The lethal business of IVF clinics

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Four year into their marriage, Geeta (name changed) and her husband had everything that they could hope for, except for a baby. The desperate couple consulted a gynaecologist in New Delhi. Geeta was diagnosed with tubercular infection of the fallopian tube, one of the three organs essential for conceiving.

Disheartened with the diagnosis, she went through one year of treatment. After another fruitless year, the gynaecologist advised them to consider in vitro fertilisation (IVF). The couple did some research and found out that IVF offered only slim chances of success. Yet, they visited an infertility clinic in New Delhi.

Over the next month, Geeta and her husband tried conceiving twice and failed. They coughed up more than Rs 2 lakh on the procedure, medicines and tests.

“They told us that our dream would come true,” she says. “But it didn’t, just like what happens to the dreams of the thousands who want to become film stars. The clinic exaggerated the success stories to get our money.”

Welcome to the underworld of IVF clinics, which are minting money by conning couples who are desperate to be parents as well as women who are willing to donate eggs.

As you read this, millions of female eggs are crossing borders and many illiterate women are facing potentially fatal health risks after donating their eggs. Thousands of women are being cheated and tricked into donating their eggs without being fully aware of the dangers they face as part of this global practice of “eggsploitation”, in which India is fast emerging as a major player.

In a country with unscrupulous brokers taking their pound of flesh in every walk of life, the unregulated IVF business encourages unethical practices and exploitation in commercial surrogacy, which is the latest and the hottest in India’s booming “outsourcing industry”.

IVF clinics are mushrooming all over the country because the surrogacy market is a multi-crore business. A study by a United Nations team conducted in 2012 had said that India was a $400 million market, but industry insiders say that the actual figure could be double that.

A Tehelka investigation into the IVF business reveals the ugly underbelly of human greed, shamelessly and dangerously riding piggyback on the emotional and sentimental vulnerability of the longing to be a parent. As part of the investigation, Tehelka met doctors, donors, parents and activists and found out that India is sitting on a ticking time bomb of a deadly health hazard.

Every day, thousands of socio-economically backward women are tempted into donating their eggs for monetary benefits. Health experts say that the after-effects of egg donation will only be known at least five years down the line, which leaves the country poised for an unforeseen tragedy of female homicide.

A rough estimate says that about 40,000-45,000 women are facing serious health complications due to egg donations done without proper precautionary measures.

Photo: AP
Photo: AP

When ‘luck’ dawned on Vimlesh Devi, a resident of Kapashera colony in southwest Delhi, her neighbours turned green with envy. Her husband Rajesh, a security guard, had bought a new motorcycle. Their one-room house was soon filled with material possessions. There were signs of money coming into the house.

Little did the curious neighbours know that though Vimlesh, 25, had received a windfall, in the process she had got sucked into the vicious cycle called surrogacy.

Married off at a young age, Vimlesh had four children before her husband died. Her mother got her married off to Rajesh, but her financial struggles did not end. That is when an agent approached her with the prospect of “quick and easy money” by selling her eggs. Soon, Vimlesh and her sister-in-law sold their eggs through the agent, who duly took his share of the pie.

Baby boom IVF clinics are multiplying because the surrogacy market is profitable, Photo: Tehelka Archives
Baby boom IVF clinics are multiplying because the surrogacy market is profitable, Photo: Tehelka Archives

After donating eggs twice, Vimlesh went for the jackpot — surrogacy — for Rs 3 lakh. Once the baby was delivered and the money changed hands, Vimlesh had truly tasted the lure of money. Apparently, her husband usurped the money by giving her a pan card saying it is a debit card of the account where her money had been deposited. Despite that hiccup, Vimlesh had gone one grade up — she became an agent, and began approaching women in her neighbourhood with promises of quick and easy money.

The tale of Vimlesh Devi is one of the many highlighted in Ishani Dutta’s documentary Wombs on Rent, which talks about the rampant cheating and exploitation taking place in the rural parts of the country.

The story of Vimlesh and her gradual shift from a tentative egg donor to a hesitant surrogate mother to a crafty agent is symptomatic of the intrinsic manipulative nature of this business.

Tehelka’s investigation reveals that most of the women around Kapashera are now interested in replicating Vimlesh’s new source of livelihood. Though they are not so sure-footed about the whole process, they are willing to go ahead with the idea of making some quick money without depending on their husbands.

Meanwhile, Vimlesh is not so keen on conceiving a child of her own. She believes that any attempt to have children of her own would only jeopardise her chances of being a surrogate again.

What emerged from our investigation is the manipulation of power initiated by influential lobbies involving doctors and agents. With the lure of money and the promise of a better livelihood, the blatant abuse of women’s bodies and reproductive health is horrifying. And with their initiation into “broker/agent roles”, they are further manipulated to feed this vicious system.

There are thousands of women like Vimlesh all over the country, and they hardly have a clue about the health hazards involved in egg donation and surrogacy. Illiterate and struck down by needs and financial woes, this could sound like a great escape route for them.

Like any new technology and treatment method, the IVF treatment is supposed to be a blessing for couples without children. But the illicit dealings in the industry are endangering many innocent lives and thereby proving to be fatal. Thousands of female egg donors are said to be facing serious health conditions.

In fact, IVF is still not a widely understood treatment despite the large number of clinics cropping up all over the country, including remote towns. As per the statistics of Sama, a resource group dealing with women and health issues, the sudden increase in the number of IVF clinics, from 500 to 2,500, within a short span of time has only created more problems than solutions.

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Delivering Happiness Is A Lucrative Business

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In 1996, Dr Gopinathan set up the CIMAR Infertility Clinic in Edappal, Kerala, with a budget of around Rs 2 lakh. Now, he is at the helm of a Rs 150 crore medical business, which includes infertility clinics and hospitals in Kerala, Tamil Nadu and the United Arab Emirates.

There are many allegations of malpractice against the hospital chain, but it continues to thrive in the name of providing treatment for infertility. The Tehelka investigation discovered that their main source of income comes from egg donors, who are sourced from Jharkhand, Odisha, the Northeastern states and Nepal.

CIMAR runs a multi-specialty hospital for surrogate mothers in Kadavantra, Kochi. When Tehelka enquired about the donors, the money given to them and their health security, the hospital authorities said that “all these are handled by our brokers”. Hence, the buck is passed on to the brokers conveniently by the hospital. Sadly, this is the story of almost all infertility clinics.

Kerala has become the hub of the infertility treatment business due to the migration of labour to West Asia. Apart from Non-Resident Keralites, many Arabs visit the state to get treatment for infertility-related issues.

There are allegations that the clinics deliberately prolong the treatment to extract as much money as they can. However, they are not alone in this unholy nexus. The lack of awareness about in vitro fertilisation (IVF) treatment among the clients helps the business flourish.

When someone is willing to donate semen or eggs, there are a number of procedures to be followed, including medical tests. But none of the clinics follow the guidelines. In some cases, the doctors promise the clients that they will provide sperm belonging to upper-caste men, especially Brahmins. They also allegedly market the sperm of donors with good educational qualifications — graduates from prestigious institutes like IIT and IIM.

However, in reality, the sperm is generally collected from any random male who has a decent sperm motility rate. This is then packaged as sperm from “tall, good-looking, Brahmins” to couples seeking quality sperm.

The desperate couples fall for this trick and end up spending large sums of money in the hope of getting a baby of their dreams. Little do they know that they have been taken for a ride.

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The basic turnover of the IVF industry is going through the roof. At last count, it was reportedly
Rs 20,000 crore per year, and this whopping money from exploitation mainly goes into the pockets of doctors and brokers, contributing to India’s “pregnancy tourism”, a vicious form of what is euphemistically called “health tourism”.

Belly up For rural folk, donating eggs has become an easy way to make a quick buck, Photo: Reuters
Belly up For rural folk, donating eggs has become an easy way to make a quick buck, Photo: Reuters

In the name of infertility treatment, doctors are the main drivers of this exploitation. That is why more and more gynaecologists are desperately seeking a diploma in IVF. This is entirely against all medical ethics as no rules and regulations are followed.

“Most of the fertility specialists in India are gynaecologists,” says Dr Sunita Reddy, a medical anthropologist. “After a few years of practice, they learn some basic art methods and set up clinics in metros or smaller cities.”

The brokers’ main targets are villages, where they prey on poor women for egg donors. They charge hefty sums from rich, childless couples but pay peanuts to these poor women who donate their eggs.

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The Battle For The Bill

The tussle between two ends of a spectrum — those concerned about women’s health and the medical community — will come to an end soon. The Union Ministry of Health and Family Welfare will table the Assisted Reproductive Technologies (Regulation) Bill during the ongoing winter session of Parliament. Once the Bill becomes an Act, the law could help turn India into the surrogacy capital of the world.

In 2008, the Supreme Court remarked that commercial surrogacy had reached industrial proportions with rich families creating a huge demand for test tube babies and poor women supplying wombs for rent. In the same year, the ART Bill was drafted with the aim of “regulating the market”.

The Bill was revised in 2010 and 2013, but its intention was clear in both versions. It allows for surrogacy and egg donation with certain safeguards, which are not seen as nearly safe enough by women and public health experts, given the potentially fatal consequences of the medical procedures involved. The 18th Law Commission analysed the 2008 version of the ART Bill and noted that “wombs in India are on rent, which translates into babies for foreigners and dollars for Indian surrogate mothers”. Arguing against commercial surrogacy, it recommended the prohibition of surrogacy for commercial purposes.

Justifying the Bill, which will put India in the list of countries, including Ukraine, Georgia and Thailand, that allow for ART, the Union government argued that progeny is crucial for an Indian family. The interviews Tehelka had with ayurvedic and unani doctors apart from authorities of infertility clinics, indicated the pressures faced by young married couples within the joint families and the society to have children. In this context, the Union Ministry of Home Affairs issued guidelines that in vitro fertilisation could be used only by married heterosexual couples, prohibiting single women, men and gay or lesbian couples, empowering the traditional family.

“The help-seeking behaviour of involuntarily childless women is to be seen within the cultural constraints of femininity/motherhood, low self-esteem and gender power asymmetries,” says sociologist Jyotsna Agnihotri Gupta, who conducted a study on infertility. “When confronted with their own or their husband’s infertility/sub-fertility, women seek ART to realise their desire for a child and to overcome stigmatisation, a sense of loss and self-esteem.”

Ruhi Kandhari

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The procedures involved in fertility treatment are primarily aimed at revenue generation. When prospective parents approach the doctors for IVF treatment, they are quoted a big budget. Later on, with manipulative skills and exploiting the lack of awareness among patients, the bills are grossly inflated. While the doctors claim that they give a handsome amount to the egg donors, the donors get only Rs 20,000- Rs 25,000, a fraction of the amount charged by the doctors and brokers.

The Tehelka investigation reveals that most egg donors are uneducated and don’t even know how to count the money. “The lack of informed consent is a grave concern,” says Dr Prachin Ghodajkar, an assistant professor at jnu’s social medicine department. “Most women who approach clinics as egg donors are from socially and economically backward classes.”

In egg donation, time is of the essence as far as the frequency of production is concerned. But the greed for money prompts these brokers to exploit the donors continuously without running mandatory medical checks. This leads to medical complications among the donors. In fact, there have been cases where a woman donated eggs eight times in a month. Eventually the donor’s health deteriorates and leads to medical complications.

The risk of cancer is quite high among the donors because of the heavy dose of hormone injections and medication administered to enhance their egg-producing capabilities. After all these “inhuman treatments”, the egg donors are left to cough up Rs 15,000-  Rs 20,000 for medicines to survive the after-effects of the procedures.

At that time, neither the broker nor the doctor does anything to help them cope with the after-effects. As a result, these poor women silently slip into coma or death.


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1 COMMENT

  1. Having practiced Gynecology for 35 years,I fail to understand the thrust of your article.Yes,egg donor is a big business.
    But what kind of cancer are you talking about that the donors get??Never heard of that.
    And then you glibly state”they slip into coma”….Whaaaat???
    Its possible during trans-vaginal retrieval of eggs,some poorly trained physician perforated the blood vessel leading to internal hemorrhage and death.Your article fails to covey that.
    Its an important public health issue and I am glad Tehelka is focusing on it.But next time,please do more research.

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