Since gestational surrogacy was legalized in 2002, it has become one of the fastest growing industries in India’s rapidly developing economy. A recent World Bank report projected that by 2020 India’s surrogacy enterprise will reach $2.5 billion. In just over a decade, more than 500 surrogacy clinics have cropped up throughout the country, all eager to supply infertile western couples with the child of their dreams—for a price.

In The Baby Chase: How Surrogacy is Transforming the American Family, Leslie Morgan Steiner chronicles Rhonda and Gerry Wile’s four-year journey to conceive via surrogacy. Their story involves an egg donor, two gestational surrogates, four trips to Mumbai, a host of doctors, and over $35,000 to yield their three kids. What is left untold are the many hidden costs of surrogacy, both for the children conceived through this method and for the vulnerable women who participate in the practice.

Shopping for a Surrogate: America vs. India

The Wiles married in 2000. Due to a rare medical condition, Rhonda’s uterus was 60 percent smaller than normal, rendering her incapable of carrying a child to term. Gerry was a firefighter and Rhonda a registered nurse. Together, they earned a combined household income of anywhere between $100,000 to $150,000 a year—a comfortable living for a family of two, but by no means an income capable of financing a surrogate pregnancy in the United States, which can easily cost upwards of $100,000.

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An American surrogate is typically paid between $20,000 and $30,000. Agencies charge approximately $15,000, and another $45,000 to $65,000 are spent on legal and medical fees. Other costs may include travel, egg donor fees, and medication. If there are pregnancy complications, total costs can easily reach $200,000. All of these are out-of-pocket expenses that are not covered by health insurance and cannot be funded by bank loans, as there is no collateral to offer in exchange for the financing of a child. As Steiner observes, “even the wealthiest U.S. citizens, the financial elite, may have trouble devoting $80,000 to $100,000 to the conception of a baby, knowing they still need to be able to afford the care, feeding, clothing, and education of a child in the United States for the next 20 years.” In a rare moment of moral consideration, Steiner asks, “How practical—how morally just—is surrogacy as a solution to infertility, when 97 percent of Americans can’t afford it?”

Eight thousand miles away, Drs. Yashodhara Mhatre and Sudhir Ajja founded Surrogacy India in 2007 under the banner of “Making Babies Possible.” By contrast to the American system, an average Indian surrogate fee is $5,000 with minimal medical expenses, rendering surrogacy a viable option for couples like Rhonda and Gerry Wile.

Who are these women who consent to carry someone else’s child? As one might expect, these are impoverished women looking to make a better life for their families. In some cases, their husbands force them into the practice. While the $5,000 surrogate fee might seem modest to us, in India it’s enough to purchase a home or pay for several children’s education. Yet, in an effort to improve their family’s lives, these women are often separated from them, forced to live in surrogacy facilities in order to receive proper medical attention and monitoring.

Traveling to India

In April 2008, the Wiles made their first visit to Mumbai, where Rhonda underwent IVF. Her treatment yielded ten eggs, which were then fertilized with Mike’s sperm. Because the Wiles were their first American clients, the doctors at Surrogacy India tried to increase their chances of success by transferring five embryos into the surrogate’s uterus, instead of the standard three. But Indian law mandates that surrogates may carry a maximum of two babies at a time. Had all of the embryos implanted, the Wiles would have been forced to abort three (or more, if any of the embryos twinned, as is very common) of the children they had worked so hard to obtain.

The Wiles returned home. Two weeks later, they were informed that none of the embryos had successfully implanted. After the initial heartbreak and financial loss, they scraped together the courage and the money to return to Mumbai for a second attempt. Another five embryos were transferred into a new surrogate. Two weeks later, there was another negative pregnancy test. Undeterred, the Wiles made the bold decision to return to try again with an all-or-nothing bet. This time, they would use two surrogates and donor eggs. The decision to use donor eggs, however, would mean that the child would have no biological relation to Rhonda, only to Gerry.

In February 2009, the Wiles heard the words they had been waiting for three years to hear: “You are pregnant.”

Except that Rhonda was not pregnant—her surrogate was pregnant from a donor’s eggs and her husband’s sperm. In August 2009, the Wiles returned for a third time to India, where their son Blaze was born. Moments after birth, he was brought out of the delivery room and turned over to his eager parents. Meanwhile, the surrogate mother, with whom he had spent the previous nine months bonding, was left alone in her hospital bed. As Steiner notes, “[Surrogacy India] has found that immediate bifurcation makes the transition easier for surrogates in the long run.”

The Wiles returned home and began to adjust to life with the child of their dreams. A year later, they received a phone call from Surrogacy India wondering if they might want to try once more. Their egg donor, Blaze’s biological mother, wanted to do another round of egg donations, and the clinic still had some of Gerry’s sperm frozen. Their laboratory doctors could complete the fertilization and the transfer without their being present. In other words “the Wiles could, in fact, be eight thousand miles away during their next baby’s conception.”

This time, three embryos were transferred into the surrogate, all of which implanted. After five weeks, one fetus spontaneously aborted, which Steiner deems “fortuitous,” considering that Indian law would have required the abortion of one of the embryos. Even so, their surrogate was pregnant with twins. In July 2012, the Wiles became a family of five.

The Untold Consequences of the Baby Chase

In many ways, The Baby Chase reads like an adventure novel. Rather than climbing Everest or reaching Mordor, the Wiles journey toward a child to call their own. Both Rhonda and Gerry Wile are portrayed as down-to-earth people with strong family values. It’s hard not to cheer them on in their quest, as their sincerity leads to great sympathy. Indeed, they are type of folks that one feels would be, and probably are, excellent parents.

The Baby Chase is also a first-rate primer on the mechanics of surrogacy. Steiner understands and clearly explains the many technicalities involved in the surrogacy process. While her profound compassion for infertile couples cannot be faulted, it’s her lack of ethical consideration of the limits of these technologies where she falls short. In the book’s acknowledgements, Steiner candidly writes that her “inspiration for this book sprang from a belief that everyone who wants a baby deserves a baby.” Unfortunately, it’s this unqualified support—and tacit endorsement of any possible means of conception—that dulls her analysis of the challenges raised by third-party reproduction.

The focus of this book is Gerry and Rhonda Wile, and by extension, every couple who struggles with infertility. Some attention is given to the surrogates, but the desires of the intended parents trump all other concerns. Steiner never considers the possibility that children conceived via surrogacy might be troubled by aspects surrounding their conception—as children conceived via third-party reproduction so very often are. Numerous studies over the past decade have revealed that children conceived through egg or sperm donation have serious concerns about their identity and the financial arrangements that made their conception possible. Might the Wiles’ children be bothered that their conception was the result of their parents seeking to satisfy their own desire for children, while giving little consideration to their own future needs?

While Gerry and Rhonda have decided to tell their children how they were conceived, many other parents do not—a fact that psychologists agree is to the detriment of the child. A 2001 article in the journal Human Reproduction concluded that “Disclosure to children conceived with donor gametes should not be optional.” Another 2014 study in the same journal found that many donors eventually seek information about their children and sometimes seek to establish relationships with them. The biological link between parent and child is undeniably intimate, and severing it has lasting repercussions for both parties. As the field of donor conception grows, social science data increasingly document this reality.

In June 2013, one of the first major longitudinal studies of children conceived via surrogacy was published in the Journal of Child Psychology and Psychiatry. The study examined thirty surrogacy families and found that children born through surrogacy show elevated levels of adjustment difficulties. Moreover, the lack of a “gestational connection” to their biological mother or father may place children at increased psychological risk.

Biology Matters

Throughout the book, Steiner stresses the innate desire to create life as “the universe’s most powerful biological craving.” She goes on to posit that “nature wants us to give in to both urges, the sexual impulse and the deep craving to have children.” In other words, biology is important—it reveals things about ourselves and influences our actions. Later, she returns to the importance of biology in explaining the Wiles’ decision to pursue a second surrogate pregnancy after the birth of their first child: “Blaze [their firstborn] would have a companion who shares his genes, his biological mother, his unusual birth story, and his birth country.”

As Steiner admits, biology tells a story—and the majority of children conceived via third-party reproduction are prevented from knowing essential parts of their own heritage, including vital information such as a family’s medical history. Steiner attempts to show that one’s innate biological desire to reproduce justifies the pursuit of third-party reproduction. Yet these very methods deny the importance of another innate biological instinct: to know one’s origins.

You can’t have it both ways—either biology is important, or it is not.

As Steiner knows, biology is important—and that’s one major reason why surrogacy should give us pause. “Gestational surrogacy, at its core, relies upon, and exploits, the separation of the three building blocks of fertility—egg, sperm, and uterus,” admits Steiner. Yet this exploitation is often presented as a win-win situation. Couples like the Wiles are desperate for a child, and Indian women of woeful socio-economic status are looking for inventive ways to provide an income for their family. But surrogates face serious health risks, especially since they very often carry twins. Considering the unknown risks involved in surrogacy and egg donation, is it really ever possible for these women to give full consent to the risks involved?

In 2012—the same year that the Wiles welcomed their twins—in the town of Ahmedabab, a thirty-year-old Indian surrogate named Premila Vaghela died due to pregnancy complications. Dr. Manish Banker, the IVF specialist at the hospital where the surrogate died, told the Times of India that “Premila paid the price of offering herself as surrogate with her life.” Such a price is incalculable, but for some it’s just part of the business of surrogacy and the broader world of assisted reproduction.

Steiner acknowledges that only 20 percent of Surrogacy India’s surrogates express interest in being a surrogate a second time. She describes in detail how the Wiles’ second surrogate was unable to listen to the heartbeat of the twins during the pregnancy as it caused her too much distress, nor was she able to explain to her children that she was pregnant.

Yet Steiner concludes The Baby Chase by praising the miracles of assisted reproduction and hailing surrogacy as “today’s most radical infertility solution.” The fact that childbearing has been separated from sex is radical, but regrettably Steiner’s book fails to address the hidden costs of surrogacy. The Baby Chase is racing full speed ahead into the brave new world of assisted reproduction, and where it is headed is anyone’s guess. The profit to be made, along with temporary happy endings, makes it all the more difficult to look back.