We are now seeing many patients who are being advised surrogacy by their IVF doctors, because they have failed 2-3 IVF cycles. When the IVF cycles fail, the diagnosis the doctor glibly trots out is " failed implantation" - and then promptly advises surrogacy. The implication is that if the embryos fail to implant, the "fault" must be with the patient's uterus; that her body is faulty and is rejecting the embryos which the doctor has so carefully created in the lab; which is why her best solution would be to use a surrogate !

Actually, this is completely flawed thinking, which benefits only one person - the IVF doctor. For one thing, it gets her off the hook for the IVF failure. After all, if the patient's body is rejecting the embryos, what can the poor doctor do about this ?

Many doctors will run an extensive series of very expensive, complicated tests to confirm their " diagnosis" . These include tests for tumour necrotic factor (TNF)-alpha , interferon (IFN)-gamma levels and natural killer ( NK ) cells. Because these tests are very " sophisticated" , they have to send the samples to a specific center ( which is usually in a different city - or even a different country !) This just adds to the cost - and the mystique ! Many of these test results will come back as abnormal (the dirty secret is that many fertile women also have abnormal test results !), and the doctor will then use this abnormality as a pretext for doing surrogacy.

Doctors are happy to do surrogacy because it is much more lucrative for them ! It's also much easier to manipulate the medical records of the surrogate. This is why many surrogates will get pregnant - and then mysteriously miscarry after a few weeks !

There are many reasons why patients fall for this poor quality advise ! For one, patients often do not bother to do any homework on their own. They trust their doctor, and are happy to blindly obey whatever their doctor advises. Secondly, many infertile women have low self esteem. They believe their bodies are flawed and are quite willing to accept the blame for the failure. Many infertile women feel their uterus is defective. They often mistake the PMS they get every cycle for early signs of pregnancy, which is why they believe that they must be getting pregnant every month, but that their body is expelling the embryo , because of excessive body heat or immunological incompatibility ( depending upon their level of medical sophistication) ! Also, some are quite fed up of doing IVF, and are quite happy to find a surrogate who can carry the baby for them, so that they do not need to go through the emotional ups and down of an IVF cycle themselves. Surrogacy seems to be the perfect solution for them !

This is especially tragic in the case of the older infertile women. The commonest reason for IVF failure in these women is genetically abnormal embryos , and this is because the eggs of older women have more genetic abnormalities, because they have "aged", and these eggs cannot be screened for these abnormalities . They would be much better off using donor eggs . rather than doing surrogacy !

The biggest tragedy is that often the reason for the repeated IVF failure is the fact that the embryos are of poor quality , because the IVF lab is not very competent. Unfortunately, the documentation is very poor - and these labs do not even bother to provide patients with photos of their embryos !

Rather than do surrogacy, many of these patients would be far better of finding a better doctor ,rather than trying to find another uterus !

Authored by : Dr Aniruddha Malpani, MD and reviewed by Dr Anjali Malpani.

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