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Donor Deaths in India Highlight Surrogacy Perils

Tuesday, June 17, 2014

Two women have died from causes tied to their role as egg donors in India's booming market for artificial reproduction. Advocates are pressing the government to publicize health warnings and pass regulations.

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Two women have died from causes tied to their role as egg donors in India's booming market for artificial reproduction. Advocates are pressing the government to publicize health warnings and pass regulations.
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Street in India

Credit: Pranav Yaddanapudi

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NEW DELHI (WOMENSENEWS)--When Yuma Sherpa told doctors at a private fertility clinic here that she wanted to back out, her husband's lawyer says they encouraged her to keep going.

Sherpa was assured the pain of the injections to make her super-ovulate, or produce far more than the usual one egg during her menstrual cycle, would end once her eggs were harvested. But when the 26-year-old shop assistant died after the surgery in January, her husband filed a complaint with the Delhi Medical Council charging medical negligence.

"The tragic death of the young woman in the prime of her life is shocking," Sudha Sundararaman, vice president of the All India Democratic Women's Association, told Women's eNews in a phone interview. "While there are laws in the country to prevent the sale of blood, there are no binding guidelines for such procedures related to assisted reproductive technology. With no monitoring of their impact on the health of women, most clinics just do as they please."

Sundararaman's Delhi-based association is one of several women's groups seeking a criminal investigation into Sherpa's case and government regulation of the booming assisted reproductive technology industry in India.

The women's groups have written to the Delhi police as well as the federal health minister demanding an inquiry into the reasons for Sherpa's death. They want the license and qualifications of the doctors and staff at the clinic to be checked and the clinic's facilities to be reviewed.

In a normal reproductive cycle, a single egg matures during ovulation. Assisted reproductive technologies inject gonadotropin, a hormone, to produce multiple eggs. Since there is no standard protocol on gonadotropin dosage or limits on the number of eggs that should be retrieved, some doctors use a dangerously high dosage that allows them to harvest as many as 50 eggs in surgeries that require anesthesia, heightening the risk of the procedure.

Doctors attending to Sherpa have denied charges of negligence. Until a detailed forensic autopsy states the reason for her death, Sherpa's husband cannot file a police case, says Vikram Pradeep, the lawyer assisting her husband.

In March, an initial post-mortem report conducted by the All India Institute of Medical Sciences, a premier government hospital, said the cause of death remained "pending the availability of viscera and histopathology reports from the (government's) Central Forensic Science Laboratory."

Case of Indefinite Delays

"It is already six months and we have not received the viscera report yet," Pradeep said in a phone interview. "I have filed a case in the district court on behalf of Sanju Rana, Sherpa's husband, because of the indefinite delays in the case."

Neither the police nor forensic lab officials could be reached for comments on the delays in the case.

The All India Women's Association, which was the first organization to protest against Sherpa's death, has tried but failed to expedite the report by the lab, which blames the delay on a backlog.

Activists say some of the regulatory delays are tied to money. The $2 billion fertility industry in India is an integral part of the country's growing medical tourism industry, which grew 15 percent between 2005 and 2010, . In the absence of regulation, cheap medical facilities are making India an increasingly strong magnet for childless couples.

Fertility centers openly invite women in the age group of 25-30 to join them in helping childless couples. "The concept is promoted as a way of easy income generation for women," said Sundararaman. "Health professionals in the western state of Gujarat have openly accepted they were helping unemployed women stand on their feet. It is no wonder why the private sector is balking at the regulation of assisted reproductive technology."

"The business volume of this trade is rising with the number of surrogacy cases increasing at a galloping rate," said Ranjana Kumari, director of the Delhi-based Center for Social Research, in a phone interview. "The lack of regulation also poses a problem for government agencies to initiate legal provisions and take substantive action against those found guilty."

Pradeep says Sherpa's family had turned down the clinic's offer of about $500 for the eggs it had already harvested. "Many cases of negligence go unreported because families are unable to pursue cases against the medical clinics even when there is disability arising from such procedures, mainly because they are economically disadvantaged and simply accept the money," said Pradeep.

Hoping to Set a Precedent

He added that unofficial agents of fertility clinics often persuade women such as Sherpa to donate their eggs. "These middlemen need to be held accountable as well. We are hoping that this case will set a precedent by way of court directions for regulation and punitive action which will safeguard the rights and health of donors."

In August 2010 Sushma Pandey, a 17-year-old working in a scrap depot, died in a Mumbai hospital after severe abdominal pain two days after she had donated eggs for the third time within18 months. The Mumbai High Court asked the police to investigate the role of the hospital, but so far no one has been held responsible. Pandey is India's first known case of death from egg harvesting; she suffered "brain hemorrhage and pulmonary hemorrhages due to ovarian hyper stimulation," according to news reports quoting her autopsy results.

For each session she had earned a little over $400.

Such payments often present women struggling with poverty with an offer they can't refuse, activists say, which limits their ability to make a truly free choice. Given that, they want more publicity of medical warnings and for the government to protect low-income women from making excessively risky decisions.

In 2005 the federal Indian Council of Medical Research recommended that a donor should be between 21 and 35 years old, should donate a maximum of six times with at least three months between every donation. The guidelines also say ovarian stimulation should be carried out with the utmost caution to avoid ovarian hyper stimulation syndrome and that donors should be informed about the risks of fertility procedures, such as swelling, pressure in the ovarian area, vaginal dryness, hot flashes, ovary loss and even death.

Pradeep, the lawyer for Sherpa's husband, says the Delhi clinic did not warn her about the risks. "The prescribed guidelines insist on not just proper counseling but the signature of the husband on the consent form. Neither was done."

Draft legislation that would make the Indian Council for Medical Research guidelines legally binding has not yet been presented to the lower house of Parliament (for which the elections just concluded in May).

Draft Bill Insufficient

Deepa Venkatachalam, a health activist with Sama, a Delhi-based advocacy group for women's health, says any bill that goes before the new parliament must limit the commercialization of women's bodies and provide stronger protections to the cash-strapped women who often donate eggs or become surrogates.

"The draft bill has significant gaps," said Venkatachalam, who spoke to Women's eNews in Delhi  "It is important to promote accountability among the providers, establish systems of audit of clinics and follow up regarding the health of donors."

Sundararaman, of the All India Democratic Women's Association, agrees. "Protection offered to egg donors and surrogates are completely inadequate, especially in terms of the medical risks that they undertake," she says. "There is no mention of 'death' in the entire draft bill. A comprehensive, effective and enforceable law is essential to safeguard the interests of poor women who are the worst affected by the unscrupulous and unethical practices."

The Indian Council of Medical Research in 2013 established a national registry to track and standardize the hundreds of thousands of fertility clinics estimated to be operating in this country of 1.21 billion people. But the process has been slow. As of May 31, only 237 had met the minimal specifications for medical training, facilities or staffing. None have been certified yet since the second part of the process, which includes physical inspection, has not started, said Dr. R. S. Sharma, deputy director general of Indian Council of Medical Research, in a phone interview.

The clinic where Sherpa donated her eggs is one of those now awaiting certification. "I sought information about the clinic from the clinic under the Right to Information Act," said Pradeep. "The council responded saying no clinic was registered with them yet."

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