Outsourcing babies

WHAT IS a family? Bayit Yehudi MK Avi Wortzman, formerly deputy minister of education, had the answer. “A family is a father, mother and children, and not two fathers and a child,” he said in the Knesset, protesting a parliamentary decision to grant tax credits to same-sex parents. Medical technology has expanded Wortzman's definition of family, thanks to in vitro fertilization (IVF) and surrogate mothers. The first “test tube baby,” Louise Brown, was born in England in 1978. Since then, it is estimated that five million such babies have been born worldwide, nearly a million of them in the United States. As many as 10,000 IVF pregnancies occur each year in Israel, and the number is rising. In the Bible, our foremothers Sarah, Rebecca and Rachel were all barren for years and suffered. Today, they would probably benefit from IVF, which has enabled surrogacy. Female ova can be fertilized with semen and implanted in a host mother's womb. This has made it possible for gay couples to have children, using the semen of one partner together with donor eggs and surrogate rent-a-womb moms. The first such surrogate pregnancy occurred 30 years ago. In March 1996, Israel became the first country to formally legalize surrogacy under the “Embryo Carrying Agreements Law.” The law required every surrogacy contract to be approved by the state. Since 2014, same-sex couples can sign such an agreement, but the surrogacy itself cannot be done for them in Israel. More than any other technology, surrogacy is a fascinating mixture of science, politics, religion and, of course, money, sparking a lively public debate. In the end, surrogacy is about couples and their often desperate quest to share the joy of becoming parents, fathers and mothers ‒ a blessing sometimes taken for granted by conventional families. This is the story of a gay Israeli couple, Tal and Amir, and their saga of becoming parents of three surrogate babies, born in Kathmandu just before the Nepal earthquake on April 25. The story, in full, is recounted in a podcast by Israel Story staffers Maya Kosover and Yochai Maital, my son, together with RadioLab. Israel Story is an Israeli podcast, recounting interesting and unusual human-interest stories, founded by Mishy Harman, which is broadcast on Army Radio on Saturday evenings and is now launching a new season. RadioLab is an American podcast, broadcast on some 500 public radio stations. Its head producer Jad Abumrad, co-host Robert Krulwich and producer Molly Webster, who reported the story, joined Kosovar and Maital in researching Tal and Amir's saga across several continents. We're going to be parents of three! The story begins in Jaffa, at a party. Kosover is there. So are Tal and Amir, a newly married homosexual couple. Kosover knows Tal, since her parents are hearing disabled and Tal is well-known in the deaf community because he signs for the deaf on television news. Amir, his partner, is a psychologist who works with autistic children. Tal thinks, “I'm going to be a parent, a father of three! My God, maybe this is my last party, I'm going to be a parent. Father of three!” Tal and Amir. Three babies. Four countries. Two fathers. Two surrogate moms. And a devastating earthquake. The surrogacy process: Four countries Maital explains there are two options today for gay couples to have families. There used to be three, but adopting children from Third World countries is no longer an option. In the past few years, these countries one by one have banned adoption by gay couples as conservative politics combine with homophobia. The second option is becoming popular in Israel, the so-called new family. Gay couples get together with a woman who has no partner and agree to joint parenting. The mother lives separately. It is a bit like divorced parents, Maital explains. You sign a contract, everything is specified in it. Tal and Amir went to the coparenting woman with whom they had met and asked if she could commit to bring two children into the world, one with Tal's sperm and one with Amir's? She said no! A year went by and Tal and Amir decide their best option is the third choice, surrogacy – sperm from a gay man fertilizes ova from a woman donor; the fertilized egg or eggs are implanted in the womb of a second woman, who carries them for pay during pregnancy and gives birth. The baby or babies are then delivered to the parents. Surrogacy is illegal for gay couples in Israel, but legal for straight couples. There is a large demand for it among gays as there are many gay couples in Israel, and many want children of their own. Companies have sprung up offering international brokering of sperm, eggs and ovaries. “Baby outsourcing,” Abumrad calls it. One of those companies is Israel-based Lotus Surrogacy (“Allow us to accompany you on your special journey to parenthood”) founded by Dana Magdassi. Tal and Amir hire Lotus for their project and begin to work with Magdassi. The business of surrogacy There are large conferences where prospective gay parents gather and hear pitches from companies. At the time, surrogacy existed in Mexico, Thailand, Nepal and the US. The cost varied from about $38,000 in Mexico to $150,000 in the US. Tal and Amir go to two such conferences. After the second one, they take out a calculator and begin to think, how can we do it? Money. We will have to pay a lot of people. And, even then, we are not guaranteed a baby. You buy a process, not a baby, Tal observes. He knows of a friend who tried it five times, and still no baby. Global surrogacy politics are fluid. In 2013, India basically outlawed surrogacy for gay couples. So did Nepal and Ukraine. But there is a loophole. Indian women can be surrogates in Nepal. Hence, agents in northern India find Indian women, mostly in poor villages, and move them to Nepal where they are impregnated with donor eggs and deliver babies in local hospitals and clinics. The first Israeli surrogate baby is born in Nepal in January 2014. Many more follow. But is surrogacy moral? Tal and Amir wrestle with ethical dilemmas. Amir says, this is what we need to do to be a father. For Tal it is hard. He asks, is it moral to do this? To use another woman to give me a present like that? To use other people for my own benefit? I know she will never see this baby again. Tal and Amir argue back and forth. One argument wins the day. If we're going to do it, we'll do it with Lotus, they decide. They believe that Lotus pays surrogates $12,000. For a rural woman in India, that is a massive life-changing sum. Tal says, with it she can buy a house, pay dowries for her daughters, send her kids to college. So, it is not exploitative. Kosover explains that the egg donor in this case is a woman from the Ukraine. Maital notes that most egg donors are from Eastern Europe, because they are “white” and “cheap.” The process of choosing an egg donor is a bit like the Jewish dating website JDate. Amir explains, you choose the egg donor from a website; the most straight act I did in a long time was picking out a lady [egg donor] from a set of photos. The criteria? Well, height! It's easy to measure. Then, eyes. The woman we chose has big eyes, Amir explains. Light brown hair, a nice nose. It was very uncomfortable to choose the donor, Tal says. It's like… genetic selection. Or eugenics! Tal and Amir tell Lotus: We would like to rent two wombs, one for each of our sperm, two surrogate mothers. Lotus says, fine, it will cost $50,000 to $60,000 for each pregnancy. Tal and Amir provide sperm in little cups. It is frozen, and sent to Nepal to a hospital. The Ukrainian egg donors are flown to Nepal, and their eggs are removed and frozen. The surrogate Indian mothers are moved to Nepal, the embryos are implanted, they become pregnant. Four countries, for one baby. Within a few months, both surrogate mothers of Tal and Amir are pregnant. One carries twins, because in IVF sometimes more than one fertilized ovum is implanted to ensure at least one “takes.” Ultrasound films are taken of the three babies and sent to Israel. Tal says, I look at the pictures on my cell phone, all the time. But there is not much for me to do. Not much happened. That was about to change dramatically. The twins are born! At 6 a.m., Magdassi, from Lotus, calls Tal and Amir. Amir answers. Tal hears him say, are they OK? But, it's too early, eight weeks too early! Twins were born. Amir says, I was crying. These are Tal's babies. Tal is on a plane the next day and gets to the hospital in Kathmandu. I was shocked, Tal recounts. Because one baby, we named him Gil, weighs only 3.8 pounds (1.73 kg), and the other, we called him Yuval, only 4.8 pounds (2.2 kg). I was scared to touch them, Tal recounts. I expected them to stay in the hospital for a month. But the Nepali nurses say, no, they are going home tomorrow. I don't have enough time to think. I will need to be alone with them, but I have never taken care of a baby. I say to the nurses, teach me how to feed them! And, after three days, I take them home to an apartment in Kathmandu. Where was the surrogate mother? She was in the hospital, after delivering prematurely by Caesarean. Is she OK? Tal asks. Does she need anything? You cannot see her until she signs all the papers, giving up her maternal rights, Tal is told, then you can see her. He knows that if she does not want to sign, we can lose the baby. This has happened more than once in the US. ISRAEL, INDIA and Nepal must all recognize that Tal and Amir are the legal parents. Tal is terrified. He knows of a case in Thailand where a surrogate mother changed her mind and wanted to keep the baby when she found out the prospective parents were gay. Amir is in Tel Aviv. Tal is in Kathmandu. Two weeks go by. Tal calls Amir. Mazal tov! You're a dad. Your surrogate gave birth to a baby. A day later, Amir flies to Kathmandu to join Tal. For the next month, they live in Nepal in a rented apartment with their three babies, waiting for paperwork to be done. Surrogates have to sign. The babies have no nationality so they are illegal in Nepal. A DNA test must be done to establish parentage, verified in Israel. Passports are needed for the babies, and visas ‒ all of that means many trips to the Israeli Embassy. Disaster strikes: The Kathmandu earthquake The next day: Saturday, April 25. Death and destruction in an earthquake just before noon. Thousands are dead in Nepal's most destructive quake in 80 years, registering 7.8 on the Richter scale. The earthquake kills over 10,000 people and injures more than 23,000. It occurs at 11:56 a.m., and is the worst natural disaster to strike Nepal since the 1934 Nepal- Bihar earthquake. There are numerous aftershocks. Kosover gets a distraught voicemail from her friend Tal. He says, we saved the babies! We ran into the street half-naked. I am trembling! He is crying. Then Kosover loses the cell phone connection. Some 12 hours go by with no word from Tal and Amir. I did not know if they were alive or dead, she recalls. Amir recalls later that Tal grabbed his cell phone, we grabbed the babies and we ran barefoot out of the apartment and down into the street, where we ran into Gil [a friend and surrogate parent] who had four babies, and another couple who had two, nine babies in the street in all… Tal is wearing only his shorts. We stand on a pile of rubble. We see someone with a badge. He is from the American Embassy. We are Israeli, we say. We have nine babies. We need help. There is no food. He directs us to the Israeli Embassy. Tal spots a TV news camera Maital relates that the Israel embassy went into emergency mode, distributing blankets, putting up tents… And, inevitably, the news reporters came. Tal knows the media. With phones down, he realizes he has no way to communicate back home that he is alive. So he pushes his way in front of a TV camera and starts using sign language! Kosover gets a call from Tel Aviv. They are on the TV news now! she is told. We see Tal speaking to his parents in sign language. They are alive! They are waiting for rescue. The scene is surreal. Producer Webster says, you realize, all of a sudden, there is a pipeline of babies moving from Nepal to Israel. Heart-wrenching images splash across Israeli TV screens. And, for the first time, surrogacy is discussed in depth in the media. There is a huge debate: Is it OK to rent a womb from a woman? Is it immoral? But gay couples have no other choice. What should be done now with babies and surrogates in the earthquake? There are surrogate mothers waiting to give birth. We need to bring them to Israel! But legally, it cannot be done. Maital explains what happens next. Israel sends search and rescue teams and a medical aid team to Kathmandu. All the babies and their foster parents are quickly put on a plane and brought to Israel. There is a “parade of newborns” at Ben-Gurion Airport. Just over three days after the earthquake, an Israeli Boeing 747 lands on Tuesday afternoon, April 28, with 229 passengers, including 15 surrogate babies all born within the past six weeks in Nepal, and including Tal and Amir and their three babies. The TV images spark fierce debate about surrogacy in Israel. The daily Haaretz asks why the surrogate moms were left behind. Exploitation? RadioLab follows up. Using reporters Nilanjana Bhowmick in India and Bhrikuti Rai in Nepal, it is discovered that some surrogate mothers get only $3,000, rather than $12,000. Where does the rest of the money go? Simple. I call it the tomato syndrome. Bad weather recently caused tomato prices in Jerusalem's Mahane Yehuda market to soar to NIS 20 ($5) per kilo in October. Wholesale prices were NIS 12.50 or so. But growers got only a quarter of that sum. The middleman gap between grower and supermarket is huge. When the surrogate process requires many signatures, approval and red tape, in Third World countries, many palms must be greased. There is no alternative. Like tomatoes, all the middlemen profit. But that $3,000 is still life-changing for the Indian village woman. Tal and Amir take comfort in this. “Be fruitful and multiply” is the first Biblical commandment out of 613. Observant Jews attach great importance to it. For instance, Chabad's Lubavitcher Rebbe quoted his predecessor, who said “a person should actually give up his or her whole existence in order to have children.” He, himself, died childless. A Chabad website cites a halakhic decision that in vitro fertilization may be permitted, but all physical components (sperm, eggs, serums, uterus, related medications, etc.) must be only of the (halakhically married) couple themselves. This bans surrogacy by, say, Indian mothers, and naturally, for gay couples. By Jewish law, a baby born of Jewish sperm and egg to a non-Jewish host mother is “part Jewish and part non-Jewish” and hence, by some rabbis, must go through conversion. In contrast, the Catholic Church's Catechism (doctrinal manual) states that “techniques that entail the dissociation of husband and wife, by the intrusion of a person other than the couple (donation of sperm or ovum, surrogate uteruses) are gravely immoral.” The business aspect of surrogacy is straightforward. There is huge demand for it from gay couples, as well as straight couples. There is significant supply, on the part of poor women from villages in Third World countries. For them, even $3,000 is life-changing, enabling them to build houses and educate their children, when no other such option exists. When both sides of a market, supply and demand, exist, the service or product itself will exist legally, or, if it is banned, deep underground. It is far better to regulate it than drive it underground. And the option of parenting should be available for all. In countries sensitive to human rights, gay couples have won the right to marry. It appears that they now will have to fight for the right to become parents in their home countries. Some experts believe that surrogacy for gay couples will soon be illegal in most parts of the world. Maital informs me that “surrogacy has now been made illegal in both Nepal and Thailand, and is hanging by a thread in Mexico.” As a result, the US may soon be one of the few countries in the world where surrogacy is legal, safe and controlled for gay clients. The problem is that the US is also the country where surrogacy is the most expensive, prohibitively so for many couples – though birth in America conveys a US passport and the chance of a green card later for the parents. Surrogacy is just one more instance where science and technology race far ahead of our human ability to adapt and evolve our ethical and religious beliefs. In the lethal blend of money, politics, ethics and religion, one key ingredient seems to be missing ‒ compassion. Parenting is, after all, a basic human right, and the first and perhaps foremost mitzva. Surrogacy, like charity, should begin at home for straight and gay couples alike. The writer is senior research fellow at the S. Neaman Institute, Technion and blogs at www.timnovate.wordpress.com The full story of Tal and Amir and their babies can be accessed at http://en.israelstory.org/episode/10-birthstory/#sthash.F4wOuiog.dpuf birthstory

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Outsourcing babies

Human surrogacy is a fascinating mixture of science, politics, religion and, of course, money – as the tale of a gay Israeli couple illustrates.

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