Many couples experience emotional, physical, and ethical issues as a result of the process.
The Parliament has passed a measure to regulate and supervise Assisted Reproductive Technology (ART) facilities, as India is one of the primary centres for the worldwide fertility business. However, ART procedures carry several implications, and numerous couples experience emotional, physical, and ethical issues as a result of the process.
ART helps to treat infertility that includes fertility treatment that handles either the eggs or embryos. The ART (Regulation) Bill clearly states, “assisted reproductive technology bank means an organization that is set up to supply sperm or semen, oocytes or oocyte donors to the assisted reproductive technology clinics or their patients,” and by «assisted reproductive technology clinic means any premises equipped with requisite facilities and medical practitioners registered with the National Medical Commission for carrying out the procedures related to the assisted reproductive technology”.
The Sunday Guardian spoke to several ART experts to gain a better understanding of the problems of ART treatments. The specialists discuss some of the issues that have arisen, including physical and emotional difficulties for the patient, as well as financial and ethical difficulties for the couple.
“In terms of physical challenges, it depends on the kind of procedure the patient has undergone. There are several medical procedures and one doesn’t have to be bedridden and can continue the daily activities along with the natural intake of vitamins and so forth. In IVF procedure, rest is required along with medicines, injectables and one should do less strenuous activities for the initial period,” Dr Sutopa Banerjee, the directorate of Obstetrics and Gynaecologist at Fortis Hospital, Vasant Kunj, New Delhi, told this paper.
The couples undergo counseling before going through the procedure. When the patients undergo a donor gamete, the doctors assist them emotionally. The couples are well informed about the procedures in the ART.
“Patients frequently seek ART after exhausting all other options and seeing it as their last resort. The only issue, they face, is the lower success rate. Even though we say the success rate is insignificant, the couples struggle emotionally and financially, and it›s disheartening when the outcomes are negative,” Dr Banerjee said.
Patients, too, require medication and are subjected to emotional distress if the procedures fail. Due to their financial and mental distress, they go through a difficult phase and depression.
“Any kind of ART procedure is time-consuming and expensive. At any time, if the procedure is unsuccessful, it gets difficult for them to accept. Sometimes, we refer the patients to a psychiatrist also for medication. Infertility patients go through depression as a lot of patients do not have social and family support. It is difficult to accept that there is a certain level of uncertainty in these treatments,” Dr Shreya Bhattacharya, the IVF specialist and gynecologist consultant of Indira IVF, Behala, Kolkata, told this paper.
Patients need to realize that infertility can be treated. Patients are sometimes unaware of the causes; nevertheless, once they realize the root of the problem, they believe they can be parents as well.
“These days, we get many cases where the AMH level of females, even at a young age, is lower. The level of AMH helps the doctors to understand the egg count in the ovaries. In such cases, the couple needs donor eggs. If the female patient is unable to conceive, under any circumstances, they find it hard to accept that they need donor eggs,” Dr Praful Agrawal, Fertility and IVF consultant and gynecologist, Cloudnine hospital, Delhi, told this correspondent.
Similarly, doctors struggle to convince patients that the donors must remain anonymous. The information about the patients and the donors must stay confidential. “Sometimes, when we use ovum or sperm donor cycles, either of the couples are reluctant to reveal to their partner that he/she wants donor cycles. Also, many a time, the couples keep it within themselves. We sometimes wonder about the future of the child since the couples, themselves, are skeptical about donor cycles as they believe that the child is not their biological offspring anymore Therefore, we push patients for self-cycle because of these ethical dilemmas,” Dr Bhattacharya told this correspondent.
Because of the cost and availability of ART knowledge, India is regarded as one of the primary centers for the worldwide fertility sector. “The cost of treatment is also reduced because it is a developing country. The recommendations or guidelines that are followed in India for this technique are less stringent,” Dr Bhattacharya said. The Surrogacy Regulation Bill emphasizes altruistic surrogacy, stating that the surrogate should be willing to donate her services rather than being forced to do so.
The ART (Regulation) Bill 2020 regulates and supervises ART clinics, ART banks to prevent misuse. The bill states that every ART clinic and the bank must be registered under the National Registry of Banks and Clinics of India, which will act as a central database with the details of ART clinics and banks. The bill states that the National Registry “shall act as a central database in the country through which the details of all the clinics and banks of the country including nature and types of services provided by them, outcome of the services and other relevant information shall be obtained on a regular basis.”
“It shall assist the National Board in its functioning by providing the data generated from the central database of the Registry” and, “the data generated…shall be utilised by the National Board for making policies.”