The Festering Underbelly of In Vitro Fertilization (IVF) in Uttar Pradesh

My journey through the IVF care landscape in Uttar Pradesh—spanning Gorakhpur, Sultanpur, and Lucknow—revealed deeply troubling realities embedded within this booming medical enterprise. What is sold as a symbol of hope often unravels into a maze of financial burden, bodily harm, and gendered injustice.

Hope on a Payment Plan: IVF and the Illusion of Choice

In India, the average cost of a single IVF cycle ranges between ₹1,50,000 and ₹2,50,000, positioning it as a luxury ostensibly reserved for the affluent. Yet during a conversation with a doctor at the Lucknow branch of a well-known IVF center, I was told that nearly 40% of their patients come from households earning just ₹10,000 to ₹20,000 a month.

This staggering statistic prompts a difficult question: what price are low-income families willing—or forced—to pay for the possibility of parenthood? For many, it means selling ancestral land, pawning off wedding jewelry, or plunging into cycles of debt. All in pursuit of a future sold by modern medicine—a hope meticulously packaged and marketed to those yearning for a child.

At every IVF center I visited in eastern Uttar Pradesh, one constant stood out: the overwhelming crowds. Faces reflected a kaleidoscope of emotions—hope, anxiety, exhaustion. Women in hijabs and ghunghats stood beside others in jeans and kurtis, forming a curious mosaic of identities and aspirations. But beneath this visual diversity lies a deeper question: what happens when a deeply unequal society markets biomedical miracles to those without the means to afford even basic healthcare?

Most clinics offer tiered “packages,” resembling a buffet—pick what you can afford. Can’t pay the premium? You can still opt for a “basic” plan. But often, these basic packages exclude crucial tests and scans necessary for monitoring maternal and fetal health. What appears as accessibility is, in fact, an incomplete and potentially harmful compromise.

Invisible Voices, Visible Bodies: Reproductive Labor and Patriarchal Control

In a context shaped by a patriarchal state–society nexus, the IVF journey is rarely a woman’s alone to navigate. As per the 2011 Census, Uttar Pradesh lags behind the national average in literacy—with especially grim figures for women. In Shravasti, for example, female literacy plummets to just 34.78%.

Amid this backdrop, I found myself in a waiting room, watching “success stories” looped on TV screens. The pattern was striking: in most videos, the male partner narrated the entire journey. The woman—the one whose body endured the injections, hormonal shifts, egg retrieval, embryo transfer—stood silently beside him. Her silence was not incidental. It was systemic.

This visual erasure mirrored what I saw off-screen. At receptions, pharmacies, medical desks, it was men who spoke, decided, and acted. Women were central to the process—and yet sidelined at every step. Their participation was often reduced to performance: present, yet voiceless. It left me asking, again and again: whose dreams are truly being dreamt here?

Without Her Knowledge: Donor Sperm, Deception, and the (Lack of) Ethics in Reproduction

When I asked a junior doctor about the leading cause of infertility in the region, the response was immediate: “Low sperm quality.” Blame was placed on poor “lifestyle choices”—alcohol, tobacco, stress. But scratch the surface and a more systemic story emerges. Chronic economic precarity and emotional stress degrade men's reproductive health. What gets framed as individual failure is, in fact, structural violence—where economic hardship chips away at bodily vitality and emotional well-being.

Caught between stigma and patriarchal expectations, many men—particularly those at the margins—find no space to express vulnerability or seek support. In a climate steeped in hypermasculinity, infertility is not a medical issue; it's an existential threat to manhood.

This tension plays out in haunting ways. Multiple healthcare workers shared stories of men secretly requesting the use of donor sperm—without their partner’s knowledge or consent. These decisions, driven by shame and the fear of emasculation, rob women of their autonomy and bodily agency. IVF centers, incentivized by success rates, often enable such violations with little resistance.

The result? A quiet erosion of trust. A woman unknowingly carrying a pregnancy that was not honestly explained. A relationship distorted by secrecy. And a healthcare system complicit in stripping away informed consent. These are not rare exceptions. They are embedded failures—of ethics, empathy, and accountability.

Silent Wombs, Loud Profits: The Unregulated IVF Economy in Uttar Pradesh

Behind the glossy brochures and sleek interiors of IVF clinics lies a largely unregulated industry. India’s Assisted Reproductive Technology (Regulation) Act, 2021, was meant to bring transparency and safeguards. But in districts where patients lack legal literacy, awareness of healthcare rights, or access to grievance redressal, regulation becomes little more than window dressing.

Consent forms are signed but rarely explained. Counseling is cursory. Ethical lines blur in the quest for “successful outcomes.” The veneer of professionalism conceals a darker reality—where desperation meets profit, and human dignity is too often the collateral damage.

In these spaces, women’s bodies become battlegrounds—sites of hope, control, and exploitation. Men, driven by shame and pressure, make decisions behind closed doors. Clinics prioritize efficiency and outcomes over ethics and care. And the broader system—lacking meaningful oversight—allows this to persist unchecked.

If regulation continues to operate as a box-ticking exercise, we must urgently ask: who is fertility care really serving—and at what cost?

Conclusion: The Urgency of Reclaiming Reproductive Justice

What is happening across IVF clinics in Uttar Pradesh is not just a healthcare issue—it is a social justice crisis. It exposes how poverty, patriarchy, and profit intersect to reproduce inequality, even in the name of life. We must push for reproductive justice frameworks that center informed consent, bodily autonomy, emotional support, and systemic accountability.

Because behind every clinic's "success rate" is a story. And too often, it is a story of silence.

Meher Suri is a public health practitioner with a keen curiosity to explore and address inquiries that rest at the complex intersections of government, civil society, and people's movements. Grounded in the principles of intersectional feminism and trauma-informed care, she strives to advance equitable, just and contextualized research solutions that authentically center the voices of the participant(s) in question.