IVF clinics mushroom under toothless ICMR guidelines (Feature)

October 19th, 2011 - 1:34 pm ICT by IANS  

New Delhi, Oct 19 (IANS) While one-year-old Chirag takes small steps in the courtyard, his mother Savita Bhati lies still with swollen legs on a cot at her sprawling residence in west Delhi. Bedridden due to chronic osteoporosis, Savita gave birth after 34 years of marriage through in-vitro fertilisation (IVF) done at the age of 56.

She was never told about the dangers of undergoing the IVF treatment at an age when she had neared menopause and become vulnerable to many other age-related disorders.

“The private clinic I chose with my family had assured us of results. Having stayed childless for so many years, nothing sounded more important than having your own flesh and blood in the cradle,” Bhati, who underwent the IVF therapy at a private clinic in Uttam Nagar, told IANS.

“At least I will not be known barren,” she spoke as she struggled to sit with a pillow behind her back.

For Bhati’s family, the fact that it “has a heir is a blessing in itself”.

With the World Health Organisation (WHO) estimating that 13-19 million couples are infertile in India, IVF clinics have mushroomed unhindered.

The deep-rooted stigma associated with childlessness makes some clinics go all out, even if it means flouting Indian Council of Medical Research (ICMR) guidelines on Assisted Reproductive Techniques (ART), with some of them surviving on outdated equipment and lack of skilled doctors.

Fertility experts say nothing can be done with the ICMR guidelines, until the ART bill is introduced for strict compliance.

“ICMR is just associated with formulating guidelines on accreditation of IVF clinics. ART is a growing sector…If the demand is there, people will seek private care,” ICMR director general Vishwa Mohan Katoch told IANS.

“I cannot comment on the regulation of mushrooming clinics because it is not ICMR’s job,” Katoch added.

IVF, considered a form of ART, is used to conceive the child outside the woman’s body. The eggs and sperms are placed together under controlled conditions for fertilisation, after which the resulting embryos are placed back in the woman’s uterus to initiate pregnancy.

The 128-page ICMR national guidelines were given in 2005. But these have drawn flak for want of a stringent licensing procedure to open IVF clinics, other than failing to draw up any regulation on the age of the woman undergoing IVF treatment and insufficient monitoring of existing clinics.

“To open an IVF clinic, you need to get the certification needed to open a general nursing home. Licensing of the ultrasound machine is also needed because of the act banning sex determination. The staff does not matter - you keep one or two gynaecologists, have the basic infrastructure to give a hunky-dory picture of the clinic,” says Abha Majumdar, who heads the centre of IVF and human reproduction at Sir Ganga Ram Hospital.

The cost of setting up a clinic runs up to Rs. 10 million. With the cost of a single IVF treatment being around Rs.150,000, it is not very difficult to recover the initial cost, Majumdar said. The government-run centres charge around Rs.60,000.

The desperation and dreams come alive at hundreds of such clinics, with many promising a success rate that is not practical, say experts. The success rate of the treatment actually lies between 30 and 40 percent.

“The sad truth is that IVF centres are mushrooming so much that there is no cap on the procedure, equipment, quality, regulation on donor eggs, and the woman’s health condition is also ignored at times,” Majumdar told IANS, adding there is no registry maintained to tell the number of clinics.

The practices common at these clinics include the auction of donor eggs for pregnancies among 45-plus women and repeated IVF cycles in the name of achieving success - sometimes endangering the woman’s
life.

Sudha Prasad, IVF programme coordinator at the Maulana Azad Medical College (MAMC), estimates there is a new clinic coming up every 10 days. The MAMC centre, started in 2008, has done over 280 IVF procedures so far.

“Earlier it was a high-end treatment, but now even couples from small towns are coming after taking loans. The reason is the awareness and demand for the treatment,” Prasad said.

The ART bill, which was approved by the health ministry and the law ministry, is yet to be tabled in parliament. It presses for stronger monitoring and regulatory measures for the clinics.

“We have the regulatory guidelines by ICMR. But in the absence of law, they are toothless,” she concluded.

(Madhulika Sonkar can be contacted at madhulika.s@ians.in)

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