Kenyan women are earning close to a million shillings to carry a pregnancy on behalf of other women who for medical reasons cannot conceive and deliver a baby on their own.
The current trend is seeing a practice that was only considered as solution for infertile women in the developed countries gain increased acceptance in the country at a faster rate than initially thought.
Couples who are unable to have a baby because the woman lacks the uterus-the womb where the baby develops- or has medical complications that make pregnancy impossible, are now commissioning other women to host the pregnancy on their behalf.
Those who carry the pregnancy for fee or free are known as the surrogate host and the owner of the baby as commissioning couple or genetic parents.
In the past three years, a record 20 couples who gone through Nairobi IVF Centre have commissioned other women to carry the pregnancy for them. Statistics from the clinic show that close to 30 babies have been born by surrogate hosts during that period. In 2011 alone, there were seven couples who sought the services of surrogate hosts.
Happening in country where surrogacy is treated with secrecy and reservations, this is a high number. It is also instructive to note that these statistics are just from one IVF clinic, which also happens to be one of the most successful in East and Central Africa having delivered 700 testtube babies by end of last year.
The clinic enjoys a success rate of 48 per cent, far above the 2011 global average of 36 per cent, according to the European Society of Human Reproductive and Embryology.
“It is just amazing and encouraging to see how couples who had been condemned not have babies agreeing to have someone else carry and give birth to their child, something that was unheard of in the recent past,” says Dr Joshua Noreh, the Director of Nairobi IVF Centre.
Every month, Dr Noreh’s clinic, which pioneered IVF in the country, gets at least five inquiries about surrogacy, with some women inquiring how they can be surrogate hosts at a fee.
Surrogacy is an arrangement in which a woman –the surrogate host-carries and delivers a child for another couple or person-genetic parent(s). The practice is used to help women who cannot carry a baby either due to lack of uterus, or medical complications, have their own genetic children.
This practice involves the retrieval of eggs from the woman who is unable to carry the baby and then fertilizing them in laboratory using the husbands or partners sperms.
The resulting embryo is then transferred into the surrogate host womb to conceive and carry the pregnancy to term. Once the child is delivered, the surrogate host hands it over to the commissioning couple guided by the terms of contract signed between the two parties.
The swelling interest in surrogacy in the country has been occasioned by the number of women who have a faulty uterus, no uterus at all, or are experiencing serious medical complications.
At the Nairobi IVF, close to 30 women who have consulted the clinic in the past three years did not have a uterus or had a dysfunctional one. This effectively meant they could not carry a baby and had to rely on a surrogacy host to do so.
“While these women qualify to use surrogate hosts to get their own babies, many have financial challenges to afford the procedure,” says Dr Olegs Tuc’s, a clinical embryologist.
To benefit from surrogacy arrangement, the couple can spend dearly or modestly, depending on whether they are paying for it or not. If payment is done, the surrogate host negotiates with the commissioning couple of how much she will be paid. Once they have agreed, they present themselves to the doctor to start treatment.
According to Dr Noreh, the least amount they have seen a surrogate host being paid on cases they have dealt with is Sh 600,000, but in some cases is even over one million shillings.
“As doctors or clinic, we play no role in such negotiations. Ours is to offer treatment once the two have agreed on the fee. But we usually advice our patients to get relatives or friends who may agree to do it for free,” says Dr Noreh.
He adds that they have handled surrogate cases where the host, who is either a sister or friend to the commissioning parents, has agreed to carry the pregnancy for free. Besides the fees, in cases where it is paid, the commissioning couple also meets the rent and substance costs of the surrogate host.
Judith Ogeto, who was a surrogate host two years ago, says the commissioning parents used to give her Sh 40,000 every month for rent and substance purposes. They also paid her Sh 650,000 for carrying the pregnancy for nine months.
The commissioning couple further pays Sh 300,000 IVF fees and meets the hospital costs where the surrogate host will deliver.
In total, commissioning parents require a minimum of Sh 1.5 million to manage a surrogacy arrangement. In addition to finances, there are other obstacles the commissioning couples have to overcome. For increased chances of success, the surrogate host has to be someone with children.
At Nairobi IVF Centre, married women and single mothers are the main category used as surrogate hosts. Problems however arise in cases where the woman is married. Her husband has to be involved from the onset of the negotiations.
“He is informed that the wife is going to carry a baby that is not theirs and the strict conditions he has to abide with before and during that pregnancy,” says Dr Noreh.
Some of the conditions include giving up the baby immediately is born, avoiding sex for the first two months from the time the surrogate host gets the embryo, and not engaging in anything that may endanger the life and health of the baby.
Surrogate host or her husband is not allowed to make any future claims on the baby. The host further undertakes to hand over the baby immediately after delivery to avoid any bonding to take place.
To ensure the surrogate host and the husband abide by these conditions, a contract is prepared and signed by the surrogate host and husband and the commissioning parents.
While the cost of surrogacy arrangement is high, the number of couples who need the service, but cannot afford it, is rising.
Women who qualify for surrogacy are those without a uterus either because they born without it or it was removed due other medical conditions. Cancer of the uterus or other illness may result in its removal.
At the Nairobi IVF Centre, 9 women who were seen in the past one year did not have a uterus. One of them was born without it. The latter case happens due chromosomal abnormality where a woman inherits only one of the X chromosomes instead of two.
“The other missing X is in most case manifested in the lack of uterus or other abnormalities,” says Dr Olegs Tucs, a clinical embryologists working in the country.
For other women, a dysfunctional uterus caused by fibroids which are difficult to treat or other diseases, makes it difficult for them to carry a pregnancy. But there are also cases where women with normal uterus may have to rely on surrogacy to have children.
A woman with a heart disease or other medical condition which might be complicated by the pregnancy leading to death, also qualifies for surrogacy. But Dr Noreh warns that surrogacy is not treatment of convenience especially for those women who might opt for it because they fear carrying a pregnancy.
Although there have been questions that the surrogate host may influence the behaviours and character of the child, Dr Noreh says this is not true. “There is nothing transferable to the foetus from the surrogate host. Only nutrition and oxygen is what the host conveys to the baby. The rest is the genetic material of the commission parents.”
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