Conception, the un-surrogate way

CHENNAI: Last month, two shocking incidents of women being forced to donate oocytes were reported. One involved a 16-year-old in Erode, and in another, a couple in Tambaram were accused of forcing a woman to donate for money.

Artificial methods of reproduction are in high demand now; these incidents reported in Tamil Nadu prove that. But the growing demand for artificial insemination is leading to grievous consequences, which is why it’s need-of-the-hour to create more awareness and clarity on the different methods of reproduction available in India.

Donor eggs

The increasing incidence of non-communicable diseases, lifestyle changes and food patterns, hormonal changes, lack of physical activity, and the prevalent use of alcohol and drugs have led to infertility issues.

“You can choose egg freezing, wherein women can freeze their eggs in their 20s itself. Age is an important factor in determining the success of such artificial methods of reproduction. Thus, freezing the eggs can help when they want to get pregnant later,” says Dr Sumana Manohar, senior consultant obstetrician and gynaecologist, Apollo Hospital.

If the quality of your eggs is low, you can also choose a donor based on many factors, including characteristics of the donor, which you can match. Egg donation can be opted from a known or unknown source, but it can be done only once.

“When people who go through cancer treatments, there’s a depletion in the egg quality. But they can choose In Vitro Fertilization (IVF), where eggs are fertilised in a lab and then embryo implantation is done. To ensure success of these artificial methods, AI can also help in selecting a good embryo,” adds Dr Sumana.

Acceptance of artificial methods

Doctors say that malignant cancer, auto-immune diseases, irradiation, or any drug-intake can cause diminished ovarian reserve in young women. In men, the incidence of zero count has increased due to infections, lifestyle changes, exposure to irradiation or genetics, etc.

Dr J Krithika Devi, fertility consultant, Nova IVF Fertility, says that there is greater acceptance of artificial methods of reproduction among patients.

“These treatment methods are available everywhere, and more people are chooing them. Obesity is on the rise too, which leads to polycystic ovarian syndrome, which is yet another cause for infertility,” she explains. “People who want to delay pregnancy need to remember that the number of eggs in ovaries, and the sperm counts, reduce with age.”

Surrogates unaware of laws

While surrogacy in the State costs Rs 10-20 lakh, women who opt for surrogacy usually get only around Rs 5-8 lakh for it. Hospital authorities say that people recruited as surrogates are informed about the whole process and the documentation is done with their consent.

However, not all are educated enough to understand the laws of surrogacy. Plus, it cannot be verified if they were forced or coerced into it unless they volunteer the information to the police.

Experts claim that regulations on surrogacy, Assisted Reproduction Technologies (ART) bill and ART banks are unclear. “Many women don’t know that they can donate eggs only once in their lifetime and they should be of 23 years of age. People who choose to get pregnant after 30 and have difficulty conceiving are unaware about freezing their eggs when they were younger, even if they don’t have a partner,” rues consultant obstetrician Dr Arvind Santhosh.

Need to regulate fertility clinics

Several methods of artificial reproduction such as surrogacy, oocyte donation and embryo transplantation have not been regulated on cost. Most people don’t know the ideal procedure to be followed while chooising one of these methods.

“IVF clinics have mushroomed, but ART laws are not being followed in most places. Nobody checks these centres unless there’s a case of violation reported. Since they don’t maintain any form of documentation such as ID proof, age proof and/or address proof, medical records etc, hospitals are unable cross-check the information patients give them,” elaborates an obstetrician and gynecologist from Villupuram Medical College Hospital, referring the Erode case, where there was no way to verify the age of the victim. “Unless there are complaints, there’s a low probability to follow up on all these clinics to find out if they follow the regulations.”

After the recent incidents, officials of the State Health Department have conducted awareness programmes for healthcare workers on ART laws and surrogacy.

“To educate patients on assisted reproduction, the department held a session on different regulations including ART Regulations Act, TN Clinical Establishments Act (TNCEA), and Pre-conception and Pre-natal Diagnostic Techniques Act (PCPNDT) recently. Rules and procedures for artificial insemination centres, legalities involved and methods to prevent violations were discussed,” says an official from Directorate of Medical Services.

* Egg Freezing - The process of preserving mature oocytes that can be used later in life

* Egg Donation - The process of extracting eggs from a screened and selected donor, fertilising them and planting the matured embryo in the uterus

* In-vitro fertilisation (IVF) - The process of artificially fertilising an egg with a sperm in a lab

* Intrauterine insemination (IUI) - Insertion of sperm directly into the cervix, fallopian tubes or uterus

Many women don’t know that they can donate eggs only once in their lifetime and they should be of 23 years of age

- Dr Arvind Santhosh, consultant obstetrician