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For those using the multi-billion-dollar international fertility services market to become a parent, the process is fraught with legal and ethical dilemmas.

When Michael Colling looks at his 17-month-old daughter, all he sees is the beautiful little girl who gave him the gift of becoming a parent. Little Maya, with her chubby cheeks and doll-like features, fulfilled Michael’s dream of fatherhood − a “burning need” he has had for as long as he can remember.

Growing up, Michael’s biggest challenge in accepting his sexuality was the notion he might never become a father. After almost a decade, and their fair share of setbacks, Michael, and partner of 13 years Will Semmens, finally became parents in December 2015.

They are among a growing number of unconventional families made possible by Assisted Reproductive Technologies (ARTs). She doesn’t understand it yet, but Maya is the result of years of soul searching and research by the couple, who travelled the globe and eventually relied on the help of an egg donor, an Indian gestational surrogate mother and a team of international medical specialists at a fertility clinic in Nepal.

When we look at her now, we do not think about all the stress and trauma. It’s like it has all disappeared and we have other things to worry about – the ordinary things that every parent worries about.

Michael Colling

It was a long, hard, road and the couple’s international surrogacy journey coincided with increased scrutiny of the industry following high-profile controversies. Michael, 38, admits there were “dark periods” when he almost gave up on his dream.

Now the couple start their days in their home, in the Dandenong Ranges, Victoria, to the sweetest of alarm clocks − when Maya calls out “Dadda”, her name for both of them. “When we look at her now, we do not think about all the stress and trauma. It’s like it has all disappeared and we have other things to worry about – the ordinary things that every parent worries about,” says Michael, a youth worker, author and mental health advocate.

Conceived in a Nepalese clinic using Michael’s sperm and an egg from an Indian third-party provider, Maya is the happy ending to a story that illustrates the powerful desire to parent, and how ART is being used in ways not dreamt about when the first baby conceived through in vitro fertilisation (IVF), Louise Brown, was born almost 40 years ago.

Life-changing technology under the microscope

For this family, the technology has been life changing, in ways that wouldn’t have been possible even a decade ago. Their story illustrates some of the complex questions around rights and equality. These are some of the themes at the forefront of a major research project examining the history of IVF and assisted reproductive technologies by a multidisciplinary team at the University of Wollongong (UOW).

The wide-ranging project − IVF and Assisted Reproductive Technologies: The Global Experience – is funded by an Australian Research Council Discovery Project grant. Tracing the history of fertility treatment around the world, it’s a collaboration between historian Professor Sarah Ferber and colleagues Professor Vera Mackie, a leading scholar in Asian history, gender and sexuality and cultural studies, and Dr Nicola Marks, an expert in genetics, sociology of medicine and public engagement in science.

The research examines the rise of the global ART industry and the phenomenon of reproductive travel, which sees the movement of people and body parts across the globe to access or provide particular services.

Dr Nicola Marks, Professor Vera Mackie and Professor Sarah Ferber are tracing the history of fertility treatment around the world. Photo: Paul Jones

IVF began as an exciting, if controversial, medical breakthrough available for heterosexual couples unable to conceive naturally. It’s now available all over the world, with levels of access dependent on local laws and regulations.

While IVF remains expensive, other barriers, like sexual orientation, geography, medical regulation and age, have been broken down, with potential parents able to travel to other countries or jurisdictions to seek treatment, Professor Ferber explains.

“We are exploring the global dimension of IVF and the patterns of reproductive travel, which are often unpredictable and need to be understood in their changing historical, social and cultural contexts,” Dr Marks adds.

“Different cultural and legal factors come into play. Some couples will travel to a country that is less regulated, or the decision might be based on professional relationships or networks of their treating doctor.”

The global dimension of IVF and the patterns of reproductive travel are often unpredictable and need to be understood in their changing historical, social and cultural contexts.

Dr Nicola Marks

The nature in which the internet has revolutionised the global IVF industry is also scrutinised, with Professor Ferber describing it as one of most unpredictable ways the industry has evolved.

It’s possible to browse online for clinics, donated sperm, egg donors ­– or agencies that will take care of all of these. From the safety of a keyboard, dilemmas and concerns can be shared with sympathetic strangers on online forums and communities.

Michael and Will became foster parents and seriously considered co-parenting and intercountry adoption (not an option for them as a same-sex couple) before committing to surrogacy. Commercial surrogacy is illegal in all Australian states, so they chose to look overseas.

At the time, India was “abuzz” with surrogacy Michael recalls. It was a short time after the launch of the HBO documentary Google Baby, which followed Israeli man Doron Mamet and his plan to set up an international surrogacy agency in Tel Aviv, after having his first child through surrogacy.

Taking the sex out of making babies

The opening credits of the film suggest that just as the pill took the risk of making babies out of sex in the 1960s, technology has now taken the sex out of making babies and all that is needed is a credit card and an internet connection.

Doron Mamet’s agency, Tammuz, is still in operation, working with clinics and surrogates in the US, Ukraine and Russia, and Michael has recently been appointed the volunteer Australian representative for the agency.

Michael and Will’s reproductive travel took them initially to Thailand, where they decided on a clinic, selected an egg provider and paid a $2,000 deposit. But just days later the “Baby Gammy” scandal broke, with an Australian couple initially accused of leaving the baby, who had Down Syndrome, in Thailand and flying home with his twin sister. The couple, from Perth, were later found not to have abandoned Gammy.

Even with the best intentions of clients, the gestational mother can face substantial risks ... she might agree to the arrangement more from need than a personal wish.

Professor Sarah Ferber

Back in Australia, Michael and Will soon discovered their clinic had disappeared. So had their deposit. In hindsight, Michael feels they dodged a bullet. “The only silver lining was that the Baby Gammy case brought to the surface some of the questionable practices at some clinics in Thailand,” he says.

Six months later, they visited a clinic in Nepal that they felt more comfortable with.

“We felt all the checks and balances were in place,” Michael says. They were also impressed with the quality of medical support for gestational mothers. However, no sooner had they decided to go ahead than the Nepalese government launched a crackdown on international surrogacy. Advised to act quickly, they booked flights within 24 hours and started the process within a week.

Fate had one more twist in store, though. A week after learning their gestational mother was pregnant, Nepal suffered a 7.8 magnitude earthquake, the worst to strike the region in more than 80 years, claiming nearly 9,000 lives.

While they waited for news from the clinic, Michael and Will organised a fundraiser for victims of the earthquake. They later learnt that pregnant gestational surrogate mothers were living in tents on the streets. The April 2015 disaster again saw international surrogacy back in the headlines, with accusations that 26 newborn babies were airlifted to Israel, leaving the gestational surrogate mothers behind in dire conditions.

An Israeli woman weaps as she holds a baby from surrogate mother in Nepal after they disembark from an Israeli rescue plane after it landed on April 28, 2015 in Tel Aviv, Israel. Photo: Lior Mizrahi / Getty Images News / Getty Images

Eventually, the couple learnt that the woman carrying Michael’s baby was well. They kept in contact via Skype before flying to Nepal for the birth in December 2015.  In transit at Singapore Airport, Michael checked his mobile phone. He found a photo of his newborn daughter. The message read: “Sorry Dad, I couldn’t wait!”

The story of Maya’s birth speaks to the lengths to which some are prepared to go to achieve the dream of parenthood but it also highlights the paradoxes at the heart of the IVF story.

While this couple has established an on-going trust fund for the gestational mother, the issue of the risks faced by gestational mothers is one explored by the UOW research team.

“Even with the best intentions of clients, the gestational mother can face substantial risks,” Professor Ferber says. “Even bearing in mind financial benefits that might help a woman in a developing country to support herself or her family, she will face restrictions on her movement and behaviours, and might agree to the arrangement more from need than a personal wish.”

Some scenes of Indian surrogacy operations captured in the Google Baby make for uncomfortable viewing, including a doctor talking on a mobile phone to prospective clients while performing a caesarean section. The gestational mother is seen sobbing as her baby is taken away.

The risks involved in the harvesting of eggs, the IVF process and childbirth have contributed to the ban on commercial surrogacy in Australia, Professor Ferber says. It’s a position unchanged in the recently updated guidelines from the National Health and Medical Research Council, which identify concerns about the “commodification and exploitation of surrogates”.

Michael and Will’s daughter, Maya. Photo: Kate Mudie Photography

Chasing services around the globe

Michael and Will are now planning to have another baby. Nepal is not an option, as it has banned international surrogacy. Having seen friends caught up in the problems in Cambodia, Michael is refusing to “chase surrogacy services around the globe”.

This time they will use a clinic in the United States. At an estimated $100,000, the next addition to the family will cost Michael and Will around double the amount they spent for Maya.

The UOW team is also investigating the movement of clinics from one country to another in the wake of tightened regulation and concerns that ART brings risks of the exploitation of the poor and the commodification of women’s bodies.

The only silver lining was that the Baby Gammy case brought to the surface some of the questionable practices at some clinics in Thailand.

Michael Colling

“As one regulatory door closes, another one opens,” Professor Ferber says. “We have seen clinics pack up shop and set up somewhere else. It’s not that easy, because the labs need to be established. But it’s easier with so-called low-tech IVF.”

Cambodia is the latest country to ban commercial surrogacy − classifying it as “human trafficking”, with Australian nurse Tammy Davis-Charles facing charges related to running a surrogacy clinic there. The move in Cambodia follows similar crackdowns in India, Thailand and Nepal.

Professor Ferber says there is increased lobbying for the legalisation of commercial surrogacy within Australia, where some campaigners argue there is less risk of exploitation of gestational surrogate mothers and more likelihood of children born through surrogacy being able to trace their biological roots.

World perspectives 

The global fertility services market is experiencing “stupendous growth”, Professor Ferber says, with the Asia-Pacific market tipped to grow to an estimated $4.2 billion by 2020.

As well as looking at aspects of the global IVF industry, the researchers are building country-specific case studies in regions including Australia, Japan, France and some French colonies. In Japan, where surrogacy is not regulated, Professor Mackie’s research includes high-profile cases of celebrities who have undertaken international surrogacy.

Professor Mackie also highlights an interesting variation in the scrutiny of birth registration in Japan. While once women aged in their 50s bringing a baby to be registered might have fallen under suspicion of trying to pass off an illegitimate grandchild as their own, they are now more likely to face questions about whether the child was born overseas to a surrogate mother.

In parts of sub-Saharan Africa there are debates around the provision of IVF to women in communities with high rates of infertility, linked to high incidence of sexually transmissible diseases.

“There, questions are being asked about whether providing condoms would reduce the STIs and therefore the need for IVF,” Professor Ferber says.

Dr Marks’ research in New Caledonia has revealed that women living in the French South Pacific territory are able to take advantage of the French ethos of generous health care provision and can access up to four cycles of IVF, with 90 per cent of the costs covered. Women are flown from smaller islands to the capital Noumea for treatment or can also choose to travel to France to receive free treatment.

“In Australia, we have seen some of the commercial providers of ART deliberately moving into areas, including the Illawarra, and offering low cost IVF with fewer bells and whistles,” Professor Ferber says. “That is a provider looking for revenue, but it is also creating what can be seen in some ways as more equity.”

The team has already hosted an international conference, co-sponsored by the Academy of the Social Sciences in Australia, and the project will produce a series of journal articles, an edited collection of essays and a major book − IVF: The Global Experience − to be published next year.

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