Wednesday, August 5, 2009

Better infertility treatments may help many to become parents

An advertisement which said "Choose from a bevy of healthy super-ovulated women to make your family complete" encouraged Audrey and Derek (names changed), residents of New Castle, UK, to go doctor shopping for a baby across four continents. Finally, they zeroed in on Dr Aniruddha Malpani, who runs the Malpani Infertility Clinic in Mumbai.

Audrey was on the verge of a nervous breakdown, having gone through multiple cycles of fertility treatment without any results. The couple had spent nearly 50,000 pounds in the eight years that they had been desperately trying for a baby. From swanky doctor studios they had even done the rounds of astrologers, herbal doctors and miracle-promising mendicants, driven by a single-minded obsession to become parents the biological way.

This cycle of hope-disappointment-hope was finally broken when they had Derek Jr. through In-Vitro Fertilisation (IVF) treatment in Mumbai.

Audrey and Derek are one of the many childless couples who come to India with the hope of going back home with their very own bundle of joy. Fertility tourism is big business now - the industry reportedly brings in hundreds of millions of dollars into the county. In fact, reports also suggest that the number of such cases has more than doubled in the last three years. The reasons: pocket-friendly treatment, world-class heath care facilities, a large base of English-speaking doctors, relatively fewer legal hurdlest the list is long. Dr Vibha Bansal, a Delhi-based gynaecologist, elaborates, "Fertility tourism has received a great deal of media attention of late. The cost of IVF in the West is astronomical and countries enact laws that drastically curtail women's access to assisted reproduction. However, countries like Thailand, Russia, China and India, where such treatments are easily accessible, see people not only from the developed world seeking treatment but also from places like Nepal, Bhutan and Afghanistan, where such options either do not exist, entail long waiting periods or are not of a satisfactory quality." She adds that the government has made things easier by not cluttering the space with too much legalese. According to Dr Malpani, "IVF, embryo adoption and egg donation are very popular and a major reason for this is its cost effectiveness." Take a look at the monetary contrast: At private clinics in the US, which do 70 per cent of all IVF treatment, costs can run up to $18,000 a cycle. Indian clinics offer the same at around $7,200. And to make the deal even more irresistible, many fertility centres offer package deals, throwing in plane tickets and hotel stay as well.

Other than the cost factor, Dr Malpani believes "foreigners choose India because doctors here are known to be more caring". Also, while British clinics may allow doctors to implant only two embryos in a surrogate's uterus, in India this can go up to six embryos at a time - increasing the chances of conception. But Dr Amudha Hari, Consultant Gynaecologist and Laparoscopic Surgeon in Chennai, doesn't see this as positive development.

She believes that there will always be doctors who agree to treat women deemed too old or too overweight by western standards for IVF, never mind the resultant medical complications. Which is why a patient must do a thorough recce and demand to get all his/her questions answered before going in for treatment. "Infertility is like a chronic illness and couples invest a lot of time, energy and money to fulfill their desire of building a family," says Dr Hari.
After three failed rounds of IVF treatment, Bhaskar and Anita, Non Resident Indians (NRIs) in the US, found the answer to their problem in an advertisement. It led them to Nisha, 23, from Nagapattinam, Tamil Nadu, who was willing to be a surrogate. Everything seemed compatible, she was of the same build and skin colour, except for the fact that she was not married. The issue posed an ethical dilemma for the couple but it was resolved when they were convinced that she was not under any duress but wanted to fund her education to be a nurse. Anita sent her Rs 20,000 every month until the baby was born. She even monitored Nisha's diet and doctor's visits. Their son Rohan's birth, says Anita, was "nothing short of a miracle. We had lost all hope of becoming parents and are now considering having another child after three years, the same way."

Infertility treatments, whether through IVF or surrogacy, creates families. In the process, they also help surrogates find stability in life. In fact, surrogacy has helped poor people pay off debts and get out of the vicious cycle of poverty and, in Nisha's case, get her an education. But, unfortunately, this exercise is not all about gains. If driven solely by commercial interests, fertility treatments can have dangerous consequences. There is always the question of high-risk pregnancies. Sometimes women have to go through repeated surrogacies, getting injected with hormones and the like without proper medical surveillance. All this means compromising dangerously with their health.
Dr Hari recalls a case where a woman in a Mumbai slum had been pushed by her husband to attempt surrogacy for the 18th time. The husband had made this into a kind of domestic enterprise, albeit a failed one, since the poor woman suffered from tuberculosis and was unable to deliver a child successfully. Luckily, a local NGO got a wind of what was going on and took her into a rehab where she is now recovering.

Besides the health risks, there is the issue of adoption. "The many steps involved in adoption once the child is born can be a problem," says Dr Hari. The Indian Council of Medical Research has not issued any guidelines to help deal with foreign clients using Indian surrogates. So the child has to be adopted under Indian law and all procedures outlined in the Hague Convention on inter-country adoption have to be adhered to.

Experts are quick to point out that the global capital generated by the burgeoning fertility tourism market may thwart any concerted international response to the inequities and exploitation that arise in this context. The key to ensuring that the treatment process is relatively hassle-free is to choose the right clinic, one that lays down protocols and guidelines, advises Dr Hari.

Doctor shopping can be a very taxing experience. However, a welcome trend is the easy availability of information on the Internet, making it possible for potential clients to connect with doctors and seek referrals. Blogs and e-mail are handy tools in this regard. However, Dr Abha Majumdar, Head Ultrasound at the IVF Unit in the New Delhi-based Sir Gangaram Hospital, believes that the entire fertility tourism debate is over hyped. She says that the majority of those reaching out to her or those referred from other clinics are Indians (including NRIs) - foreigners make up just 10-15 per cent of that number.


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ivfmexico said...
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