On Dr. Tamar Khachapuridze's desk are two photographs of an attractive, red-haired young woman. "This is who the German couple has chosen," she said of the woman, an ethnic Ukrainian Georgian national.
Dr. Khachapuridze is the owner and director of the Surrogate Motherhood Center of Georgia, a Tbilisi clinic that has been helping infertile couples find potential surrogate mothers and egg donors since 2000 with the support of the Ministry of Health. The clinic is the only such official center in Georgia.
Prior to the clinic's opening, Khachapuridze says, the term "surrogate mother" was unknown in Georgia. But after local media covered the Center's opening, women in need of work came calling. Practically all of the 20 surrogates listed in Khachapuridze's clinic database are unemployed. "Most of the women offering their services to us are desperate. They have children and the family has no money," Khachapuridze stated.
With high unemployment and dire economic conditions, Georgia could seem a prime location for surrogate pregnancies. For now, this most controversial of alternative fertility treatments exists unregulated.
Most European countries have adopted laws to regulate assisted reproduction, which reflect various religious, cultural, political and economic values. In Austria, Germany, Norway and Finland, surrogacy is illegal. In the United Kingdom, surrogacy can be offered only for women who have no other way to have a child - - and only compensation for medical expenses can be paid. France, Denmark, Israel and The Netherlands forbid payment of any kind to surrogate mothers.
In the United States, however, surrogate mothers can charge fees of up to $20,000 depending on the state in which the process is legal. This does not include legal costs and other expenses that could raise the total cost to $70,000 or more.
By comparison, Georgia as well as neighboring Russia -- provides commercial surrogates at a considerable discount. Surrogates set the price, depending on the methods used. Traditional surrogacy -- artificial insemination of the father's sperm into the surrogate's egg, which she will carry to term -- is more expensive than gestational surrogacy, in which the surrogate's genetic information has no influence on the child. The surrogate in this case is only a "carrier."
For Georgian couples who turn to the Surrogate Motherhood Center, the minimum price for gestational surrogacy is usually $5,000, while foreigners can expect to pay double that. The fee does not include medical expenses and compensation for work loss. So far, only Georgian couples have benefited from the Center's services.
Dr. Khachapuridze hopes that the price will draw more Westerners to her clinic. "In France, couples are looking and waiting for surrogate mothers. Here, it is the other way around."
Unlike in the West, however, no law currently limits how many times a woman can be a surrogate mother, a situation which concerns Khachapuridze because it increases the risk of involuntary incest. There are also no regulations as to how often a sperm donor's sperm can be used. In Tbilisi, officially only the Jordania Institute performs IVF, although Khachapuridze claims several gynecologists may perform the practice on the side.
To provide some legal framework for such treatment, Georgia's parliament is drafting a reproductive health law, which is expected to be ratified in the autumn. This would be a first step towards implementing a comprehensive legal structure which would define the responsibilities of all institutions connected to the health field, including regulation, licensing and enforcement.
"Many people are in need of alternative pregnancy methods, but these must be regulated," said MP Giorgi Gegelashvili, deputy chairman of parliament's healthcare and social issues committee.
Khachapuridze states that her clinic tightly monitors the surrogacy process, but something less than a formalized protocol seems to prevail. The reproduction specialist claims her own 10-year experience with infertility helps her screen potential surrogates. "Would I want that woman to carry my child?" is the question Khachapuridze says she asks herself when interviewing potential surrogate mothers. Punctuality can also count as an indicator of reliability, she said. "Is she late for interviews? Does she call back to check progress?"
Under the clinic's rules, women are accepted for genetic surrogacy only if they are married and after several long discussions with the surrogate parents. One person involved in the surrogacy must be the biological parent. "There is less likelihood that the mother will end up keeping the baby, since her husband would not want to bring up another man's child," Khachapuridze explained.
Georgian law does not prohibit a genetic surrogate from keeping her child, and the Surrogate Motherhood Center's contract with surrogate mothers does not state that the mother must give up the child. One clause, however, asserts that if the surrogate chooses to keep the baby, the donor father can only pay her 25 percent of the lowest salary in Georgia. Khachapuridze insists that the clause prevents potential blackmail. "But we have never had such a case," she added.
In regulating surrogacy, MP Gegelashvili sees financial issues as relatively minor. "The problem is when the procedure is a danger to the health of the fetus," he said in reference to four fetal deaths which occurred during a multiple fetal pregnancy procedure.
Opinions about the practice of paying for surrogacy remain sharply divided, however. "I don't think it's immoral to accept money to carry somebody's baby," commented Ia Bersenadze, a Tbilisi journalist who said that she had contemplated IVF to assist her pregnancy. After consulting with her priest, Bersenadze said that she chose to adopt a child instead.
The Georgian Orthodox Church has no official policy on surrogate motherhood, although many priests believe that any form of IVF is unnatural and should be condoned only for exceptional cases.
Paul Rimple is a freelance writer based in Tbilisi.