New Delhi: “We are actively recruiting egg donors!” reads the advertisement on the website of one of India’s top in-vitro fertilisation clinics.
“Our patients are happy to pay generously for your generosity! They pay you up to Rs40,000 ($800) every time you donate”.
A lack of regulation surrounding fertility services in India and the lucrative returns on offer to those that provide them has turned India into a popular hub of “IVF tourism”.
Childless couples from overseas are attracted by the relatively low-cost treatment, as well as “friendly rules” when it comes to egg donors and surrogate motherhood.
According to the private Indian Society for Assisted Reproduction (ISAR), there are some 400 IVF clinics in the country, providing an estimated 30,000 assisted reproductive treatments a year.
There are no precise estimates for what percentage are taken up by foreigners, but doctors say overseas demand is fuelling a boom.
“Nearly half of our patients come from overseas. Of them, nearly half are of Indian origin,” said Aniruddha Malpani, whose IVF clinic in Mumbai is considered among the country’s best.
A full IVF cycle at the Malpani clinic costs $4,500, including medicines. In the United States, the average cost is $12,400, according to the American Society for Reproductive Medicine.
Malpani offers a top-end service, but the same treatment is available from other Indian clinics at less than half the price.
While cost is a big factor in drawing people from abroad, equally important is the lack of effective regulation.
“India has friendly rules. There are no restrictions on egg donation,” said Manish Banker, vice president of the ISAR.
In Britain, the British Human Fertilisation and Embryology Authority (HFEA) has outlawed payments to surrogates and British IVF clinics allow doctors to implant only two embryos into the uterus in a treatment.
In India, five implants are allowed, substantially increasing the chances of pregnancy, and there is no shortage of egg donors.
“Attitudes towards egg donation are changing fast. Thirty years ago, Indians would balk at the idea of donating blood to a stranger, but now they don’t,” said Malpani.
A majority of Indian egg donors are housewives who are paid between Rs6,000 and Rs40,000 ($120-800), depending on their education level. Many of the women come from poor families.
Among the foreigners seeking fertility services in India, a good number are couples of Indian origin who come home to look for an Indian donor.
“Having a baby is an emotional issue,” said Malpani, who runs the clinic with his wife Anjali.
“These people should be called reproductive exiles, not reproductive tourists. No one likes to travel for medical treatment,” he said.
Critics, however, say the absence of regulation poses health dangers, as well as ethical issues about “rent-a-womb” exploitation.
“This business is like any other outsourcing industry. The only difference is the treatment offered here is very poor,” said Puneet Bedi, a specialist in foetal medicine at New Delhi’s Apollo hospital.
“Doctors here take short cuts, they implant more embryos than needed which multiplies risk to the mother.”
A draft bill on assisted reproduction has been drawn up and is expected to be tabled in parliament soon, but women’s health activists argue that it is aimed more at promoting a lucrative business than addressing health and ethical concerns.
“It was getting embarrassing for the government to keep saying there is no law in the country, so they had to come up with something,” Bedi said.
On the back of a booming industry, medical companies have launched special deals that offer a range of health and travel services targeted at foreigners.
Right from arranging the medical visa - which was introduced three years ago to boost medical outsourcing - to providing recuperation holidays, companies like Mumbai-based Forerunners and Delhi’s Life Smile take care of all requirements.
“Most people who come to us, especially for IVF, go in for a travel package too, since they have come all the way to India,” said Kamal Parpyani, managing director of health tourism company Life Smile.
According to a 2004 study, India could earn as much as $2 billion annually by 2012 through medical tourism, including from fertility services for overseas patients.
Doctors say Indians will benefit not just from the revenue, but also a reduction in the cost of expensive treatments as demand and competition grows.
“It’s a market economy. The bad doctors will be weeded out and benefits will trickle down to people in smaller towns,” Malpani said.