Egged on by lack of law

The HC’s recent directive to investigate the role of a hospital in the death of a 17-year-old who allegedly passed away after three egg donation sessions in just 18 months has opened a can of worms — that human eggs have become commodities and donors are exploited, simply because there is no law to regulate the procedure. Kanchan Srivastava peeps into the womb of the problem

Till last week, the website of a well-known artificial reproductive technology (ART) centre in Colaba ran this “appeal” from a patient seeking an egg donor: “Are you a young professional or university student who lives in Mumbai and is financially strapped? After several failed IVF attempts, our only remaining option is to find an egg donor. We are willing to pay Rs1 lakh to you. Please email at…”

Dr Anirudh Malpani, owner of this centre, was quick to take off the advertisement after his attention was drawn to it. Defending the decision to upload it on the centre’s website, he said, “This was a three-year-old post, uploaded only to help a patient who was in desperate need of a donor.”

Such advertisements on several in-vitro fertilisation (IVF) centres’ websites, which make no bones about offering money to surrogates/egg donors, are a dime a dozen. But then, legally, one can’t take umbrage at them. They aren’t really breaking any law, simply because there isn’t one. A private member’s Bill has been gathering dust in the assembly from 2011 and a draft ART (Regulation) Bill has been pending at the Centre since the year before that. A set of guidelines, drawn up by the Indian Council of Medical Research (ICMR) in 2005, exist only on paper. One of the guidelines on the sourcing of oocyte (egg cell) donors states, “Law firms and semen banks will be encouraged to obtain and maintain information on possible oocyte donors and surrogate mothers.” In the absence of such banks, most fertility clinics offer to double up as ‘suppliers’ of egg donors and surrogates.

Brisk business
The Bombay high court recently pulled up the city police for not looking into the role of a hospital at Bandra in the death of a 17-year-old, three-time egg donor, Sushma Pandey, around two years ago. The minor had died two days after visiting the hospital.
Pandey’s death should have ideally served as a warning to errant fertility clinics and underage donors. As per the ICMR guidelines, an egg donor has to be at least 21 years old and there should be a gap of three months between donations. But that has not been the case.

The business of egg donations has exploded in the last few years. Fewer and fewer people have qualms about putting up the human egg — as well as the womb — for sale given the high demand for them. And when sourcing gets tough, in come the touts, who often reportedly exploit poor women by making them donate eggs repeatedly in a short span of time, while making sure that they get the smallest share of the money that changes hands.

Women aged above 40 with premature ovarian failure, polycystic ovary or endometriosis require egg donation. But, some centres push many women who fail to get pregnant to seek egg donors instead of trying their luck through mutliple IVF treatments, citing the higher success rate and cost-effectiveness of the procedure.
A source claims that such donations, which usually go without a hitch, are an open secret and that Pandey’s death was an anomaly.

Well-known IVF experts Dr Nandita Palshetkar and Dr Hrishikesh Pai, who run a chain of fertility centres across the country, as well as the hospital where Pandey had registered for egg donation, however, refuse to comment on this.

That assisted fertility is a booming business is a given. Bhiwandi alone has four IVF centres and Pimpri-Chinchwad has three, says a state health official.

The state government, however, doesn’t have a complete list of all fertility clinics. The public health department has been able to provide a list of just 51 centres registered in 12 corporations, excluding the Brihanmumbai Municipal Corporation. Several officials from the Federation of Obstetric and Gynaecological Societies of India — which has 209 member societies and over 25,000 individual members — and the Indian Medical Association (IMA) express their surprise at the absence of records and allege that the government isn’t serious enough about tackling the issue of egg/semen donations and surrogacy.

Grey areas
The ICMR guidelines are left open to interpretation because they don’t clarify if donors’ gametes (mature sexual reproductive cells) can be sent abroad or the number of times a woman can donate eggs. Foreign clients offer a higher profit margin to agents/clinics. A drove of them even come to India because the procedure is cheaper here.

During a normal reproductive cycle, a single egg matures. Assisted reproductive technologies, however, pump in gonadotropin —a reproduction inducing hormone — into the body, which gives multiple eggs. There is no standard protocol on the dose of gonadotropin or the number of eggs which should mature. This is allegedly exploited by agents/fertility centres. “A few doctors use a high dosage of gonadotropin to get as many as 50 eggs, risking the life of the donor. Extra eggs are shared by other couples,” reveals a doctor.

Dr Duru Shah, head of Gynaec-World, an IVF centre, defends the procedure. “It reduces the cost of an IVF treatment.” Dr Shah claims that a dose of gonadotropin can’t be fixed as every woman’s response to drugs is different from the others’.

Dr Malpani says, “Eight to 40 eggs maturing through a single dose are fine. In case of hyper-stimulation, the process can be cancelled by doctor/recipient/donor.” But, such cancellation hardly occurs.

Dr Jayesh Lele, secretary of the state unit of IMA, says, “The study of IVF is not offered through a specialised course or degree. Any gynaecologist can become an IVF expert after little training.”

Manufacturing of consent
Fertility procedures can go wrong in a number of ways — they can cause swelling, pressure in the ovarian area, vaginal dryness, hot flashes, ovary loss and even death.

A donor is supposed to be apprised of these risks. But, again, they are often given a miss. Doctors reportedly obtain consent, but it is hardly an informed one, says Dr Dayakrishna Mangal, programme coordinator of the United Nations Population Fund, Maharashtra. He insists on a national registry of donors.

A former donor reveals that slumdwellers and maids comprise a major chunk of egg donors. “Agents approach poor girls and women with kids who have alcoholic or unemployed husbands and persuade them to join the business.” Touts hired by ART clinics then arrange all documents — right from birth certificate to PAN cards needed for donation/surrogacy. “Everything is kept under the wraps. I didn’t even tell my relatives before donating eggs,” says the donor.

A recipient gives around Rs1 lakh for eggs, including tests, but no one knows how much of it trickles down to the donor. Clinics claim to pay Rs30,000-40,000. Guarav Wankhede, owner of a Mumbai-based agency — Becoming Parents — says he pays donors Rs50,000.

Why is MCI silent?
The Medical Council of India (MCI) can take suo moto action against errant centres, but it has been silent despite several cases surfacing in recent times. Dr Kishore Taori, chief of state unit of MCI, argues, “If someone gives us proof, then we will take action.”