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IVF: Solving Infertility for India, and the World

Senior journalist and communication strategist, A subject matter expert on bureaucracy, governance, PSUs, start-ups and policy matter.
Jul 12, 2018 6:18 AM 6 min read
Editorial

With infertility on the rise due to erratic lifestyles and late marriages, increasing number of couples in India are opting for Assisted Reproductive Technology (ART). According to AMR, a global market research firm, India's In Vitro Fertilization (IVF) industry is projected to grow at over 18% annually, reaching a market size of c. $830 million by 2023.

 

After struggling for over 10 years...40 year old Chitra Lavasa, on the verge of her childbearing years, finally became a happy mother of a baby girl in February this year. All thanks to the IVF treatment which she and her husband decided to undergo 3 years ago.

 

The Lavasas are not alone. Like them, thousands of childless couples across India are undergoing IVF treatments in the hope of becoming soon to be parents.

 

What is IVF?
IVF: Solving Infertility for India, and the World

IVF or In Vitro Fertilization is an Assisted Reproductive Technology where an egg and a sperm are allowed to fertilize in a laboratory dish. Within two to five days of fertilization, the resulting embryo(s) are transferred to the mother’s uterus through a fine tube. The baby born through this process is colloquially called a Test Tube baby.

 

If the mother's eggs or father's sperms are not healthy enough, the couple can go for egg or sperm donor.

 

Though IVF is required in case of surrogacy as well – what differentiates the two is that in case of surrogacy a third person’s womb is ‘rented’ out to the intended parents.

 

The Infertility Scenario

 

According to a report by EY, nearly 10-15% of married couples in India are unable to conceive by natural means. While female specific factors account for 40-50% of infertility cases, male factors are lately on the rise and can constitute 30-40% of cases. Drivers remain unknown for the rest.

 

The report cites increasing use of contraceptives, late marriages, growing number of working women who delay having kids, rising alcohol and tobacco consumption, obesity, increasing prevalence of medical conditions such as poly-cystic ovarian syndrome (PCOS), endometrial tuberculosis, and sexually transmitted infections as key factors which lead to high prevalence of infertility.

 

Nearly 22 to 33 million couples in the reproductive age are suffering from lifetime infertility.

 

The IVF Market in India
IVF: Solving Infertility for India, and the World

Against this background, there is a boom in the IVF market in India. According to a report by the investment banking firm Aurum, the IVF market in India - estimated at $228 million (INR1,500 crore) in 2015 is expected to reach $760 million (INR5,000 crore) by 2020. These estimates tie well with the AMR data mentioned earlier.

 

The growth is also fuelled by the huge demand from international patients. The country has become one of the most favoured destinations for infertility treatments due to the combination of low cost treatment and state-of-the-art technology at par with the best in the world. In the US, an average IVF cycle costs $10,000 (c. INR6,88,570), whereas in India it is about  $3,000 (c. INR2,06,549). Considering that the treatment often requires multiple cycles, it is no wonder that “Fertility Tourism” is now attracting nationals from the US, UK, Japan and Australia. The easy availability of egg donors in India is another incentive. 

 

The Indian IVF industry is also seeing a surge in foreign investments with several global players in the sector setting up.  For example, while renowned UK IVF operator, Bourn Hall, has opened two clinics each in Gurgaon and Kochi; Japanese financial services firm, Orix Corporation, has expressed interest to buy shares of Bengaluru-based fertility clinic chain Nova IVI Fertility for INR250 crore-INR300 crore. Leading US-based investment bank Goldman Sachs is also a key investor in Nova. Poland-based Medicover has invested INR660 crore to open 50 fertility clinics pan-India by next year.

 

Prominent hospitals like Apollo, Max and Cloudnine have also forayed into the IVF segment, to compete against other domestic players like Morpheus IVF, Bloom IVF and Indra IVF.

 

Legal and Ethical Issues

 

Though IVF is a boon for childless couples, it comes with a baggage of legal and ethical issues.

 

With no regulatory framework in place for registration of IVF clinics or reporting of clinical outcomes, the sector has become largely unorganised in India. Many IVF clinics are reportedly operating at sub-optimal levels.

 

The ART (Regulation) Bill, which is still in the drafting stage, is looking at addressing this issue by establishing a National Registry for the regulation and supervision of IVF clinics.

 

However, at the same time, experts rue that the proposed legislation is silent on the regulation of the semen banks, which are a key player in the ART industry.

 

These banks not only provide donor semen but also donor oocytes or eggs and surrogates. The egg retrieval from a donor is a complicated process which needs sophisticated equipment and expertise. Observers say that the process of equipping semen banks for these procedures is not clear in the proposed ART guidelines.

 

Renowned Delhi-based gynaecologist Dr M Gouri Devi argues that the draft Bill “should not accept the social stigma attached to infertility as a norm” and should ideally encourage adoption and foster parenthood.

Women’s health activists say that the proposed Bill should clearly mention the various health risks and adverse outcomes of IVF technology.

 

Experts also raise concerns on lack of regulations against excessive sperm and egg donations. Such a scenario would lead to several genetically-related children around the world. There are several media reports of sperm donors fathering over a dozen children. In 2016 the BBC published a report where a sperm donor claimed to have fathered 800 kids!

 

Some observers also fear that ART will give humans the ability to manipulate their genetic heredity. In the book, Making Babies: Birth Markets And Assisted Reproductive Technologies In India, award-winning health journalist and consultant Sandhya Srinivasan writes, “...what humans will do when they gain the ability to choose offspring genetic variants...How extreme will they go?...Will parents choose genes that create more extremes in personality? One can imagine some parents aiming for offspring minds that are perfect to become a calculating, driven, domineering, and charismatic CEO while other parents aim for cognitive attributes that make a great scientist or iconoclastic inventor or musician.”

 

The concerns of Srinivasan are not unfounded. According to a Times of India report, there is a growing trend in childless couples seeking IVF treatment to look for egg or sperm donors who have high paying jobs, belong to high caste and are educated, fair, tall and vegetarian!

 

And there is no way this trend can be prevented. There is no law which prohibits a couple to go for a ‘customised child’.

 

The Indian Council of Medical Research (ICMR) makes it mandatory for an IVF clinic to record relevant information of egg or sperm donors such as height, weight, age, educational qualification, profession, colour of the skin and eyes and family background with respect to history of any familial disorder. All the information is shared with the recipient.

 

The Way Forward

IVF: Solving Infertility for India, and the World 

The Government should intensely review the regulatory aspect of the industry for quality management of IVF centres and safety of patients.

 

Experts also suggest that Government should make it mandatory for all infertility clinics to register under National ART registry of India (NARI). As per the EY report, only 30% clinics at present are registered with NARI.

 

Mandatory registrations should follow setup of minimum quality standards for centres, data and process protocols to prevent genetic profiling and sex selection, confidentiality guidelines, patient and donor consent norms, storage standards etc.

 

Technology can no doubt open doors for childless couples. However, in matters of public health it becomes imperative to set a framework protecting all stakeholders from purely commercial considerations. Such a holistic approach is key to bring in a better tomorrow.