/OCI card)
• She is a widow/ divorcee (ever married) Need
  proof of marriage, divorce, death of husband
• Is between the age of 35 45 years ( certificate
  of age)
• Can provide her own eggs
• Woman does not have any surviving child
  biologically/ through adoption / through
  surrogacy earlier or have a child who is mentally
  or physically challenged or suffers from life
  threatening disorder or fatal illness with no
  permanent cure ((affidavit for infertility/
  disability for existing children)

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3.C Eligibility based on Medical
IndicationSurrogacy rules 21.6.22 item 17

• She has no uterus or missing uterus or abnormal
  uterus (like hypoplastic uterus or intrauterine
  adhesions or thin endometrium or small
  uni-cornuate uterus, T-shaped uterus) or if the
  uterus is surgically removed due to any medical
  conditions such as gynecological cancer.
• Intended parent or woman who has repeatedly
  failed to conceive after multiple In vitro
  fertilization or Intracytoplasmic sperm injection
  attempts. (Recurrent implantation failure)
• Multiple pregnancy losses resulting from an
  unexplained medical reason, unexplained graft
  rejection due to exaggerated immune response.
• Any illness that makes it impossible for woman to
  carry a pregnancy to viability or pregnancy that
  is life threatening.
• (Proof). Previous test reports and treatment to
  make sure embryo can be formed with Both gametes
  from the intending couple and for single woman,
  ovum has to be the womans

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3.D Eligibility Surrogate Mother (As per
clause 4.iii.b, surrogacy Act 2021)

1. Should be willing to be surrogate mother without
   force / coercion (affidavit for willingness)
2. Willing for altruistic surrogacy (affidavit for
   willingness for no payment) (contract for
   financial arrangement as per consent form)
3. Ever married (marriage/divorce/husbands death
   certificate)
4. Has a child of her own 3 years old ( birth
   certificate of living child/affidavit)
5. Between 25 35 years of age on the day of
   implantation (age proof) Adequate margin of 6
   months to give time for board permission to be
   completed and insurance to be effective)
6. Has not been a surrogate mother before and does
   not have three failed attempts of surrogacy
   before) ( Affidavit to the effect)
7. Will not be providing her own gametes for the
   surrogacy ( affidavit for the same)

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4.aMedical Fitness

• Commissioning Couple/woman

• Surrogate

• General medical fitness for both partners/woman
  (history, exam, Inv)
• Gynae exam
• Medical proof of Indication and availability of
  self gametes
• Psychological fitness proof
• Proof of no living child/mentally or physically
  challenged child

• General medical fitness for Surrogate(history,
  exam, Inv)
• Gynae exam and fitness for pregnancy
• Consent for willingness
• Psychological fitness proof
• Proof of healthy living child of at least 3 years

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5.A documentsTable 1 Basic documents
ITEM Valid documents
Certificate of PIO Passport, OCI/PIO card Aadhar residence proof
Residence proof Aadhar residence proof
Marriage certificate Marriage certificate/Other govt document proving/ marital status Affidavit
Single ever married woman Marriage, divorce/ death of husband
Age husband 26-55 (keep at least 6 months) Date of birth/ aadhar/matriculation/ passport/other equivalent
Age wife 25-50(keep at least 6 months) Date of birth/ aadhar/matriculation/ passport/other equivalent
Single woman 35-45 years(keep at least 6 months for completion of formalities) Date of birth/ aadhar/matriculation/ passport/other equivalent
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5.b Documents from Surrogacy clinic couple/woman
For eligibility of couple/woman and advise for surrogacy Prescription slip copy
Certificate/affidavit that intending couple/woman does not have a child(biologically/adopted/ earlier surrogacy) Medical certificate of infertility/BOH
Certificate that intending couple/woman has a child is mentally or physically challenged or suffers from life threatening disorder or fatal illness with no permanent cure Summary of Medical records and disability certificate from competent authority
Medical summary to indicate indication and any other medical problem Detailed summary of previous treatments and outcome
Reports to prove that gamete/s shall belong to couple/woman Semen report/AMH and USG
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5.c Documents from Surrogacy clinic surrogate
CERTIFICATE AND PSYCHOLOGICAL FITNESS for surrogacy and surrogacy procedures from a registered medical practitioner Psychologists certificate (Board )
Counseling by an independent counselor Written informed counseling sheet
Medical fitness for surrogacy Medical summary including fresh tests
consent consent
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6.Consent and agreement between surrogate and
Couple/woman
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Application to medical Board
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7. Medical Board clearance

• Apply to AA with all above documents (no official
  format available)
• Referred to medical board
• Get clearance ( No official format available)
• For both commissioning couple/woman and surrogate

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The Ball is in Judicial Court
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8Insurance Cover

• NOTIFICATION New Delhi, the 21st June, 2022
• 5. Insurance coverage.- (1) The intending woman
  or couple shall purchase a general health
  insurance coverage in favour of surrogate mother
  for a period of thirty six months from an
  insurance company or an agent recognized by the
  Insurance Regulatory and development Authority
  established under the provisions of the Insurance
  Regulatory and Development Authority Act, (41 of
  1999) for an amount which is sufficient enough to
  cover all expenses for all complications arising
  out of pregnancy and also covering post- partum
  delivery complications.
• (2) The intending couple/woman shall sign an
  affidavit to be sworn before a Metropolitan
  Magistrate or a Judicial Magistrate of the
  first-class giving guarantee as per clause (q) of
  sub section (1) of section 2 of the Surrogacy
  (Regulation) Act, (47 of 2021).

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8Insurance Cover
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9.A Two more contracts before court order

• Separate Financial agreement between couple/woman
  and surrogate
• Consent and agreement between surrogate and
  Guarantor to accept baby in case required

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9.bCourt Order

• 3. Order concerning parentage and custody of the
  child from court of the magistrate of the first
  class or an Executive Magistrate or Public
  Notary, which shall be the birth affidavit after
  the surrogate child is born. Order to cover
  parentage of child in case of separation of
  couple during surrogacy or to survivor in case of
  death of one of them during pregnancy, or in case
  of death of both of them
• ( needs to be drafted by a lawyer. No format
  available and no guideline which documents are to
  be provided)

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9c Important points to be included in affidavit
FORM 2 See rule 7
Parentage and custody of the child
Order concerning parentage and custody of the child for guarantor also if required (item 20)
The intending couple or intending woman shall not abandon the child, born out of a surrogacy procedure, whether within India or outside, for any reason whatsoever, including but not restricted to, any genetic defect, birth defect, any other medical condition, the defects developing subsequently, sex of the child or conception of more than one baby and the like
A child born out of surrogacy procedure, shall be deemed to be a biological child of the intending couple or intending woman and the said child shall be entitled to all the rights and privileges available to a natural child under any law for time being in force.
Has not been a surrogate mother before and does not have three failed attempts of surrogacy before Will not be providing her own gametes for the surrogacy
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Final Clearances
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10 From AA Certificate for Essentiality for
couple and eligibility for surrogate

• Application to the AA for certificate of
  Essentiality for couple and eligibility for
  surrogate
• Required- medical certificates, insurance, court
  order
• No formats are available

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11 Final check list for application to
State/national board for certificate of
recommendation 

• Application duly filled
• Proof of marriage / marriage Certificate (if
  applicable)
• Certificate of Age/Birth Certificate / 10th
  Certificate / or Equivalent
• Certificate of Medical Indication obtained from
  District Medical Board
• Medical certificate for physically / mentally
  challenged child from District Medical Board (If
  applicable)
• Certificate of essentiality for Couple / Woman
  obtained from appropriate authority
• Order of Parentage from court
• Insurance cover for surrogate
• Certificate of Medical Psychological fitness
  (Surrogate Mother)
• Certificate of essentiality of intending couple /
  intending woman obtained from appropriate
  authority
• Certificate of eligibility of Surrogate Mother
  obtained from appropriate authority  

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12Certificate of recommendation from the board

• No formats are available

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The procedure
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13. Start case

• Director of surrogacy clinic to verify the
  following, before initiating surrogacy treatment
  and document verification
• Certificate of essentiality
• Certificate of eligibility of surrogate mother
• Certificate of eligibility of intending couple /
  woman
• Approval for availing surrogacy from state ART
  board

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Important Points

• One embryo to be transferred in the uterus of a
  surrogate mother during a treatment cycle, only
  in special circumstances up to three embryos may
  be transferred. (As per Section 9, Surrogacy
  Act 2021, )
• The number of attempts of any surrogacy procedure
  on the surrogate mother shall not be more than
  three times. (As per clause 4.iii.b.III
  Surrogacy Act 2021,)
• Surrogate Mother can withdraw consent any time
  before ET. (As per clause 6.2 Surrogacy Act
  2021,) Consent from for withdrawal to be signed
• MTP can be done on Surrogate Mothers Consent as
  per Provisions of MTP act. Consent for MTP to be
  taken. Permission from the AA to be taken.(As per
  clause 3.vi Surrogacy Act 2021,)
• Records for 25 years

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Conclusion
surrogate
Commissioning Couple