Dark side of IVF boom: Money pours in but industry remains unorganised

India is in the midst of IVF boom. With people marrying late, lives in cities becoming busier & more stressful, & air pollution taking its toll, more & more couples are turning to IVF for conception

In the summer of 2022, a 16-year-old woman in Erode, Tamil Nadu, drank floor cleaner in an attempt to kill herself. She had been put in a government home after the arrest of her mother and stepfather on charges of forcing the girl to donate her oocytes — a cell in an ovary that goes on to form an ovum — to fertility centres on eight occasions for money.

The case blew the lid off the murky side of in vitro fertilisation (IVF), a procedure that helps people with fertility issues have babies by combining eggs with sperm in a laboratory.
 

About 2,300 km up north from Erode, in Greater Noida, a young woman reportedly died following a botched-up IVF procedure at a private hospital. The doctor was allegedly untrained and had a fake degree.
 

Last September, the Delhi Medical Council suspended a doctor’s licence for a month because she was charged with providing eggs from a patient undergoing IVF treatment, without her consent, to two other women.
 

India is in the midst of an IVF boom. With people marrying late, lives in the cities becoming busier and more stressful, and air pollution taking its toll, more and more couples are turning to IVF for conception. In certain cases, there is support from governments. Sikkim, where the birth rate has plummeted, the government has been offering cash to childless citizens for IVF treatment. This week, Goa became the first state in the country to provide IVF free at government hospitals.
 

India completes 300,000 IVF cycles a year. Each IVF cycle costs Rs 1.7 lakh to Rs 2 lakh, and another Rs 1 lakh to Rs 1.5 lakh during the nine months of pregnancy, resulting in a market size of Rs 6,000 crore to Rs 7,000 crore a year. By 2030, 

the number of cycles could double. 
 

The country is among the top three in the world with more than 2,500 fertility clinics.
 

No wonder, investor money is pouring in (see graphic). Last month, private equity giant BPEA EQT said it would buy a majority stake in the country’s largest fertility clinic chain, Indira IVF, reportedly valuing it at $1.1 billion.
 

However, less than half of the country’s IVF industry is organised, meaning with either corporate hospital chains or clinic chains or renowned gynaecologists. “Around 51 per cent of the market lies with smaller, standalone clinics,” says the head 

of a large IVF chain who does not wish to be named.

• IVF cycles in a year: 300,000
• Unorganised sector’s share: 51%
• On the cards: cleanup, consolidation

Naturally, horror stories abound. Gujarat is one of the largest surrogacy and IVF hubs in the country, with an estimated 150 IVF and surrogacy clinics. Not all of them are kosher. “There are more unregulated clinics in Gujarat than regulated ones. Malpractices such as extracting every last ounce of eggs leave the donors on the brink of menopause at a young age. All this for a paltry sum paid to the donors, while the clinics pocket a hefty amount,” says an IVF expert.
 

There is also a lack of infrastructure and documentation, and fees run into lakhs of rupees.
 

“I think there is a certain glamour associated with the IVF procedure among the young medical professionals, but the erstwhile rosy picture is not there anymore. At times the young professionals are not fully trained,” says Lucknow-based IVF expert Geeta Khanna, stressing the need for an insurance cover for IVF.
 

The new Assisted Reproduction Technology and Surrogacy Act, which came into effect last year, seeks to bring in 

much-needed stringency and streamlining of operations.
 

However, regulations are also likely to increase the cost. Nayana Patel, medical director of Akansha Hospital and Research Institute in Anand, Gujarat, says the cost could rise by 15 per cent.
 

Kshitiz Murdia, CEO of Indira IVF, says the new law is designed to ensure patient safety and transparency at the clinics. Several smaller players, he says, are now interested in working under the umbrella of a big corporate player to be compliant.

Vineet Mishra, director, Institute of Kidney Diseases and Research Centre, Institute of Transplantation Sciences, in Gujarat, says: “With the regulations coming in, the industry will see consolidation.”
 

Large clinics have started coordinating among themselves through social media groups to remain on the right side of the law. “We always discuss any issues, any interpretations of the law that needs clarity, and share the challenges we face in WhatsApp groups. Since there is no industry body for this sector at the moment, these informal gatherings help,” says the head of an IVF chain on the condition of anonymity.
 

At least half of the unorganised sector is expected to get consolidated in three to five years as more states adopt the new law and some get convicted under criminal proceedings.
 

Among other things, the new law limits the number of oocytes taken from a person, which involves two distinct components. The first concerns limiting the number of embryos transferred to a patient to avoid multiple births during the IVF treatment. Previously, clinics would implant three to five embryos to increase the chances of pregnancy. However, this led to health risks for both the mother and the babies.
 

The second part relates to donors. The law initially restricted retrieval to not more than seven follicles from a female donor. A recent notification requires all follicles to be retrieved to ensure the safety of the donor.
 

Now a donor can only donate once in her lifetime. IVF centres cannot stimulate the donor to retrieve more eggs and must get 12 months of insurance coverage for donors from the couple using the oocytes.
 

“Certain norms such as the upper age limit should be reconsidered. Also, the punishment for medical offences seems to be a bit too harsh,” says Patel, adding that egg dona­tion being limited to once in a lifetime is also “a bit tricky”.
 

Doctors in Chennai claim the growth of the industry has slowed since the final regulations came in March 2022, and that patients in Tamil Nadu have to wait for a year for their IVF treatment to begin.
 

About 400 km from Chennai, in Erode, a 16-year-old woman who attempted suicide won’t be complaining about the slowing 

pace of the business.