Fertility Tourism in India

Fertility tourism or reproductive tourism is a form of medical tourism, in which one travels to another country for treatment of infertility.¹  The main reasons for going abroad for treatment include long waiting times related to a shortage of eggs and sperm in the patient’s own country, lack of donor anonymity, over-regulation, high costs and poor experiences of treatment. In vitrofertilization and donor insemination are the major procedures for which fertility tourism is undertaken.

It is estimated that 9% of couples worldwide are infertile.²   For many couples longing for a child, infertility is like a chronic illness. They invest a lot of time, energy and money to fulfill their desire of having a bundle of joy in their life.

In the late 1970s, infertility treatments in the form of assisted reproductive technologies (ARTs) became commercially available in industrialized countries for the first time and soon became popular. Their growing demand spawned several ethical, religious, and health concerns, prompting some governments in industrialized countries to start regulating the services by bringing in stricter legislation. As certain procedures (such as the implantation of multiple embryos) were banned or limited, and some patients excluded from treatment (e.g., older women, single women, homosexuals), besides the long delays (due to limited supply of donated eggs stemming from restrictions on payments to donors, for example), patients felt severely hamstrung in accessing proper treatment. The rapid emergence of ART clinics in India and other developing countries was in part a fallout of these barriers.³

In recent years, India has grown into a major destination for fertility tourism. This country offers hi-tech facilities, without the drawbacks that other countries suffer from. In India, ‘commissioning couples’ can expect high-quality care, cost effective treatment, a high success rate and few legal hurdles. Donor eggs, sperm, and embryos are freely available, and women can become pregnant through IVF or can hire a surrogate – a woman who bears a child genetically unrelated to herself, whom she will give up on delivery. India provides the best medical outsourcing facilities to foreign patients seeking a cure for their infertility. These facilities, whether for IVF or surrogacy, make India a hot destination for infertility treatment.⁴

Why is India the preferred destination for infertility treatment?^5,6

• India was the place where the second test tube baby was born on October 3, 1978 – just 2½ months after the birth of the first test tube baby on July 25, 1978 in the UK.
• Indian doctors are known to be more caring and most of them speak English.
• Quality medical care is available in India at affordable prices. The total cost of IVF or other infertility treatment in India is much lower than that in the USA, even after factoring in the travel costs.
• The quality of medical care in many of India’s hospitals and clinics is comparable to that offered in developed countries like the USA. The standards and practices of these facilities are maintained by strict quality assurance testing.
• Several hospitals and clinics are specialized for doing IVF/ICSI and have excellent facilities throughout India. These clinics have successfully treated thousands of couples for infertility.
• Most of the developed countries have strict laws that considerably curtail women’s access to assisted reproduction. But in India, there is total absence of government regulation. Indian IVF practitioners are self-regulating and only have to refer to a set of guidelines, not work within them.
• India is one of the few countries around the world in which commercial surrogacy is legal.
• Age rarely poses a problem in India. Couples of even advanced age have conceived through treatment in India.
• Ethnicity is also no problem here. Couples coming to India are not just people of Indian descent who want a baby who resembles them, but also white couples who are have no problems with having ‘brown’ babies.
• The large number of tourist destinations in India also attracts prospective patients, who can combine treatment with pleasure and enjoy a ‘reproductive holiday’!

Fertility tourism has become a big business now in India and the number of foreigners coming for infertility treatment has more than doubled in the last few years. Not only IVF and other infertility treatment, surrogacy programs in India have also become increasingly popular with foreign patients wishing for children.⁵  

Infertility treatment centers in all the major Indian cities offer the best medically advanced infertility technique of in vitro fertilization in India at a less cost budget. Now many renowned medical institutions are providing infertility cure with modern medical treatment facilities and modern healthcare amenities. There is even the facility of making advance online registration for getting appointments from Indian doctors.⁷  

In India, it is the market that rules. Clinic websites offer “many healthy young fertile Indian women” who are “superovulated exclusively for you” in dollar rates payable online by credit card. Moreover, Indian clinics do not hesitate to put more than double the number of embryos allowed in the UK into the patient’s body. Even though many women understand that multiple-births are not a good thing, they also realize that the higher the number of embryos, the greater would be their chances of getting pregnant.⁶

India is also the world’s top destination for commercial surrogacy due to the availability of a large number of willing women, and the fact that commercial surrogacy is legal here. It is estimated that India’s rapidly growing commercial surrogacy industry is worth US $ 445 million per year. ³

The flip side

Although the infertility clinics, healthcare providers, medical tourism companies, the broader tourism industry, the Indian government, and the women who provide surrogacy services – all profit from this industry, but whether the interests and rights of infertility patients, surrogates, egg donors, and the resulting children are protected remains an open question.

As the demand for fertility services keeps mounting, the legal, moral and ethical concerns related to its practice also increase. The unregulated, global nature of commercial surrogacy and egg and sperm donation is often accused of being highly vulnerable to exploitative practices.

The problem was highlighted by the case of the Japanese couple, who hired a surrogate Indian mother. But during the pregnancy, the couple divorced and refused to accept the baby. Both the parentage and nationality of the baby came under a cloud as far as the existing definitions of family and citizenship under Indian and Japanese law were concerned. The situation soon grew into a legal and diplomatic crisis.

Opponents of this practice accuse the prospective parents of treating the surrogate mother like an object or a factory to produce something in return for money, but the product is not something inanimate but a live child. They demand stricter laws and an end to this practice.

Although the Indian Council of Medical Research (ICMR), under the auspices of the Indian Ministry of Health, issued voluntary guidelines for ART clinics in 2002 and updated them in 2005, these guidelines are not binding. Continuing ambiguity on key issues, such as surrogates’ rights, surrogates’ minimum age, contract specifics, informed consent, and requirements regarding adoption made the voluntary guidelines a target of considerable criticism in India. ³

Recently, the Assisted Reproductive Technologies (Regulation) Bill – 2010, was introduced to prevent misuse of assisted reproductive technology, and encourage safe and ethical practice of this technology. It is the latest attempt to regulate fertility services that some fear are spinning out of control.⁴

References

1. Fertility tourism. Available at http://en.wikipedia.org/wiki/Fertility_tourism. Accessed on May 8, 2012.
2. Boivin J, Bunting L, Collins JA, Nygren KG. International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care. Hum Reprod. 2007 Jun;22(6):1506-12.
3. Points K. Commercial surrogacy and fertility tourism in India: The Case of Baby Manji. Available at http://www.duke.edu/web/kenanethics/CaseStudies/BabyManji.pdf. Accessed on May 8, 2012.
4. British Council. Fertility tourism. Available at http://www.google.co.in/url?sa=t&rct=j&q=latest%20attempt%20to%20regulate%20fertility%20services%20that%20some%20fear%20are%20spinning%20out%20of%20control&source=web&cd=1&ved=0CFUQFjAA&url=http%3A%2F%2Fwww.britishcouncil.org.in%2Fdebatingmattersindia%2Fdownloads%2FFertility_Tourism_DMITopicguide2011FINAL.doc&ei=NVqrT8SlNM_nrAfLp8QL&usg=AFQjCNEOPg0gwy7Ku2uKULqPGt5_jpV1kQ. Accessed on May 8, 2012.
5. Fertility Tourism in India. Available at http://www.onlymyhealth.com/fertility-tourism-in-india-1298540620. Accessed on May 8, 2012.
6. Prasad R. The fertility tourists. Available at http://www.guardian.co.uk/lifeandstyle/2008/jul/30/familyandrelationships.healthandwellbeing. Accessed on May 8, 2012.
7. Bhojwani D. In Vitro Fertilization In India For Infertile Couples At An Unbelievable Low Cost. Available at http://www.slideshare.net/dheerajbojwani/in-vitro-fertilization-in-india-for-infertile-couples-at-an-unbelievable-low-cost-presentation. Accessed on May 8, 2012.