Yet if surrogacy is getting the most attention, much more of the other forms of assisted reproduction are going on here - for example, egg donation has shot up with the economic downturn, Dr. Gupta said.
Dr. Gupta won't allow clients to select the gender of their babies, but there are few other requests he will turn down. "Everyone can afford surrogacy," he said; many of his clients are rural farmers or the urban poor, people who have borrowed money or sold land to pursue IVF. "They feel they are nothing without a child," he said. "I ask, 'Can you sell [an acre]' Invariably the reply is yes. 'Then you can get a baby.' "
The Satyanarayans had no qualms. They are seeking a son to replace their teenage boy who died last year. "We have land and we want someone to have it when we go," Satyabati Satyanarayan said a few minutes after Dr. Gupta assessed her readiness for the donor eggs they will pay $6,500 to have fertilized and implanted.
While a Canadian IVF clinic will not implant more than two embryos in a woman under 37 for fear of creating a multiple-gestation pregnancy, Dr. Gupta's policy is less strict. "You can get a 40-50 per cent success by implanting three or four, and if they are multiple, we reduce the number - if more than two is [not desired]" he said. "Except with Muslims - they make a fuss [about aborting some of the embryos]"
He said that while he has created only four sets of triplets, his clients have given birth to more than 1,000 sets of twins. "It's a two-for-one bonus," he said with a grin.
Dr. Gupta sees 100 patients each day; counselling for assisted reproduction consists of a few minutes of chat with women about their options to maximize the chances of pregnancy. Upstairs, his wife merges the eggs he harvests in the early morning with sperm collected from sheepish men emerging from a room with a selection of DVDs. In her spotless lab, the only quiet place in the teeming three-storey clinic, dozens of embryos grow each day. Downstairs, her husband decides who will get them. "There is no regulation, so you do the most ethical thing you can," he said.
Assisted reproduction includes a host of procedures and techniques, some common and some still experimental. These are among those offered in Indian clinics.
IN VITRO FERTILIZATION
This is one of the most commonly used procedures. A woman's eggs are combined with a man's sperm in a dish in a laboratory. Once fertilization has occurred, the resulting embryos develop for 3 to 5 days before being placed in a woman's uterus.
A man's sperm is placed into a woman's egg with a microscopic needle, rather than many sperm positioned close to the outside of the egg, as in IVF, in a dish in a lab. Once fertilization occurs, the resulting embryo is placed in a woman's uterus.
DONOR EGG OR EMBRYO
An egg donated by one woman is mixed with a man's sperm and the resulting embryo is implanted in another woman's uterus. This procedure also can be done with a donated embryo.
One woman agrees to carry an embryo to term and give the baby to another woman after birth.
In a lab, one of the outer layers of an early embryo is perforated by chemical, mechanical, or laser-assisted methods to assist in implantation of the embryo in the uterus.
IN VITRO MATURATION
A process that matures a woman's eggs in the lab, rather than naturally in the ovaries.