A South Asian woman and man stand close together with their foreheads touching. The South Asian woman is holding hands with a White woman who is visibly pregnant.

What would you give for a baby?

A look at the struggles—monetary, social, cultural—behind surrogacy for South Asian American couples

Courtesy of Shiv Reddy

Words by Pooja Shah

In the ongoing battle over reproductive rights in the United States, a recent ruling in Alabama has added another layer of complexity and controversy. In a first-of-its-kind decision, an Alabama court has ruled that frozen embryos can legally be considered children. This judgment could have far-reaching implications for fertility treatments—for example, IVF clinics in some states pausing their services—and has therefore reignited debates around defining when life begins.

This ruling comes on the heels of the U.S. Supreme Court's overturning of Roe v. Wade last year, which eliminated the federal constitutional right to abortion and allowed states to set their own laws regarding abortion access. Reproductive rights advocates condemn it as another dangerous assault that could make aspects of IVF and fertility choices like surrogacy uncertain for those in Alabama and might force patients to travel out of state to have the baby they want. 

For same-sex couples and heterosexual couples unable to conceive children naturally, surrogacy offers a path to biological parenthood. But the evolving political and legal landscape means this route is becoming increasingly fraught, with LGBTQ+ advocates warning of growing obstacles. In addition to the political hurdles, those in the South Asian diaspora may face an added layer of social stigma, cultural biases, and lack of support from their community. 

Navigating Transcontinental Surrogacy Options

Amrit Kapai and his husband Nicholas Kouchoukos, from the Bravo show Family Karma, know firsthand the challenges same-sex couples face in creating a family through assisted reproductive methods like surrogacy. The couple from Miami, Florida is currently undergoing surrogacy in Colombia. 

"We chose Colombia for two main reasons—price and a favorable legislative environment for LGBT couples," Kapai explains. "The price is a lot less than in the U.S., though still a hefty price tag and and equally important, LGBT couples enjoy fully equal rights in terms of surrogacy as heterosexual couples."

Two men sit at a table with beer glasses in their hands. Their dog looks at a plate of food and licks its lips.

You may know Amrit Kapai and Nicholas Kouchoukos from "Family Karma."

Courtesy of Zaid Esaak

Overcoming Language Barriers

During their initial trip to a fertility clinic in Bogotá, the language divide became palpably apparent. "Only one of us can really communicate in Spanish," Kapai says. "The staff at the clinic speak English, but certain things are lost in translation."

While Kouchoukos is fluent in Spanish, subtle nuances and phrases get muddled at times due to language barriers, and exclusively speaking in Spanish sometimes isolates Kapai out of the conversation. Yet lingual barriers are far from the only obstacles international surrogacy clients must navigate. The sheer logistics of coordinating across countries and time zones is enormously cumbersome, not to mention the psychological toll this takes on potential parents.

"The process is so mentally and emotionally exhausting," Kapai says. "We have so many hurdles to face—from governments, to our country’s and Alabama's laws, to even language barriers."

Two men sit at a fountain in front of a large residential building.

Kapai and Kouchoukos have been trying for a family through surrogacy.

Courtesy of Amrit Kapai and Nicholas Kouchoukos

Even in countries with LGBTQ+-friendly surrogacy laws, the process comes with immense financial strain, complex logistics across borders, and socio-cultural challenges. In addition, same-sex couples are living in a world where acceptance is still lacking in many communities.

"We wonder at times how our family will be perceived by the outside world, whether our children will feel singled out in a negative way," Kapai tells JoySauce. "That's the beauty and the mess of the human experience."

Facing the Financial Barriers

For Cole Carothers and their wife Shilpa Nandwani, from Austin, Texas, the path to parenthood has been paved with both joy and hardship. Their first child was conceived through IVF, using a sperm donor. But it was a traumatic pregnancy for Nandwani, who carried the baby, as she was diagnosed with the life-threatening HELLP syndrome, a variant of preeclampsia, after delivering five weeks early.

Carothers and Nandwani rejoiced in their new baby's arrival, but they faced difficult decisions about expanding their family. With frozen embryos remaining, surrogacy seemed a possible solution. However, a harsh reality quickly set in: the costs.

"We do not have the financial means to pay for surrogacy, but hope one day we can," Nandwani says candidly, after having paid for one round of IVF already.

The financial barriers they face are twofold. First, paying out-of-pocket for surrogacy alone can easily soar into six figures (including medical expenses, medications, embryo transfers, and more). Add to that the prior costs of IVF and you have a pipeline to parenthood that prices out many hopeful parents. Carothers and Nandwani’s situation exemplifies how affluence is often a prerequisite to accessing surrogacy and other reproductive options. 

"For queer couples that don't have a uterus, the cost is different for donor eggs than donor sperm," Nandwani reveals. Because they required a sperm donor for their IVF cycle, they had to shoulder both the costs of donor sperm and the IVF procedure itself.

Though health insurance can provide some financial relief for fertility treatments under certain plans, it’s not always a reliable option. "My prior fertility insurance (Progyny) did show surrogacy as an option for LGBTQ+ family planning, but I no longer have that benefit when my workplace changed insurance policies,” Nandwani adds, which serves as a reminder that this option is not accessible to all.

Battling Societal Biases for South Asians

On top of the universal trials that come with assisted fertility methods, South Asians often grapple with added cultural stigmas that make an already stressful process even more burdensome.

For Sharanya Mukhopadhyay Sekhri, a speech language pathologist and professional Odissi dancer from California, parenthood was of utmost priority. But she and her husband experienced a traumatic loss in the process. "I delivered my stillborn daughter and then almost lost my life due to complications," Sekhri recounts. "Thereafter, I was told I could never carry again."

Fortunately, Sekhri and her husband had embryos banked from their 2019 IVF cycle, and the couple decided that surrogacy would be their only path to biological parenthood. Even more upsetting than the financial and emotional hurdles were the stigmas rooted in South Asian culture. "My parents and in-laws did not want us to tell anyone we were resorting to surrogacy because they wanted to keep it under wraps," Sekhri states, alluding to the ways in which cultural stigma played a role in who Sekhri and her husband shared their news with. But the power of family ultimately became Sekhri’s lifeline; her close friend and coworker became their surrogate.

"I don't want to be the victim anymore," she declares firmly. "I want to empower others to be proud of their stories and what they have gone through."

Now, with two healthy children, Sekhri does not linger on the pain of her past. Instead, she moves with resolution to a new melody—one where the voices of reproductive trauma are amplified rather than muffled. "I don't want to be the victim anymore," she declares firmly. "I want to empower others to be proud of their stories and what they have gone through."

In South Asian communities, topics related to sex, infertility, and assisted reproduction tend to be taboo or deeply private matters not openly discussed. But, the stories of these couples, all from various walks of lives, showcase the importance of reducing stigma so that others who may pursue these options don’t feel alone in the journey. Further, as the heated national debate continues to place reproductive freedoms at the forefront, the ability to build families through assisted fertility methods hangs in the balance. As the nation reconciles how to move forward in light of legislative changes, the perseverance and stories of these couples who are choosing or chosen surrogacy provide guidance for hopeful couples.

Published on May 7, 2024

Words by Pooja Shah

Pooja Shah is a lawyer and freelance writer based in New York City. She writes on food, culture, travel, wellness and lifestyle. More of her work is at www.pooja-shah.com.