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Patel's office is a gloomy, narrow room with a computer at one end and an ultrasound machine behind a fraying living-room curtain at the other. Her enormous desk sits in the center, piled high with papers. The room is constantly packed with nurses, patients, and anyone else who cares to wander in — nobody ever knocks before entering.

Making her rounds of the upstairs ward, where pregnant surrogates have been admitted for monitoring, Patel says the business has taken off beyond anything she imagined. She has about 150 foreign couples on her waiting list, and every week three new women apply to be surrogates. She works 14-hour days and insists she's only involved in surrogacy because there's a genuine need. "I accept patients who have an established infertility problem," she says. "I've had some women ask to do surrogacy because they don't want to give up work for a pregnancy, but I turned them down flat."

All the same, Patel admits there are dangers if the surrogacy business continues to grow in India. "There is little regulation by the Indian Medical Council, the body that oversees such practices," she says. "Rules need to be tighter to ensure women are not exploited."

As a guest speaker at many international infertility conferences, Patel isn't fazed by the foreigners who beat a path to her door — including clients from Taiwan, Japan, the U.S., Europe, and Australia. But she refuses to treat gay couples, revealing her deeply conservative cultural roots. "I get e-mails from gays and lesbians," she says, "some of them very well written — but I don't feel right about helping them." The people she does feel good about helping are the local women — the surrogates — so long as they're not being coerced by their husbands or in-laws eager for a paycheck. "I must be certain it's a woman's own decision," she explains. "If there's any sign of tension or unwillingness, I spot it straightaway." Patel also helps to ensure each woman keeps control over her fee. "For example, if she wants to buy a house, we'll hold her money for her until she's ready. Or if she wants to put it in an account for her children, we'll go with her to the bank to set up the account in her name." The money gives many women their first taste of empowerment.