Poverty-ridden Tamil Nadu women forced to sell eggs at fertility clinics despite risks
In December 2021, the Lok Sabha passed the Assisted Reproductive Technology (Regulation) Bill, 2020, to regulate assisted reproductive technology services, and sperm and egg banks that have mushroomed across the country.
She is only 40 years old but has donated her blood, her eggs, a kidney, been a surrogate to support her family and has already reached menopause. For this Chennai-based woman living in an impoverished neighbourhood, being a donor is a euphemism as she got paid every time, which used to repay her loans.
“All this while, I made sense that I was doing something good by helping those who do not have children,” she said. “But now I feel like I am close to dying with so many problems in my body. It’s like I didn’t do good, but I sinned.” Her breathlessness – one of the consequences of what she has put her body through – made her pause often while speaking.
The recent case of a 16-year-old girl’s eggs being illegally donated to fertility clinics across Tamil Nadu, Kerala and Andhra Pradesh have brought the focus on how women are exploited as most egg donors in India are poor women. Tamil Nadu government took immediate action – arrested the family and intermediaries and sealed the four hospitals in the state. The case is now in the Madras high court.
According to activists, fertility clinics often receive these women or egg donors through a network of agents. The women receive anywhere from ₹20,000 to ₹30,000 for selling their eggs, which is substantially more than what they otherwise earn. But injecting hormones, and repeatedly stimulating ovaries to make them produce multiple eggs for retrieval could have several medical consequences.
Women like the 40-year-old mentioned above are part of an unregulated global IVF egg donation market. In December 2021, the Lok Sabha passed the Assisted Reproductive Technology (Regulation) Bill, 2020, to regulate assisted reproductive technology services, and sperm and egg banks that have mushroomed across the country. The Bill seeks stringent punishment for those practising sex selection, sale of human embryos or gametes, or found running agencies, rackets and organisations for such practices in violation of the law. It came into force in June.
The law is clear that only a woman between 21 and 34 years who have already given birth can donate eggs. And a woman can donate her eggs only once. “There is no problem if the law is followed. But if there is any violation our government will take stringent action against hospitals,” said health minister M Subramanian. “We have now apprised all districts of ART guidelines. The case of the child (the 16-year-old girl) who was also sexually assaulted is one of the worst things that can happen. Through that, we got to know about this issue in-depth. Some support the practice of adult women being egg donors. They say it is for their livelihood and is better than prostitution.”
A ‘GOLDEN EGG’
Married at the age of 15 and a mother at 17, the now 40-year-old Chennai woman began donating her eggs at the age of 33, which is late compared to most other donors. She donated her eggs thrice continuously. With a gap of six months between each donation, she completed the cycles within less than two years.
It was a time when she had taken a ₹50,000 loan for marrying off her first daughter. She has two other daughters and a son. She had borrowed money from a neighbourhood lender who often showed up at her home in the slum. “Every morning, they used to come to my house and verbally abuse us for not repaying on time,” she said. Watching this, an elderly woman, whom she didn’t know much except that she worked as a cleaner in the hospital, approached her one morning. The elderly woman planted the idea of donating her eggs to earn money and solve her problems. Her four children didn’t agree at first. “They were embarrassed. They thought people would shame us. If you are born a woman, especially a poor woman, people find ways to shame you no matter what you do. I convinced my children. I made them understand that families may be wealthy, but if they are not blessed without a child, they come to people like me. We are making their life better,” she said.
And so, she went to a private hospital with the elderly woman. The staff checked her height and weight, which was 55kg, and later her ultrasounds were taken often. The first time she was given 10 hormone injections – one day each.
A woman usually generates an egg or two every month, so the hormone injection’s role is to stimulate her ovaries to make them produce multiple eggs for better chances of harvesting them. After about 20 days, she was put under general anaesthesia. On the surgical table, her eggs were extracted and fertilised with sperm in a laboratory, popularly known IVF – in-vitro fertilisation.
The hospital then gave her ₹30,000, out of which ₹2000 went to the elderly woman. “I got 28,000 though I know my eggs are sold for lakhs.”
The Chennai donor woman doesn’t know where the sperm comes from and who receives her fertilised eggs, which would be implanted in another woman’s uterus. The Indian Council for Medical Research guidelines does not allow donors and couples to meet.
But people on the other end of this process, the couples who receive egg donations, do make requests for the kind of woman they want as their egg donor. “The foremost request is for a fair woman,” says A J Hariharan, secretary of Chennai-based Indian Community Welfare Organisation. Since 2012, his organisation has worked with 8,000 women who are surrogates and egg donors in Chennai and adjacent districts of Kancheepuram and Thiruvallur. “The next request is for a woman from the same caste, although this is not openly expressed. They would say something like they want a vegetarian egg donor. They also want egg donors from the same religion. The hospitals and agents readily agree but mostly dupe them. And only till the procedure do they treat them like a golden egg and golden woman. Once they don’t need her, nobody is there to care for them,” Hariharan said.
MONETISING THE OOCYTE, FAILING ON HEALTH
A 33-year-old woman from Tamil Nadu’s Cuddalore district has donated her eggs eight times. “They only paid me ₹25,000 each time,” she said. She had a loan of ₹ 2 lakh, so she donated eight times between 2014 and 2016.
“I had to do it for my family. Now, I’ve won against my challenges, and I will never go back to doing this,” she said. She became familiar with this egg donation when she had gone to visit her sister’s birth at a local hospital and saw posters all over saying: Wanted: Egg Donors.
She consulted the doctor, and her life changed for the better and worse. Her husband had abandoned her and the children, so this money got them through. In between the donations, she conceived a third child, who is frail. The woman herself has become frail and fatigued over time. “Each time, the procedure took a minimum of 55 days,” she said.
While she didn’t wish to speak more about her “struggle”, the 40-year-old Chennai woman said that she has breathlessness, insomnia, pain in her limbs, especially on her knees, and always feels fatigued. “If I lie down, I cannot get up. It takes so long, and my shoulders, banks and limbs hurt so much,” she said. She sleeps on the floor, wakes up at 7 am and cooks for her family. Since she has stopped donating, she goes to collect scrap from the dump yard to sell.
She didn’t even know the gender of the baby. “99% of surrogate babies are C-section babies,” said Hariharan. Six months ago, she had an early onset of menopause.
The frequent egg donations can cause a life-threatening condition called OHSS Ovarian hyperstimulation syndrome (OHSS), said Chennai-based gynaecologist Dr Akhila Bhatt. “It may cause extreme changes in the menstrual cycle, monthly swellings because of increased stimulation of ovaries, early onset of menopause, pregnancy due to some unretreived eggs or premature ovulation. Sometimes there could be infection and bleeding too,” Dr Bhatt said. “This is a time-consuming and stressful procedure since the procedure is mostly anonymous, and a donor knows that she may have no role to play in the child’s life.”
The Chennai egg donor said the hospital had warned her of health complications. “But I wanted money. So, my thinking was first to repay the debts, and then I will think about my health,” she said. “If I had money, would I do this?”
Cuddalore-based activist Arokiya Mary from the All-India Democratic Women’s Association said that innumerable women are stuck in this business due to poverty. “We have thought a lot about how we can protect these women from being exploited. And we don’t have an answer. They are all doing it only for their livelihood. The state has to do something for them,” said Mary.
Once these women reach an age where they can no longer donate eggs and become surrogates, some of them turn into agents. “Sometimes hospital staff tells the women the broker is charging you ₹5000, I will charge you only ₹2000, so next time, come to me directly. The network keeps thriving,” said Hariharan. “It’s also booming because when in other countries there are more restrictions, regulations like in Norway, they connect to egg donors and surrogates here.”
He said that these women should be included in government schemes such as the case widow pension. “So that they don’t feel the need to do this repeatedly,” he said, calling for enumeration of the total number of surrogates, and egg donors and only allowing direct links between medical institutions and these women without agents.
The Chennai egg donor reached out to agents from the time she donated her kidney six years ago and her eggs seven years ago. “Nobody is picking up my call. I’m struggling.”