Fertility clinics aren't just serving the international market, they're increasingly serving the domestic market as well. And regulation has not kept pace with the proliferation of clinics as India emerges as the Wild West of fertility. In recent years, facilities have been accused of a litany of shocking abuses -- from exploiting impoverished women who became surrogate mothers to prescribing unapproved fertility drugs to delivering "stateless babies" who are refused citizenship by both their mother's country and their Indian birthplace.
The Indian government is gearing up to pass a new law to regulate the fertility business, prepared by a 12-member committee of the Indian Council of Medical Research and expected to be tabled in parliament in the coming months. It mandates that all fertility clinics be registered with the government; spells out specific guidelines for the sourcing, purchase and storage of gametes; and also explicitly enumerates the health and legal rights of surrogate mothers and babies delivered by them.
But one pressing issue has remained beyond the purview of regulation: How old is too old to get pregnant?
In 2008, Rajo Devi Lohan, an Indian woman from a tiny village in the northern state of Haryana, became the world's oldest mother at the age of 70. About a year and a half later, Bhateri Devi, a 66-year-old from the same state, became the world's oldest woman to give birth to triplets.
In India, as in many other countries, medically assisted procreation techniques have long been the preserve of the upper-class elite. But in recent years, with proliferating clinics hawking cheap treatment, it is fast becoming the trend du jour among middle- and working-middle class couples, including the elderly. Bearing children at an old age is considered anathema to cultural norms in India, as the Biranjes have learned, but it often does not overshadow the social pressure to reproduce.
After about five decades of a childless marriage, both of the Haryana women were impregnated by fertilized eggs implanted to their post-menopausal uteruses by Dr. Anurag Bishnoi, who runs a private fertility clinic in the city of Hisar. Lohan's health rapidly deteriorated after her caesarean delivery and she suffered internal bleeding. In various media interviews, she said she is still surviving on pain killers and wasn't forewarned by Bishnoi about the dangers of giving birth at her age.
Critics say Lohan's predicament is not an isolated case. Fertility clinics generally don't offer patients reliable information about IVF's low rate of success and high probability of health complications and fetal abnormalities. Women over the age of 50 who undergo IVF are known to be prone to a high incidence of gestational diabetes and pregnancy-associated hypertension. With an older uterus being less capable of effecting normal labor and vaginal delivery, the chances of cesarean delivery in women of this age group are significantly higher after IVF than with natural conception. There is also a high probability of twins or triplets -- which increase the chances of maternal and neonatal morbidity.