India's Dark Side of IVF: Exploitation and Trafficking in the Egg Donation Market

India's unregulated fertility industry exploits vulnerable girls, highlighting the urgent need for stronger legal protections.

### India's Fertility Underworld: Exploitation and the Fight for Justice
* 🌍 Rising global demand for IVF and egg donation exposes a dark side in India, with cases of underage girls being exploited.
* 👧 The illegal egg retrieval from a minor in Varanasi highlights a widespread problem, with estimates suggesting "hundreds of similar cases" across the country.
* 💔 The case reveals a systemic failure to protect girls, despite societal reverence, exposing a "big collusion" involving middlemen and clinics.
* 💪 Guria India, a 35-year-old NGO, fights sex trafficking and exploitation, highlighting the need for holistic solutions beyond rescue operations.
* 🧪 IVF, while offering hope for parenthood, presents risks like ovarian hyperstimulation syndrome, and egg donation raises ethical concerns.
* ⚖ ️ The Varanasi case investigation, initially promising, slowed, omitting crucial actors like doctors and the large clinic, Nova IVF, from the initial charges.
* 💸 Nova IVF's rapid growth, fueled by investors, allegedly led to compromised standards, showcasing the dangers of unregulated growth in the fertility industry.
* ⚠ ️ The case underscores a larger criminal network facilitating egg sourcing and forged documents, leaving the ultimate fate of the eggs and potential children born from them unknown, posing haunting implications.

As more women in the workforce delay having children until later in life, they are increasingly turning to the fertility industry. The market for IVF is growing across the world almost everywhere. Consequently, the egg donation market is growing really quickly too.

Our investigation found that in India, some of the worst cases of harm were surfacing. Cases of children lured into selling their eggs. Egg retrieval for minors is illegal and can be life-threatening.

This case, in some ways, is just the tip of the iceberg. The human egg has become a global commodity. Donor eggs provide hope to some families, but there is a dark side to it. You're talking about one Varanasi case.

I can guarantee there must be hundreds of similar cases happening all over the country. Most people don't talk about it. Most people are simply bought off. What a big collusion! Where do you place women and girls in this country?

You are talking about respecting girls. You can worship girls in the temple, but when it comes to giving them real justice and real action, as a nation we are failing, I would say. It was a very spontaneous beginning. When I was in college, I attended my cousin's wedding.

Generally, women in commercial sex work are good musicians and dancers, so she was performing there, and the way people were treating her was unacceptable to me. So Guria began. Since people were not addressing this whole issue of sex trafficking,

I thought this is what I'm going to do. 'Guria' basically means doll. Children, especially girls, play with dolls and then throw them away. Similarly, I see women in the red-light area being played with and thrown away.

Guria India was one of the pioneers in the fight against sex trafficking and sexual exploitation of women and children in India. We work on rescue operations, education, vocational training in the red-light areas, and legal interventions.

And of course, restoring the children.  In our 35 years, we've worked on one issue, going deeper and deeper with a very holistic vision. People say, "Oh, you're doing a great job," but there are hardly any people who want to walk even a few steps along with you. I'm glad I found Gopal because he's a crazy man, and I only want crazy people.

Traditionally in India, it's always been the man's job to earn the money, so he makes the decisions. And it's the woman's job to make babies, and that's still true in many parts of India. If a woman cannot have a baby, that's a huge social stigma. IVF is in vitro fertilization.

A fancy word; "in vitro" means 'glass,' and "fertilization" means what's not happening in the fallopian tubes, in the bedroom—we're doing it in our test tubes. A lot of clinics will do what is called egg donation.

A lot of clinics will do what is called egg donation.

You're using someone else's eggs. That's what it means. The woman starts to produce about 40 follicles every cycle, of which one becomes mature. When we do IVF, we give a hormonal injection so that, instead of the follicles dying,

we save those which would otherwise have died. Because the more follicles, the more eggs you can get. And the more eggs, the better the chance of getting embryos and therefore achieving a pregnancy. Once the follicles are mature, which we can track

by doing ultrasound scans and blood tests for estrogen levels, we take her into the theater and then we stick a needle through the vagina into each of these follicles. We extract the follicular fluid, and the embryologist then checks it under a microscope

where he identifies the egg. If you're young, the chances of you then producing lots of eggs increases considerably. The risk with producing lots of follicles with superovulation is what is called ovarian hyperstimulation syndrome. But with severe hyperstimulation,

then a lot of these patients will end up in the intensive care unit. Because the ovaries become large, they collect a lot of fluid, and they have breathing problems. So it can be really challenging. It's every IVF doctor's nightmare, quite frankly.

I first learned about the Varanasi case from a very short article in the local newspapers. It barely caused any media interest at the time, but I immediately thought, "Oh my gosh, how often does this happen?"

So you have IVF, but not all IVF requires a donor egg. It's in situations where you can't use the IVF patient's own eggs. So maybe the woman is infertile, or in the case of gay couples, for example.

IVF cycles requiring donor eggs are still a small slice of the overall IVF market, but it's a segment that's growing very, very fast. It's also growing in a mostly unregulated, unmonitored space.

There are tens of thousands of egg retrievals happening every year in India. This is the one that's come out of the shadows. So that made it really important. The case was triggered on October 17th, 2023, when the

girl's mother went to the police station to file a complaint. Within three days, a group of inspectors from the police and from the state's chief medical officer visited the clinic and conducted an inspection, where they took the girl's case file.

A day after that, the chief medical officer issued a report that was really quite stunning. It outlined a whole bunch of irregularities that they had found. For example, the girl had signed all of these affidavits and consent forms in English, but she only spoke Hindi.

They said clearly she was using a fake ID; she didn't appear to be 23 years old, the minimum age for donation. And that two doctors had examined the girl. About a week after that, police drew up what's called an FIR, a first information report.

report, which is an important document. It essentially gets the wheels of justice turning. At that point, the police were compelled to investigate the incident. Within a couple of weeks of that, in mid-November, they arrested four people. So at the beginning, it really looked like the investigation

was progressing pretty quickly, but then something sort of changed when the charge sheet came out on January 20th. It named five people. The five included Seema, and the charge sheet and other records claimed she was the woman who was known

to the girl, had sort of been there with her every step of the way, taking her to the clinic, helping her make a fake ID. And then she was there on the day of the girl's retrieval. She told the girl, 'Wear a sari; it'll make you look older,'

put a wedding necklace around her neck and a bindi on her forehead to make her look like a married woman. The charge sheet and other records also claimed Seema had worked with another woman named Anita, another agent. Anita was sort of responsible for the backend.

She was sort of like at the top of the pyramid. She understood how to get fake IDs and affidavits made. It said she worked with two other men, and another one of the suspects was Seema's husband, who had signed off pretending

to be the girl's husband on the forms for the clinic. Only those five initial suspects were named. There was no mention of the doctors. There was no mention of the clinic. And so that really gets you thinking about an industry player

behind this that let it happen, and there was no mention of them. We tried counseling the family; they were too intimidated, actually. They're in trauma because of what happened. Okay, so there are so many things

that they're not ready to believe in anybody. They're threatened. The family's in turmoil. You have to help them pluck up courage to fight back. There was a whole infrastructure behind this incident, middlemen who are helping these types of things to happen.

So you have an egg bank and then you have this diagnostic center. They had done a physical examination of the girl and didn't spot the fact that this teenager was maybe not 24 years old, as she claimed. The clinic that conducted this retrieval was Nova IVF.

It's a big chain, by some counts the second biggest in the country, backed by some of America's most powerful financiers. Its rise happened in the early 2010s. That was a period when India's IVF sector was

completely unregulated. Clinics were mushrooming everywhere. Early on, Nova was doing really well. It had a great reputation for quality services. Its success rates were going up. There was a real clinical rigor to it. But then, increasingly, the investors were pushing

for faster growth. So that's where we see, you know, the company sort of change hands through a series of investors. As the management shifted, this pressure to grow grew faster, and former employees tell us that standards began to fall.

Sex trafficking has been all about the criminal nexus. A similar criminal nexus is functioning here as well, as I see. The police investigation has come across this Nova hospital, the doctors, you know, so many people. Why the hell hasn't

the police arrested the doctor? Why is the hospital still not seized? They're nowhere in the scene. Then who has done it? When police began investigating the case, they began looking through WhatsApp messages and electronic payment records, claiming

that this group had been sourcing donors for clinics across the city. Claiming that this group had been forging paperwork for possibly hundreds of egg donors. Records claimed that one of the other clinics they were sourcing for was one of the biggest IVF chains in the world.

What happened to this girl was part of a much larger operation. We still have no indication that the police are investigating these other people or plan to charge any more. We don't know where the girls' eggs ended up. And there's a possibility by this point that a child

or multiple children may have been born from those eggs. Does that family know that the eggs were sourced from a minor? Probably not. If you were to find out at some point that you were born of an egg that was taken from a minor,

how would that make you feel? These are some of the really haunting implications of this case. So if you notice the fibroids are in various different places, and therefore we need to figure out where your fibroid is, and some fibroids... You know, there used to be a time when I was proud about

Being an IVF doctor used to bring me joy because I helped so many people.  I'm not proud anymore because so much of this mud and dirt sticks to other clinics. For years, IVF clinics operated in a regulatory vacuum.

Unfortunately, there was so much abuse of the IVF system, especially in the form of egg donations, where many poor women were exploited. Honestly, I think things are only going to get worse. We think it's happening somewhere else...

It's happening in that country. It's happening in that society. It's happening in that family. No, it will happen to your family too. It will happen to you as well. If things continue this way, I don't think we'll get a conviction, but we will try until the end. We're known for that. We don't give up.

Irretrievable: Inside India’s Fertility Underworld | Bloomberg Investigates

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Bloomberg Originals

The Growing Global Fertility Industry and its Dark Side in India

Increased demand for IVF and egg donation due to delayed childbearing among working women.

Discovery of severe harm in India's fertility industry, including underage egg selling.

The Varanasi case as a tip of the iceberg in the global commodification of human eggs.

Widespread corruption and lack of justice for exploited women and girls.

The Fight Against Sex Trafficking and Exploitation in India

The origin and work of Guria, an organization combating sex trafficking.

Guria's holistic approach to rescue, education, training, and legal intervention.

Challenges faced by Guria in its fight against exploitation, including lack of support.

Traditional Gender Roles and the IVF Market in India

Traditional gender roles impacting women's reproductive choices and social stigma around infertility.

Explanation of IVF and egg donation procedures.

Risks associated with egg retrieval, including ovarian hyperstimulation syndrome.

Initial discovery of the case and the limited media attention it received.

Context of IVF and donor eggs in different situations.

Rapid growth of the unregulated egg donation market in India.

Timeline of the police investigation, including initial actions and irregularities found.

Details of the charge sheet and the individuals involved, excluding key players.

Challenges in counseling the victim's family due to intimidation and trauma.

Nova IVF and the Systemic Issues in India's Fertility Industry

Identification of Nova IVF as the clinic involved and its background.

Nova IVF's growth and the impact of investor pressure on standards.

Questions regarding the lack of arrests and investigations of key players.

Findings from the police investigation, including sourcing donors for multiple clinics.

The broader implications of the case, including the unknown fate of the eggs and potential children born from them.

Reflections on the State of the IVF Industry and the Future

Personal reflections of an IVF doctor on the ethical implications and the industry's future.

Concerns about the widespread abuse of the IVF system and the potential for future exploitation.

The pervasive nature of the problem and its potential impact on everyone.

Determination to continue the fight for justice and accountability despite challenges.