At the risk of being accused of piling on, I have to share this new study that paints a very troubling picture of the medical ethics and standard of care being utilized in ART arrangements in New Delhi, India:

Expansion and proliferation of assisted reproductive technologies (ART) has been facilitated by economic globalisation wherein reproductive tissues like sperm, ova, and uteri are traded like any other commodity to make profit, says a new study, adding that India has emerged as the surrogacy outsourcing capital of the world.

Titled ‘Reproductive Tourism in India: Actors, Agencies and Contemporary Transnational Networks’, the study was conducted by the Centre of Social Medicine and Community Health, JNU, Sama-Resource Group for Women and Health and King’s College London.

The study focuses on the scenario in New Delhi where a large number of private hospitals and government institutions offer ART. It was found that public sector institutions offer only altruistic surrogacy services which are medically indicated. Leading obstetricians and gynaecologists from a top government-run hospital admitted that they have performed in-vitro fertilisation (IVF) in some cases where they were not sure if it was altruistic surrogacy.

One doctor said that she once had a patient, a doctor by profession who bore a surrogate baby for her sister-in-law who was also a doctor, married to a doctor, since they could not have their own biological baby. “We do counsel about adoption, but the urge to have their own child is very strong here,” she said. She gets about five to six surrogacy cases a year and they are all Indian couples. According to the doctor, the surrogates are clearly doing this to educate their children and get ahead in life.

At trust hospitals, the focus is on infertility and IVF and not on surrogacy. They handle about two to three surrogacy births and about a hundred IVF cases a year. The commissioning couple brings the surrogate and the doctors ask no questions, but makes sure that the papers are in order. The hospital does not cater to foreign clients, but has had NRI customers. Their charge is same whether for IVF or surrogacy, which is Rs. one lakh per cycle. The doctors in these institutions feel that sensational media coverage has boosted the industry that sorely needs regulation.

At the only private hospital that agreed to be interviewed for the study, the doctor said that she had been providing IVF services since the early 1990s. She did have some clients seeking surrogacy, but she did not like the issues attached to it and so had stopped catering to such clients. She has restarted offering this service of late since she knows a reliable third party agency that handles all legal and other issues. She deals only with the medical aspect, till a pregnancy is successful, after which an obstetrician takes over.

All the doctors were aware of some doctors running hostels for surrogates where they could be monitored and supervised. This was, of course, against ICMR guidelines. On the other hand, surrogates clearly need such institutions since they need to stay away from home for a long period and then return claiming that they had been away on work, so that their neighbours do not find out about their pregnancies.

Many of the commissioning couples also prefer the surrogate to stay in a hostel so that they could be in regular contact with the surrogate, and indeed bond with her, even as the doctor keeps an eye on her and supervises her diet and medication. The surrogate’s husband and children are permitted to visit her regularly.

All the doctors interviewed are highly qualified specialists. They have been in this field for 20 years or more and all of them are members of Federation of Obstetric and Gynaecological Society of India (FOGSI) and the Indian Society for Assisted Reproduction (ISAR). In the public sector institutions, post-graduates are trained in assisted reproduction. The other doctors interviewed, one from the trust hospital and the other from a clinic, are also involved in training workshops as members of ISAR.

It was found that due to severe shortage of qualified embryologists, medical and ethical rules are flouted with aplomb. While untrained doctors pass off as embryologists, there are no standard guidelines for facilities required or uniform rate of charges and payment. The harvesting of up to 20 eggs, the insertion of any number of embryos and the widespread practice of embryo-sharing are the unethical practices.

The study observed that immediate passage of the ART (Regulation) Bill in Parliament is the need of the hour; it will create transparency because ART banks, and not clinics, will deal directly with surrogates. The registration of such banks would also mean that middlemen, who now thrive, would be weeded out.