It should have been Myleen and Jan Sjodin's greatest happiness. Their newborn was healthy, they were in exotic India and, following Myleen's uterine cancer, their surrogacy was successful.
Instead, the Toronto couple claim, it all turned into a nightmare as the doctor hiked her fees just before the baby was born, hitting them at their psychologically weakest point. She also didn't pay outside hospital bills and tried to use India's infamous bureaucracy to delay their homecoming, the couple say.
"We were robbed of our joy as first-time parents," Jan Sjodin said.
Surrogacy, along with other parts of India's medical tourism trade, has grown dramatically in recent years with physicians here overseeing an estimated 1,500 surrogacy births for domestic and overseas couples in 2010, a 50% jump in two years. The specialty is a tiny part of a fertility treatment business, including in vitro fertilization, hormone treatment and egg and sperm donation, that's on target to reach $2.3 billion next year.
The very flexibility, relative affordability and minimal regulation that have made India attractive to many also leave ample room for abuse, critics say, with medical boards rarely sanctioning their own members and lawsuits dragging on for years, or even decades.
Surrogacy -- sometimes dubbed "rent-a-womb" -- is a procedure by which a woman carries another's fertilized egg to term, usually in cases where the biological mother's uterus is damaged.
Concerned about abuses, legal loopholes and the nation's reputation, the Health Ministry in late January drafted India's first surrogacy law, setting out age limits, how often surrogates can give birth and guidelines aimed at preventing "stateless" babies. Although critics say the proposed rules don't go far enough, all sides agree that legislative infighting makes passage unlikely anytime soon.
Meanwhile, financial irregularities and ethical shenanigans have increased, fertility experts said, because profits are huge and any doctor here can in theory become a fertility specialist overnight.
"Today, unfortunately, even the smallest clinics are doing surrogacy because it's a simple procedure and four times as profitable" as other fertility treatments, said Dr. Aniruddha Malpani, a fertility specialist in Mumbai. "Some aren't up to the mark, and foreigners get fleeced."
Some of the biggest problems involve citizenship. In 2008, "baby Manji" was left stateless after a Japanese couple divorced in the middle of the surrogate pregnancy, and Tokyo refused to recognize the infant after the mother gave her up. And last year, a Canadian couple were shocked when a required DNA test found surrogate twins weren't biologically theirs.
The industry has also been accused of taking advantage of impoverished Indian women. "Are babies commodities to be planted and harvested?" said Kama- yani Bali Mahabal, a Mumbai-based women's advocate and attorney, who says poverty and illiteracy engender exploitation.
Just the opposite, counters Dr. Nayna H. Patel, who runs the Akanksha Infertility Clinic in Anand, a gritty city that's turned surrogacy into a growth industry.
Patel undertakes about 100 surrogacies annually. She drives to her "surrogate house" -- where local women stay during pregnancy -- in a late-model Audi.
"Women were, are and always will be exploited, just look at the job market," said Patel, who appeared on "Oprah" in 2007. "But how can you call this exploitation? They're helping couples have babies and helping their families."
Diksha Gurung, 28, sits nearby in an embroidered black sari, her stomach bulging with the twins she's carrying for a Japanese couple, her second surrogacy. She'll earn $7,500 for nine months' work, allowing her to buy a house, motorbike and English-language education for her sons.
"When I first considered this, my husband was furious and the neighbors appalled, thinking you sleep with the foreigners," she said. "But I explained the process, and now several in my neighborhood are surrogates."
Indian medical procedures carry risks, but so does U.S. healthcare, said Jason Schwartz and Jennifer Flam from Walnut Creek, Calif., who had surrogate twins through Patel's clinic in February. "Are you really protected anywhere?" Flam added.
Myleen Sjodin, a technical-manual writer from Texas, and husband Jan, a Swedish software engineer, decided on Indian surrogacy partly because, at about $15,000, it was much cheaper than in the U.S., where the procedure can exceed $60,000. To save more, Myleen Sjodin also started a referral business.
In late 2009, she underwent the procedure with New Delhi's Dr. Shivani Sachdev-Gour after agreeing, the couple said, on a "special deal" $12,500 package, offset by credit she'd received for referring others. As with many Indian surrogacy clinics, the doctor's office arranges for a surrogate and handles hormone treatments but the birth takes place in a larger hospital.
Myleen Sjodin referred six clients to the clinic. But three weeks before the due date, she said, the doctor's office said the earlier agreement was only the "base price," and that the final fee would be $7,000 higher.
"They jacked it up, knowing intended parents are quite desperate," Myleen Sjodin said. "I was extremely nervous, scared and angry."
After their daughter Amari was born in September, more problems ensued, the Sjodins said. The doctor, they said, presented a hospital bill three times the going rate without paying the hospital where the caesarean section had taken place.
Worried that the surrogacy doctor might hold the baby as leverage, the couple said, they paid the hospital directly and got their daughter out. But when they tried to leave India, Myleen Sjodin said, the doctor's team frustrated their bid to obtain an exit visa, adding delays and significant expense to their daughter's homecoming.
In a brief telephone exchange, Dr. Shivani said, "Everything that woman says is a lie," before adding that she was too busy to speak.
In written comments, her office said it charged the Sjodins less than half the normal fee (the clinic's fees rose by 50% from late 2009 to mid-2010 to $28,000 for a basic package), that Myleen Sjodin was not only getting credit for her referrals but also collecting a premium from other couples in violation of their understanding, that the immigration department was only following procedures and that the timing on settling the bill -- just before the birth and their arrival in India -- was common courtesy.
"Myleen screamed and used abusive language at me in my own office," the doctor wrote. "The accusations are twisting facts for getting a good sensationalist media story."
Back in Toronto, the Sjodins say their daughter is healthy and they're happy the unpleasant experience is behind them.
"Our goal is that other intended parents don't get manipulated," Myleen Sjodin said. "I love Indian culture and we thought we were getting a good deal, but in the end we've paid nearly as much as doing it in the U.S."
Anshul Rana in The Times' New Delhi bureau contributed to this report.