A consultant in gynaecology at the Indraprastha Apollo Hospital, New Delhi, Dr Puneet Bedi, specialises in high-risk pregnancy. He was trained in in vitro fertilisation (IVF) techniques in the UK and has observed the proliferation of infertility clinics across the country over the years. In a conversation with Ruhi Kandhari, he discusses unethical behaviour and medical malpractices in the context of infertility treatment and surrogacy in India.
Edited Excerpts from an interview •
What malpractices and unethical behaviour have you observed in the mushrooming infertility clinics in India?
First of all, doctors tend to exaggerate the medical condition. Surrogacy is only required when there is no uterus and donor eggs are required when the ovaries have either stopped functioning or have been removed. But, as both these procedures add to the costs, doctors recommend them even when they are not necessary. For example, a woman may need just one prescription of drugs for
Rs 1,500, but she is sold surrogacy for lakhs of rupees. This kind of prognosis plays on the stigma associated with an infertile woman.
Moreover, when people pay lakhs of rupees, what they really want is a son. ivf clinics guarantee that in violation of the PCPNDT (Pre-Conception and Pre-Natal Diagnostic Techniques) Act.
Secondly, infertility doctors often do not have adequate training in the hardware and software required for ivf. There are no checks and balances such as accreditation. In India, any mbbs graduate can do it without any training. Thus, any doctor can open an infertility clinic.
Thirdly, malpractices are encouraged by kickbacks from pharmaceutical companies. If a doctor prescribes hormones costing between Rs 1,000 and Rs 5 lakh in one cycle, he gets up to 60 percent of that amount from the pharma company. A doctor makes money by prescribing drugs to patients. That is why they often prescribe over-dosages. The child may never be born, but the doctor will make money. A drug company promotes hormone injections like toothpaste or any other non-medical product. The more a drug is prescribed, the more profitable it is for both the company and the doctors.
In short, the doctors do not know the procedure, the patients do not need it and the drugs are over-prescribed for inflating the costs. People are given packages, including drugs and hospitalisation, for ivf technology. Babies are sold like packages. The failure rates of ivf are not discussed, nor are the risks and complications. The patients are not told about the cost of post-operative care in case of complications. The bottom line is that there is nothing called informed consent in practice in India.
Couples seeking infertility treatment have no clue what they are in for. There is nothing medical about the whole process. Infertility clinics are just a marketing gimmick in private medicine with an aim to make profits.
What are the health risks involved for egg donors and surrogates?
The risks are terrible. A woman normally makes only one egg in a month. In order to harvest more eggs, the donors are given very high doses of hormones. The more eggs they can harvest, the more they can sell. That is how the donors get exposed to a ridiculous amount of drugs. Also, doctors get more money from the pharma companies when they prescribe more drugs. But, the more drugs you give, the more life threatening are the complications. For example, the ovary can sometimes grow to the size of a football. It can lead to dehydration and even death.
In every hundred cases of ivf, up to five women will get hyper-stimulation, which could be potentially life threatening. In such cases, intensive-care treatment is required for saving the woman.
Secondly, egg donation has long-term consequences, which are not fully known. What we do know is that it certainly increases the risk of ovarian cancer.
How big is the infertility industry in India? Does a doctor need any certification or specialisation to set up an infertility clinic?
It is not clear, but everyone with a medical degree — and sometimes even those without one — have set up infertility clinics. They are not answerable to anyone. They just sell hope. When they are selling dreams, they don’t have to deliver anything. There are more than a few hundred clinics in New Delhi alone. They are mushrooming everywhere, even in the smallest towns, on the highways and so on. The size of the industry certainly runs into crores of rupees.
Teaching ivf technology is also big business. Lots of small-time doctors, who initially sold themselves as ivf specialists, are now selling themselves as teachers and trainers and making huge amounts of money. There is no regulation, protocol or pre-structured training for ivf. There is no certification. Just like people teach driving or swimming, there are those who teach ivf.
Tehelka came across yunani and ayurveda doctors, acupuncturists and ivf clinics, everyone claiming to offer a cure for infertility. What is each one’s role? And what is the role of middlemen such as brokers and reproductive tourism facilitators in this industry?
Everyone sells hope. And it’s easy as most of these conditions are self-curing. I would be in favour of homeopathy, ayurveda and siddha, because they would probably do less harm than ivf. The success rates are more or less the same. A woman may not get a baby, but at least she won’t die of the so-called treatment.
Further, there is a broker for everything, including hiring of surrogates. The distribution of money is completely unregulated. The actual sufferer, who is the egg donor or the surrogate, gets only a fraction of what the commissioning couple pays. All human rights issues are completely overlooked. The surrogate, in some cases, is not allowed to see her family. She is treated like a bird in a cage. There are hostels with scores of such women, most of whom are in need of money. Some of them suffer from massive psycho-social trauma. If you have a heart and soul, you won’t be able to stomach what’s going on in these hostels.
Reproductive tourism is a new industry in India because few other civilised countries would allow this kind of nonsense. When it was allowed in Italy, people from other European countries used to go there. In Australia, too, the regulations were lax, but now, after years of evidence on how harmful ivf can be, all first-world countries have strict regulations.
Do you think the Assisted Reproductive Technology Act can help regulate the industry?
This proposed Bill is interesting as the Union health ministry asked the Indian Council of Medical Research (ICMR) to draft it, but the ICMR outsourced the job to a committee. Members of that committee actually drafted the Bill and most of them own an ivf clinic. It is hilarious. Like murderers drafting the Code of Criminal Procedure. The people who are the potential offenders have drafted the Bill. So it is completely pro-industry.