After three miscarriages and learning she would never be able to carry a baby to term, 36-year old Adrienne Arieff turned to surrogacy. Her search for a surrogate would lead her far away and around the world to India.
"My doctor basically told me, 'You have to adopt or choose surrogacy'," she said. "The contracts [in India] are much more straightforward, its more of a one stop shop, just much less red tape, and I had already gone through so much. So something as cliche as just having a little bit more certainty after such an emotional roller coaster was sounding rather appealing."
So Adrienne traveled to Anand, India to the Ankansha Infertility Clinic. There, she met her surrogate, a 26-year old Indian woman named Vaina. She is a happily married mother of three from an impoverished village. The two connected immediately.
"She did say to me, I want you to have what I have...a family."
After a course of in vitro fertilization in India, Adrienne and her husband's embryos were transferred to Vaina. Weeks later, back in the States, Adrienne learned the pregnancy was a success. Vania, on the other side of the globe, was carrying Adrienne's babies- fraternal twins.
"I was just a bit of a crazy person, I think I screamed or something."
So excited about the pregnancy, Adrienne returned to India to bond with her surrogate for the last trimester.
"Every day I would go and see her and we would spend a couple hours together."
And when Vaina was in delivery, Adrienne was able to be by her side.
"When I saw my babies, the first reaction was, 'Oh my god, they are so cute,' " she said. "I was definitely in love and they were so different. One is named Emma and the other is India. It is quite easy to put those names to their faces. It just fits."
Adrienne shares the experience in her book "The Sacred Thread," which began as a journal for her daughters.
"So my girls would have some sort of documentation of how hard it was to have them, and how happy we were to have them on this planet."
Emma and India are now three years old.
"They're just cute little kids," Arieff said. "They're just like any other happy toddler. We have a lot of fun."
Health officials say surrogacy in India has become big business, with an estimated 1,500 surrogacy births in 2010, up to 50% in two years. Part of the demand is financial, in the US, the cost of surrogacy is around 100 thousand dollars. In India, it is about half- and that includes all medical expenses.
Adrienne's surrogacy was handled entirely in India, but some US couples choose to begin the process here, at clinics like Indian Egg Donors in New York City.
Dr. Anita Nagpal is the director. Her clinic facilitates surrogacy between the US and India, from choosing Indian egg donors to arranging exit visas for the babies once they are born.
"Everything is taken care of by the team in India," Dr. Nagpal said. "We baby sit them literally through the whole process."
Over in India, Dr. Shivani Sachdev-Gour is the founder and director of SCI Healthcare and ISIS Hospital and Multispecialty Centre in New Delhi. Their center gets referrals from US based clinics like "Indian Egg Donors". Dr. Sachdev-Gour says they manage between 20-25 surrogacy cases each month, 95% are from international clients.
Her state-of-the-art center is staffed with nurses, technicians, and embryologists and is equipped to facilitate the entire in-vetro fertilization process.
Dr. Sachdev- Gour explained, "The lab has access only from the operation room, which means we've created three sterile areas before there is access into the IVF lab."
Once a surrogate is carrying a baby, she is closely monitored throughout the pregnancy, often living at the center with her family.
"They have a caretaker who will look after them and they have a caretaker to take care of their children," Gour said, "And obviously they have to have another kid."
There are potential pitfalls to surrogacy in India.
Dr. Jamie Griffo the program director of the NYU fertility center explains, "The financial aspect of it is important," he said. "If it can be done less costly, which some of these countries do I think that's an advantage for patients. The problem is you get what you paid for sometimes, I mean the lower costs sometimes reflects qualitative issues and regulatory issues that may not be in the best interest of the couple and the baby that results."
While the India surrogates are well compensated for the job, some argue that surrogacy in India is exploitative. Others say it is bringing much needed income to the surrogate's family.
Susan Markens is an assistant professor of sociology at Lehman College and has written books on surrogacy. She has been watching the growing debate over Indian surrogacy.
"It becomes the story about gender empowerment, that you're helping these poor women out in a way that they really couldn't," Markens said. "The debate really marries the debate about globalization in general when we are using cheap labor. Are we exploiting them or are these workers getting better conditions and better pay than they would otherwise?"
"Surrogacy is not for everyone," Arieff said. "It worked for my husband and I it was something that worked for us. I wouldn't say it was pleasant and rosie. We had infertility problems and this was our option that ended up working out."