India's Fertility Market: Exploitation of Vulnerable Women

India's impoverished women risk exploitation donating eggs to fuel a booming fertility industry.

### The Hidden Cost of Egg Donation in India's Fertility Market
* 💔 Sumati, a fertility agent in Chai, persuades neighborhood women to **exchange their ovarian eggs for cash**, navigating a **complex and often exploitative industry**.
* 💰 Suti, a 40-year-old woman from a life of poverty, transitioned from being an egg donor and surrogate to a broker, taking a **10% cut** from each donor she connects with fertility clinics.
* 📈 India's fertility market is part of a **$35 billion global industry**, but the arrangement is rarely equal, as impoverished women often donate eggs out of **financial desperation** while clinics profit significantly.
* ⚖ Although the 2021 ART Act aims to protect donors, the reality is that egg donation remains **largely underground**, with many women unaware of the **risks or legalities involved**.
* 💉 The egg retrieval process involves painful procedures and health risks, including the **potential for severe complications**, yet many women prioritize **immediate financial needs** over long-term health.
* 📜 Illiteracy among many donors leads to a **lack of understanding of consent forms**, leaving them **vulnerable to exploitation** and **unable to seek necessary follow-up care** after donation.
* 🚫 Advocates warn that the fertility industry **exploits India's poorest women**, with laws feeling **distant and ineffective** in addressing the inequalities faced by these vulnerable populations.
* 🤝 As the demand for IVF increases and cultural pressures mount, the **exploitation of marginalized women** in the egg donation process raises **critical ethical questions** about the **true cost of fertility** in India.

Their blood wounds and ovarian eggs: just some of what Sumati convinces neighborhood women to exchange for cash. It's an open secret that she is the fertility agent in the shadows of Chai's vibrant cityscape. Countless women face the harsh reality of having few ways to make a

living, with loneliness circling her doorstep. Forty-year-old Suti has only known a life of poverty. Years ago, Suti donated her eggs and later worked as a surrogate before becoming a broker, connecting other women with fertility clinics and taking a

roughly 10% cut from the donor. Her role is crucial in shaping India's fertility market, a rapidly expanding part of a $35 billion global industry. But this trade is rarely an arrangement between two equals. Impoverished women with few job opportunities are donating their eggs to

survive, while clinics are making significant profits. As these women supply the product underpinning India's booming fertility industry, we ask: What is the true price of an egg? Sumati was born into what's considered to be the lowest-ranked caste

in India's social hierarchy. Now she recruits local women to serve as egg donors. With no running water, residents rely on communal taps – a fixture in this area that Sumati uses as a place to find her clients. She requested we only use her

first name for her safety. The egg donors we spoke to also asked that we keep their identities hidden for safety reasons.

Young girls and women are approached by hospital workers, cleaning ladies, relatives, and friends. Sourcing egg donors is a big challenge; there is not much awareness, and you cannot pay money legally. So how do you source egg donors? There are some intermediaries who help in

getting egg donors. You cannot see any upper-class, very rich people, or millionaires donating. Raw material is being supplied by the marginalized people. The Dalits are among the most marginalized groups within the Indian caste system, often deprived of quality education and jobs. But these women carry something

more valuable than anything among their family's modest possessions: their fertility. For Sumati, this is the way she can turn that possession into cash. She's a cog in a sprawling network of agents and go-betweens across the country, profiting from the sale of human

eggs. Every 15 seconds or so, human eggs are taken from a woman somewhere on the planet to satisfy the global demand for assisted reproduction. India is now home to the world's biggest population, and it's seeing a huge demand for IVF, or in-vitro

fertilization. As the number of IVF cycles continues to climb, more eggs than ever are needed to power the industry. Ten years back, the number of clinics was very low, whereas now the clinics are mushrooming; every street has

three or four clinics. Now the problem with the fertility industry is too much competition and too much greed. Indian women face cultural demands to have children, fueling the market. Couples are also getting married later and have higher disposable income, plus there's greater awareness about

Infertility treatments. Infertility is considered a social stigma in India. If Indian people have infertility, they are ready to spend a lot, as the demand for eggs only increases. India passed a law in 2021 to protect donors who put their

health at risk during the donation process. It established a National Registry of clinics and banks and outlined requirements like age and the maximum number of eggs that can be extracted. On paper, egg donation has to be altruistic in India, but practically speaking, 10 days of injections, undergoing

anesthesia to donate eggs—nobody wants to give them free of cost. So, what happens? These ART banks and these couples pay some consideration for the egg donor. As per the ART Act, the notification says that you cannot pay anything to the egg donor, but some amount can be paid for

example, travel and food expenses; all those things can be paid. So, clinics and ART banks are utilizing this particular loophole to pay the egg donor. Egg retrieval is not without pain or risk. First, egg donors are pumped with drugs for 10 days to trigger super

ovulation, which is when the female body releases more eggs than usual. This offers a better chance of a live birth and greater profit, but can sometimes pose health risks. There have been reports of rare cases where donors face complications after their ovaries were overstimulated,

and even death. Fertility doctors also say the new rules made it nearly impossible to source eggs legally, essentially driving egg donation underground and putting egg donors at even more risk. Many people in the industry are also not very clearly aware of the nuances of the act and

Then rules and so the industry is going unchecked. Even now, it takes time to regularize the industry; more and more exploitation will be happening. The government has restricted third-party reproduction: egg donors, sperm donors—everything. And they want it to be realistic: only one donor per couple, but...

considering that the majority of the population in India is below the poverty line and they cannot afford IVF treatment, if you're going to restrict so much, how will they become pregnant? So, treatment has to be equitable; treatment has to be affordable for everybody. I...

hope that the Supreme Court at some point changes the rule. Legally, egg donors are required to sign consent forms ahead of becoming an egg donor, in the event there are complications with the procedure. But the majority of these women are illiterate, uneducated; most of the time, they will not...

read; they will sign without reading it. Dr. Shanti confirms that, at times, this could be the case. Unfortunately, these people are not coming to the clinic after egg donation for their own follow-up; they will just come for their monetary need and then they will just go away...

with the money. Even if they are interested, even if they are aware that they need to come for a check-up, they cannot come because of their pressuring need to earn. It is inhuman to treat such donors...

[Music] Donors. Advocates warn that India's poorest women are at the mercy of an industry that preys on the most vulnerable. For Sumati and the other women in her village, the people who make the laws feel worlds away. [Music]

India’s Fertility Dilemma: Inside the Rush for Human Eggs

Bloomberg Originals offers bold takes for curious minds on today’s biggest topics. Hosted by experts covering stories you haven’t seen and viewpoints you haven’t heard, you’ll discover cinematic, data-led shows that investigate the intersection of business and culture. Exploring every angle of climate change, technology, finance, sports and beyond, Bloomberg Originals is business as you’ve never seen it.


Bloomberg Originals

The hidden fertility market in India and the exploitation of impoverished women.

Sumati, a fertility agent, convinces women to donate eggs for cash, exploiting their economic vulnerability.

Suti, a former egg donor and surrogate, now brokers deals, highlighting the systemic nature of the exploitation.

Impoverished women donate eggs due to lack of opportunities, while clinics profit significantly, creating an unequal exchange.

Sumati's low caste background underscores the targeting of marginalized communities in this market.

Anonymity is requested by Sumati and the donors due to safety concerns, illustrating the risks involved.

Challenges in sourcing egg donors and the role of intermediaries.

Difficulties in legally sourcing donors due to lack of awareness and legal restrictions on payment.

Marginalized groups, particularly Dalits, are the primary source of egg donors due to limited opportunities.

Sumati's role as a cog in a large network profiting from egg sales highlights the systemic nature of the exploitation.

The booming IVF market in India and its impact on egg donation.

India's large population and increasing demand for IVF drive the need for more eggs.

The rapid increase in fertility clinics leads to increased competition and potential for exploitation.

Cultural pressures, delayed marriages, higher disposable income, and increased awareness of infertility treatments fuel the market.

The social stigma surrounding infertility in India contributes to the high demand for eggs.

Legal regulations and loopholes in India's egg donation system.

The 2021 law aims to protect donors but faces challenges in enforcement.

Loopholes in the law allow for indirect payments to donors despite the ban on direct compensation.

The egg retrieval process involves risks such as ovarian hyperstimulation syndrome and even death.

New rules make legal egg sourcing difficult, driving the practice underground and increasing risks for donors.

Consequences of restrictive regulations and the need for equitable access to fertility treatments.

Government restrictions on third-party reproduction limit access to IVF for many.

The need for affordable and equitable access to fertility treatments is highlighted, particularly for the impoverished.

Illiteracy among donors leads to uninformed consent, further exacerbating the ethical concerns.

Lack of post-donation follow-up due to economic pressures highlights the vulnerability of donors.

The inhumane treatment of donors is criticized, emphasizing the need for better protection.