My Surrogacy Experience with Dr. Malpani Part II: Finances and the aftermath

Dr. Malpani claimed that his fee schedule is very clear. Judge for yourself; see the original table below. For me, the repetition of the sections in red font created initial confusion. 

Anyway, the original schedule is the only thing I received from him before starting this process, and being utterly stupid and trusting of him at that point, I gave it no thought and barely spared it a glance. All I wanted at that point was a baby, and I did not stop to think and ask the right questions about these practical and monetary considerations. Had I done so, I may have spotted the red flags I saw later, and I may honestly have looked elsewhere at that very point.

Note that while knowing that I am an Indian citizen living in India at the time of treatment, he decided to charge me in USD based on my sojourn in America. He also did not fix the dollar rate: During the first part of my treatment, the rupee was stronger against the dollar, and I paid at Rs. 55 to a dollar. Then the rupee went on a crazy downward slide, and he then charged me at Rs. 60 to a dollar.

This struck me as rather unfair, especially since the service did not change, but the perceived value did. I honestly did not pay that much attention to the fact that he was charging me in dollars in the start since I never dreamed that the exchange rate he was giving me would change. When it did, and the unfairness (in my opinion) became blatant, I was stuck, because we were already well into the process. It was a pretty bad place to be in then, honestly.

Later, when I was talking to the people at Surrogacy India, I ask them what they do about this specific point, because I was not at all happy how this was handled by Dr. Malpani: They are apparently very scrupulous about charging Indians (with Indian passports) living in India in rupees, and if they do a rupee to dollar conversion, they have fixed it at Rs. 50 to a dollar. Kudos to them. 

How are the monies spent by Dr. Malpani? As I spent more and more time actually considering each sum he charged and each of his practices, I started to have serious issues with the way things were being done. I repeatedly asked him for detailed invoices or breakdown of the amount charged, and he adamantly refused at each point. In all fairness, that is his prerogative upto a point (we will discuss this later). 

So I paid because I had idiotically agreed to this, but it is also my right to try to analyze it retrospectively. 

To try to give you all an idea of his overheads, let me tell you all about how much blood work/ultrasounds in India cost. I got these figures from a local lab, NM Medicals, by calling them and asking them how much specific tests cost.

Note that he does use this laboratory for his bloodwork and also used them for ultrasound testing.

Full STD panel (HIV/Syphilis etc): Rs. 1700 ($28)

Prolactin: Rs. 500 ($8.34)

Beta-HCG: Rs. 600 ($10)

Routine Ultrasounds: Rs. 2000 ($33.34)

2nd trimester NT screen: Rs. 2000 ($33.34)

Triple marker screen: Rs. 2000 ($33.34)

PIO injection (taken from the Hiranandani Bill): Rs. 159 ($2.65)

(Exchange rate used for above calculations: Rs. 60 = 1 USD)

Given how laughably cheap all this is, I would not expect full prenatal screening and management (progesterone, other pregnancy hormone tests, Beta HCG tests, ultrasounds, etc) in India, from the first beta-HCG to the point of hospitalization at the end of the pregnancy, to exceed Rs. 40,000 (~$666), and this to me seems to be a *very* generous estimation.

So here are my explanations about the steps of the process- how much I paid, how much the surrogate got, and how much the medical care may have come to:

I have asked him multiple times where the money goes, and I get answers like "prenatal care costs a lot," (had to laugh at this one) or "we need to charge for coordinating services," etc. This last answer was when I asked him what he was doing with the balance that Hiranandani had repaid him.

How can monies charged for "antenatal care, ultrasound scans, hospital birth, etc" and "additional compensation of LSCS (c-section)" be reasonably diverted for "coordinating services?" when his fee schedule already includes sections such as “Registration fee” and “Surrogate Handler fee?”

He had no answers for this, and just said that he owed me no explanations. Uh, you do if you are asking me to cover hospital bills while waving a refund they gave you in my face!

At this point, I was planning to have my embryos and 2 vials of donor sperm transferred to another clinic, just in case I wanted to have another baby. I put in the request to have my biological materials transferred. He then refused my request to have my embryos and sperm transferred till I had paid him for the initial hospitalization (!!!!).

In this case, the amount he asked me to pay was utterly unwarranted, given I had paid all the stipulated fees and there was a large unexplained balance left over, in addition to the surplus he had retained from the amount supposed to go to the surrogate. 

Nonetheless, I don’t know what the situation would be if a patient defaulted on the bills they should have been paying, but I doubt it would involve the clinic deciding to hold their biological materials hostage: this is not the Wild Wild West after all; I would have thought that the SOP for a clinic then is to transfer the materials to the patient and send the unpaid dues to a collection agency or settle the matter via legal venues, but the biological materials would logically not be dragged into this process.

Nonetheless, such avenues apparently cannot be considered by Dr. Malpani, who thinks it is okay to release a patient’s private blog to a newspaper reporter without getting consent from that patient, or hold embryos (which may be her future progeny!) hostage to money. Amazingly, when I used the word “hostage” in an email and he agreed to it, and told me that I gave him no choice!

When all this happened and this man decided to hold my embryos/donor sperm samples hostage, he then demanded I pay storage fees that he had not informed me of in the past to keep the embryos that I wanted transferred with him, or he would destroy them due to “lack of space.” He was refusing to transfer my embryos while telling me he would destroy them because he had no room to store them! I looked at my options then. We went to see a lawyer, who advised me to go to the police to get my property freed, and then advised me to sue him in both consumer and criminal courts. The lawyer practically rubbed his hands together with glee at all this, because everything about these financial dealings was documented. We had the legal notice all drawn up to make him release my embryos, and maybe also go for punitive damages.

 My mother (who is herself a physician) asked me when this man has behaved so unprofessionally/vindictively (our opinions), and has clearly shown his willingness to make life as difficult for me as possible (again, no more than our opinion), would I trust that the embryos and sperm in his care would have been handled ethically and correctly, even if I forced him by legal means to transfer them? Would I want to pursue expensive fertility treatments using said embryos and/or sperm, when I had no guarantee that they had not been damaged while being in his care? My father also voiced the same concerns. My answer was I did not know, but anything was possible, given his behavior, which I would never thought he would be capable of, given our initial interactions.

Even if I gave up on my embryos and sperm (my parents make valid points, I think)---he keeps refusing to transfer them and keeps sending me emails that he will destroy them due to “lack of storage space” unless I pay up---I could sue him for monetary damages---these are 50% of my embryos from my second IVF cycle, and the donor sperm that I have paid through the nose for. This man, has, in writing, refused to transfer them, while citing limited storage space as a reason for destroying them (!!!) The mind truly boggles.

I could also sue him (in lawyerspeak) for the mental agony I suffered: I was insanely stressed out in the final month of Gauri’s gestation due to this man’s behavior and her discharge against medical advice. I was actually terrified for my baby’s safety and wanted him/her to be out of this man’s control as soon as was humanly possible. Then there is the fact that, after my surrogate went home with a clear vaginal swab against my wishes, she came back with a greenish discharge indicative of an STD, and the fact that my poor baby was born with what looked like a respiratory infection acquired in utero and required IV antibiotics for one whole week!

But I had an epiphany. One day, late at night, I was up with Gauri, I saw an email from him asking for money to store my embryos and sperm samples after refusing to transfer them. He was asking me to pay storage fees that I can never remember him mentioning before (I went through the emails to check). I was instantly taken to such an angry, stressed-out place. It is that place that I have gone to so often with him. This man has disturbed so much of my life….should I still let him be in it, making me angry for the next few years when our legal cases in multiple courts may drag out? The lawyer assured me that I would not have to do a thing and the case would be fought while requiring no input from me, but even then. Even if it was settled quickly out of court (I suspect it would be), I want to move on. My dad initially wanted me to sue because he does not believe in taking such behavior lying down. My mom has always been against it. She wants to avoid the ugliness this battle will bring, and she is a big believer in karmic retribution.

 A man who keeps part of the fees that he states is for the surrogate: what is your opinion of that? Compare his input and her input into this pregnancy: she, having puked her way through 9 months and doing the tremendous service of growing and carrying a child at the expense of her future health, gets only Rs. 250,000 from the nearly 10,00,000 I paid him, and not even all the money he had taken from me in her name. Is it fair?

Yet, I have my daughter, not because of him but rather despite him, in my opinion. Money comes and goes, but peace of mind is far more important. So letting go is what I am going to do now, for my own peace of mind. Of course, if he vexes me any further, there is always a legal process available to initiate.

When I write all this out, it seems like a bad dream. It scarcely seems possible that the person I met in late 2010 could have behaved in this way, but he has. His behavior with me aside, which most certainly is out of character for him in my opinion, there are several issues (financial and logistical) with the way this man runs his surrogacy program. Most IVF doctors in Mumbai are not running their own programs, they actually outsource it to an agency who have the bandwidth to discharge their duties properly, and I applaud every doctor who takes this responsible step. If you want to pursue surrogacy in India, I would strongly recommend going to one of them. I will next be writing a separate review about the Malpani Clinic for IVF, and it is definitely more favorable than this, but even there, there are issues. I will be giving alternatives there, in that final post.

And as for me....I think I will have to end up getting donor sperm over from the US again, and doing a fresh IVF cycle if I want to try (at a much later point) for baby # 2. 

I just had to put all of this out there, so people going for surrogacy will not make the same uneducated, ill-informed choices that I did.

I also wanted to use my experience to say this: more of the money paid by the biological parents should go to a surrogate, with trusts being set up by the surrogacy agencies to distribute the money in installments (for example, educational trusts for her children).This is an important and constructive safeguard, because the husbands of such women may often use up all the money at one go, leaving these women destitute a short while later, forcing them to surrogacy again for another round. If you go for surrogacy in India, consider speaking to your agency and see if they can do this.