India considers government agency to license infertility clinics

The Indian Council of Medical Research has unveiled draft guidelines to regulate infertility treatment in India, prompted by concerns about unethical practices in infertility clinics.

Doctors acknowledge the need to regulate infertility treatment in India, but some infertility specialists have dubbed the proposals as "impractical and detrimental to the interests of patients."

The guidelines, released last week, specify infrastructure requirements and a code of practice for infertility clinics, as well as additional training for gynaecologists who specialise in the treatment of infertility through assisted reproductive technology.

The council has also proposed the creation of a government agency to license infertility clinics and ensure that they adhere to standards. The agency would also have the power to fix the upper limit of charges for gamete donation and surrogacy.

Infertility clinics have sprung up across India over the past decade, offering a range of modern assisted reproductive techniques. But information from patients indicates that some clinics are engaged in unethical practices.

"[The practices] range from incredible claims to overcharging to inadequate record keeping," said Dr T C Anand Kumar, a member of a national panel set up by the council to formulate the guidelines.

"We know of suspected cases in which clinics have performed the relatively inexpensive intrauterine insemination but charged couples for in vitro fertilisation," said Dr Pushpa Bhargava, an eminent Indian biologist and panel member.

Infertility specialists have welcomed the move to introduce guidelines on infertility treatment but have warned that the proposals to improve infrastructure would drive up treatment costs.

Gynaecologists have objected to a proposal that postgraduates in gynaecology wishing to specialise in assisted reproductive technology would need additional training in infertility diagnosis, reproductive endocrinology, and embryo handling.

"Postgraduates in gynaecology are well qualified to treat infertility; they don’t need to take any more exams," said Dr Sadhna Desai, president elect of the Federation of the Obstetric and Gynaecological Societies of India.

Doctors have expressed concern over the proposals to ban the use of semen from donors known to the recipient and to prohibit a known woman from acting as a surrogate. "This could lead to widespread commercialisation¾ semen sale by commercial donors and wombs on hire," said Dr Indira Hinduja, an infertility expert at Jaslok Hospital, Bombay. "Do we want to create the situation that exists in kidney transplantation today?"

Infertility specialists have objected to a proposal that gives children the right to information about their biological parents or surrogate mother when they reach 18. "Given India’s social and cultural backdrop, this is a potentially disastrous proposal that could disrupt families," said Narendra Malhotra, vice president of the federation.

The council’s draft guidelines will be debated over the next three months, after which a final version will be sent to the government for legislation.