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Journalism of Courage
When Bruna Alves, a Brazilian woman working with a surrogacy firm in Tel Aviv, Israel, wanted to freeze her eggs at 32, she chose India instead of her employer, even overlooking the fact that the company she worked for owned a chain of FDA-registered IVF clinics in Asia. “That’s because Indian facilities offer one of the most affordable rates globally, the services are top-notch, the doctors are experienced, credible, proficient in English, easy to understand, and best of all, are always available on a video call to take care of your anxieties,” says the now 34-year-old.
Young women like Bruna are increasingly opting for egg freezing, a minimally invasive process where their eggs or oocytes are extracted, frozen and stored, sealing them in at their best, so that they can be thawed, fertilised and implanted in their uterus when they are ready to become mothers. “The baby born would be as healthy as it would be if birthed by the mother early enough,” says the country’s top infertility expert, Dr Anjali Malpani. This is an example of how technology gives a woman agency to choose the time of her motherhood.
Comparing global rates, including those of her home country Brazil, Bruna ended up paying Rs 1.5 lakh for the procedure, which would have cost her Rs 3.50 lakh in Brazil and Rs 4.50 lakh In Israel. This procedure has been used for decades to help women with serious medical conditions, such as cancer, conceive post-recovery. “A majority of health insurance plans in Israel cover an egg freezing procedure when a mother’s medical condition warrants it but healthy women cannot claim it and have to pay the full cost,” she says.
Bruna now makes an annual deposit of Rs 35,000 at the Infinite Fertility Clinic in Delhi’s Vasant Vihar to preserve her eggs, which will be thawed and fertilised with a sperm in a test tube (in vitro fertilisation or IVF) when she is ready to get an embryo implanted anytime within 10 years. Her current partner has even agreed to travel with her.
She found it easy to freeze her eggs unfertilised and not as an embryo that would have required a donor sperm then and there. “I would have had to search for a sperm donor then. Also women who aren’t sure if their current partner would co-parent their child or even continue the relationship in the first place find it easier this way,” says Bruna, who is prioritising her career right now and isn’t prepared to become a mother in a foreign country without family support.
While Bruna’s friends are now considering freezing their eggs in India too, the big centres in metros are slowly becoming fertility hubs that’s widening the bouquet of medical tourism. According to Annu Puri, founder and director of Indicure, a Mumbai-based medical tourism company, the costs in India are almost one-third of that in advanced economies. “Also, Delhi and Mumbai, the two key centres have got the largest traction because of flight connectivity. Now Bengaluru and Hyderabad are also figuring high as destinations,” she says. The potential is enormous as the global fertility tourism market is expected to grow by 30 per cent in 2030.
Dr Nisha Bhatnagar, Medical Director of the Infinite Fertility Clinic in Vasant Vihar, who harvested the eggs for Bruna, has been getting a lot of queries from women in Australia, Canada, African countries, Nepal and Bangladesh. “Even non-resident Indians (NRIs) are showing interest,” she says.
Dr Ramyasree Parvathareddy, who works with Apollo Fertility Hospitals in Chennai, has been getting international clients from the US, UK, Germany and now even Seychelles, more frequently over the last year. “Most of these women are about 35 years, the threshold age at which the quality of eggs starts dipping. That’s why we ask women to harvest eggs in their younger years when the eggs are of prime quality. Some of them even have insurance coverage but it is the trust factor and some word-of-mouth that brings them to India,” she says. The cost in Chennai is anywhere between Rs 1.5 lakh and Rs 1.8 lakh, including stimulation injections needed to harvest the egg and the extraction procedure.
Giving a breakdown of her costs, Bruna says that her injections cost her around Rs 50,000 and the basic processing around Rs 80,000. She paid around 20,000 for the freezing procedure, bringing the total cost to Rs 1.50 lakh.
Bruna first took a scoring test at the Delhi clinic, where her fertile status was evaluated based on age, family history and specific medical conditions like PCOS and endometriosis. She was put on a pre-harvest protocol, which involved lifestyle correction and staying away from alcohol for five months in Israel. Then she came here, took the Anti Mullerian Hormone test that tells the woman about her ovarian reserve or the number of eggs. Any reading between four and five is healthy, while anything less than two is complicated. Bruna’s looked good. Then she took the ovary stimulant injections for the eggs to be harvested easily. “I was fearful about the changes in hormones but I felt safe and comfortable. And there was no pain,” she adds.
Fertility treatments, including egg freezing, here are individualised for each patient, factoring their other health conditions, minimising side effects and discomfort. “Each woman has a different regime adapted to their parameters. A high-quality facility will prescribe only the level of medication necessary, both increasing safety and limiting discomfort. If we compare ourselves with other countries, we have the latest equipment at par with them but the costs are lower,” says Dr Bhatnagar.
Mumbai-based Dr Malpani says that India’s technology edge is promising better outcomes. “Traditionally, eggs were frozen by a slow dunk method that gradually reduced the temperature of the eggs. Unfortunately, this led to formation of ice crystals which can be detrimental to eggs. Vitrification or a fast-freeze process eliminates the chance of ice crystal formation. With this procedure, the survival rate for freezing and thawing increases to 98 per cent. That’s why our success rate is high,” she says.
Dr Archana Dhawan Bajaj, who runs an IVF clinic in Delhi, says India has a skilled pool of embryologists who assess freshly retrieved eggs under a microscope to determine maturation status. “Now there is new technology in the West that attaches a camera to the microscope, captures images of each egg and uploads them to an AI software for analysis. We can be using it too soon,” she says.
Bruna took a break in Dharamshala on her India trip. Now that the pressure of the biological clock ticking is off, she is looking forward to birthing her child here when she and her partner are ready.
