The Human Egg Sellers

9:47Shweta Desai:We fly them out to Bangkok or to Georgia or to Kenya.

9:52Diaa Hadid:He paints it as a glamorous side hustle for the women involved and talks about a premium donor he's sent to Kenya.

9:59Shweta Desai:She was supposed to go for a safari today. I kept her one. Where is she from? Really? She's coming back in a few hours. She should be about to land now.

10:07Diaa Hadid:A safari. But for the majority of women who supply their biomaterial to the fertility industry, the reality is far. from Glamorous.

10:26Diaa Hadid:Abhigarami is 34 and lives in a slum in the southern city of Chennai.

10:34Diaa Hadid:Like other women we interview in this slum, she asks to only use her first name because she doesn't want to risk getting in trouble. The women belong to a group at the bottom of South Asia's caste hierarchy. They're known as pariah, from where the English gets the word pariah.

10:57Diaa Hadid:Abhirami and her girlfriends walk us through their homes, each a tiny room in a row of tiny rooms down a tight alleyway. They're painted bright blues and purples. Where do people sleep?

11:12Diaa Hadid:The mats are rolled in one corner, a gas burner for cooking and the other. Abhirami's husband polishes spoons in a steel mill for about a dollar a day. She says he drinks away his wages. They have two daughters, but they live with Abhirami's sister-in-law.

11:36Diaa Hadid:That's because Abhirami has no time to care for them. She works in a toy workshop assembling plastic guns. for about$3 a day.

11:50Diaa Hadid:Twice, she says, she sold her eggs to put food on the table for rent. Abhirami first heard about selling eggs from her neighbour while standing in line for her turn at the water pump.

12:07Diaa Hadid:She pleaded with her neighbour, tell me where I can go and do it.

12:19Diaa Hadid:Abhirami says when she told her husband about her plans, he thought it was sex work. She sniffs he doesn't understand the difference between thick and thin.

12:41Diaa Hadid:Abhirami says her neighbour told her, Forget about your damn husband. He's not paying the rent. You'll get 25 ,000 rupees, about$300, more than what you'd make in three months at the plastic gun factory. Her neighbour knew about selling eggs because she had been in and out of hospitals herself. To make ends meet, she used to sell her blood. She once sold her eggs when she was younger. She was once paid to carry a baby. And she sold a kidney. She shows us the scars. She took Abhirami to a fertility clinic. Abhirami says she can't read. She only finished school to the second grade. But her neighbour told her it was seven stops away on the bus.

13:23Diaa Hadid:So she counted them.

13:29Diaa Hadid:Abhirami says in the fertility clinic, she was hustled into a room where patients couldn't see her. A nurse filled out a form on her behalf and told her to sign it with her thumbprint. Abhirami says a nurse put gel on her stomach and scanned her. She says she was told to come back after she got her period. And when she returned, she was injected. She's not sure with what, but it was most likely hormones to stimulate her ovaries to produce more eggs.

13:59Shweta Desai:It hurt.

14:09Diaa Hadid:Every day for about 10 days, Abhirami went back to the clinic. She counted seven bus stops to know where she had to get off and the nurse ushered her into a room to be injected. She says she thought she'd die from the nausea she was experiencing. She began swelling around her stomach. Based on what we've heard from doctors, her response to the injections sounds like she'd been overstimulated, which isn't uncommon. She focused on the money she'd make. But when her husband noticed her swelling, she says he beat her up. Abhirami remembers shouting at him, you drink away your money, I don't have enough for rice.

14:57Diaa Hadid:She says she hid at her neighbour's house until it was time for her to have her eggs extracted.

15:08Diaa Hadid:For that, a doctor put her under anaesthesia. She's unsure how the eggs came out, but typically they're removed with a long, thin needle that goes through the wall of a woman's vagina, and they're extracted from follicles on a woman's ovaries. The nice thing, Abhirami says, was that she got to sleep overnight in the hospital for the procedure.

15:33Diaa Hadid:Even so, she says, her pain didn't end after her eggs were extracted.

15:42Diaa Hadid:Two years later, she sold her eggs for the same amount.

15:51Diaa Hadid:For years, India's for-profit fertility industry was under-regulated and highly commercial. But after a series of scandals, lawmakers reacted with a dramatic restructuring. In 2021, the Assisted Reproductive Technology Act, or ART law as it's called, restricted access to fertility treatments to married heterosexual couples and demanded that women provide their biological material for free. So this is what the underground market looks like now. Marginalized women, often desperate for money, sell their eggs for a fraction of the cost that it would be in the US. And despite the great toll it takes on them and the cash being exchanged, fertility clinics and egg banks call this a donation.

16:39Diaa Hadid:Academics who've researched this industry say, as it exists, it's a disaster for vulnerable women.

16:45Shweta Desai:You've told yourself you've done something, but actually you've only made it worse.

16:50Diaa Hadid:That's Vrinda Marava. She is an assistant professor at the University of South Florida, and she studied the fertility industry.

16:57Shweta Desai:You've created a black market. You've pushed it underground, which means the people participating in it have no protections. They have no bargaining power. If something goes wrong, they're already doing something criminal, something illegal. So who are they going to turn to for help?

17:10Diaa Hadid:We spoke to three members of the regulatory board that oversees implementation of India's assisted reproductive technology laws. They spoke on condition of anonymity because they're not authorised to speak to the media. They said the laws were designed to offer legal clarity for the industry, safety for couples trying to have a baby, and guaranteed medical insurance and care for the women whose eggs were being harvested or who were acting as surrogates. The law was meant to halt the exploitation of those women. The board members we spoke to said they were not aware of the vast underground market that has emerged since these new laws were passed.

17:49Diaa Hadid:A senior member of the board was also not aware that in one case, in the northern city of Varanasi, a 13-year-old girl was lured into selling her eggs to one of India's largest fertility clinic franchises. We met her at a charity that defends women who've been trafficked. Her parents request we keep her identity anonymous. They say their daughter's been socially stigmatised and she dropped out of school after her classmates found out that she sold her eggs. She's now 15 and she says about two years ago a neighbour told her she'd get$180 for her eggs.

18:34Diaa Hadid:She didn't understand. Eggs? Like a chicken?

18:43Diaa Hadid:But she says she really wanted a smartphone.

18:50Diaa Hadid:The teenager's lawyer, Krishna Gopal, believes this is happening to other minors, but there's no incentive for families to come forward. The teenager's neighbour was arrested, but he says the police have not followed up with the clinic that extracted her eggs.

19:20Diaa Hadid:The clinic in question is part of the Nova IVF Fertility franchise. In a statement, Nova IVF Fertility said that the teenager was screened by a separate company that signed off on having her eggs harvested.

19:37Diaa Hadid:Industry professionals who are critical of the new laws say there's just not enough oversight of this massive industry. Consider this. According to the Indian Health Ministry, there's nearly 8 ,600 fertility clinics and egg banks operating in India. Just over 3 ,200 are actually registered. That's less than half.

20:03Diaa Hadid:H says in her experience, the industry does what the industry wants.

20:12Diaa Hadid:She says clinics and egg banks don't look very hard at her IDs. She has two, and they're fake, to maximise her egg sales. The fake IDs list her as being under 30, because young women get more business. She's also lied about her height. She's on the short side. And she's lied about her faith. H is Muslim, but sometimes she pretends she's converted to Hinduism, if that's needed.

20:42Diaa Hadid:Clinic directors say some couples only want eggs from a woman who matches their faith.

20:50Shweta Desai:coming up after the break the middlemen mostly women who operate in this underground market and how they shield the industry from accountability

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21:50Shweta Desai:Plus, earn unlimited double miles on every purchase. What's in your wallet? Terms apply. See CapitalOne.com for details. This message comes from Bombas. Your feet hit the ground an average of 2 ,000 times in a mile. Bombas sports socks are designed to support you every step. Sprint to Bombas.com slash NPR and use code NPR for 20 % off. We're back. This is a Sunday story with more from NPR's Dia Hadid.

22:21Diaa Hadid:Piecing together how the industry functions was not easy. Doctors and clinic directors don't want to go on the record about their clients or their dealings. But here's what one prominent fertility doctor told us about the process, on the condition that we don't use her name or voice because she doesn't want to come into the government's crosshairs. We confirmed her account in dozens of other conversations with researchers, fertility clinic directors and women who sell their eggs. The doctor said when a couple comes to her and the woman can't produce her own eggs, she tells them that her hospital will help them, but it's going to cost a little extra.

23:03Diaa Hadid:And one way she procures those eggs is through an agent. An agent is the person who will often end up finding women. They move them through the process of extracting their eggs and they pay them. This go-between person allows the fertility clinic to plausibly say, we aren't paying women for their eggs. We're paying an agent to recruit women for us.

23:33Diaa Hadid:It was even harder to get an agent to speak to us. But we found one woman. Her name is Ruby. We connected over a crackly Zoom call.

23:43Shweta Desai:Hello. Hello. This is Ruby.

23:47Diaa Hadid:She asked we only use her first name. Of course, her work isn't legal. Ruby says she had a dead-end job at a New Delhi call centre and wanted to make more money.

24:02Diaa Hadid:Her friend talked her into selling her eggs and then Ruby realised she could make more as an agent. We hear it's common for women who age out of selling their eggs to turn to this hustle. Each month, Ruby gets about a dozen requests for egg donors, mostly over WhatsApp. Ruby says clinics mostly want women who are educated, light-skinned and pretty.

24:29Diaa Hadid:She calls them high-profile women. She finds them through her networks and social media. Ruby will find a donor, agree on a price, get their details. Sometimes she directs women to their scans, arranges their daily hormone jabs, lines up their egg retrieval. Clinics pay Ruby. She takes a cart between$50 to$100 and then passes the rest on. She says her recruits are mostly poor. They've got alcoholic husbands. They're single mothers. They've got money problems.

25:10Shweta Desai:There is an entire industry that's living off these women's biomaterial, right?

25:16Diaa Hadid:But then you don't want to pay the women themselves. This is Prabha Kadaswaran, a professor of law at King's College London. She's filed what's called an intervention in India's Supreme Court to demand women get legally compensated for the work of producing their eggs. We live in a capitalist society. This is a sector that's generating so much profit for everyone concerned. Everyone else is getting paid without any restrictions. So she says, why not the women who enable the industry to exist? Kodaswaran acknowledges a lively debate in feminist circles. Some argue all commercial egg donation and surrogacy should be banned because of how it commodifies women, how it commercializes the creation of a baby.

26:01Diaa Hadid:if that's the case.

26:03Shweta Desai:If you really have a problem with commercialization, why don't you regulate the private IVF sector? Nobody does that, right? But they want to tell the women they shouldn't do it. You know, it's a very paternalistic approach to say, you're being exploited, you're a victim, we don't want you to be exploited or your body to be commercialized, so why don't you give up everything for free? And then everyone else will use it up for their own purposes and get what they want, pay huge amounts to form their families, but you won't get anything.

26:31Diaa Hadid:H estimates she's harvested her eggs at least 30 times since she began. If each round of eggs produced one baby, she'd have some 30 biological children. H is sure, though, she's made more babies than that.

26:54Diaa Hadid:She says, if each time they've harvested 20 eggs from my body, you can assume at least 10 kids have popped out. Shweta Desai, who is reporting this story with me, tells her,

27:06Shweta Desai:You are like a super mom.

27:12Diaa Hadid:There's little research on the impacts for women who retrieve their eggs repeatedly. Critics say that reflects how little value is given to women who provide their biomaterial once their eggs have been removed. But one known impact is ovarian hyperstimulation syndrome. Mild cases can cause bloating. A severe case can cause respiratory distress. And according to reports published in two medical journals, two women died after these latest laws were passed, after they were stimulated to produce eggs. Is there more? There's no data, no reporting. And who would these women report to? There's one incident that H tells us that has never made it into a police complaint or into data.

28:00Diaa Hadid:Two years ago, she says, she went to Chennai to harvest her eggs at a fertility clinic there. The agent, unusually, was a man. She'd never worked with him before, and she didn't like his vibe. She says when she came out of anaesthesia, she realised her eye was swollen, her lip was cut, she had welts on her back, and she was wearing a diaper.

28:26Diaa Hadid:She said she fled the hospital as soon as she was able, and she told us, if that man did something to me, may God punish him.

28:37Diaa Hadid:Ever since then, H tells us, she experiences a sense of terror before she goes under anaesthesia.

28:59Diaa Hadid:Weeks after our first meeting, we see H again. This time we meet at a cafe in downtown Mumbai. She's dressed the way she likes, jeans, t-shirt, her short hair is fanned out. She's distracted, impatient and constantly checking her phone. She talks to us while complaining that she's feeling bloated, nauseous, breathless, weak. She's nursing a bruise under her right eye. She says her boyfriend is stressed, he lost another job. She says he didn't mean to hit her hard. Besides, her face easily bruises. Shweta asks her about her short hair and tells me what H tells her

29:43Shweta Desai:I had very long hair earlier but then I just chopped it because of our fight so I said, what happened? and she said, Sadiq held my hair

29:54Diaa Hadid:Her boyfriend dragged her by her hair on a sidewalk so she cut it off, despite him maybe also to protect herself

30:13Diaa Hadid:She says she's just been cheated by a new agent. She only got half the money she was promised for harvesting her eggs at a well-known hospital. H says she only got$160 because the agent told her she didn't produce enough eggs.

30:35Diaa Hadid:H was counting on that money because she's behind on rent.

30:48Diaa Hadid:So, she says, she's taking drugs to try to speed up her next period so she can be stimulated sooner to produce more eggs. H says, I don't have a choice. I know this will kill me, but we'll all die someday, right?

31:11Diaa Hadid:What comforts her is thinking about her kids.

31:18Diaa Hadid:Her 11-year-old daughter, her 13-year-old son.

31:26Diaa Hadid:The ones she birthed herself. They're being raised by her ex-husband. She says, I love them so much. Whenever I can, I give them money. They say I don't have to, but my heart doesn't listen. After all, I'm a mother.

31:43Shweta Desai:She has to run.

31:44Diaa Hadid:She pushes back her chair to leave. She's got word that she'll be able to see them. If she can leg it across town in half an hour. She's got to run.

32:03Shweta Desai:That was NPR's India correspondent, Diyah Hadid, and co-reporter, Shweta Desai. This episode of The Sunday Story was produced by Justine Yan. It was edited by Jenny Schmidt and Vincent Nee. It was engineered by Robert Rodriguez. Special thanks to Giselle Grayson and Anupama Chandra Sekharan. The Sunday Story team includes Andrew Mambo and our senior supervising producer, Liana Semstrom. Irene Noguchi is our executive producer. I'm Aisha Roscoe. Up First is back tomorrow with all the news you need to start your week. Until then, have a great rest of your weekend.

32:57Shweta Desai:This message comes from MidiHealth. CEO Joanna Strober shares the personal experience that led her to start a virtual care platform for women in perimenopause and menopause. I was having anxiety. I had gained weight. I wasn't sleeping. and my primary care doctor never once said that perhaps I was in perimenopause and that all these things could be related to my hormones. So I had a really tough time for quite a while and a friend recommended that I try a concierge doctor. She prescribed hormones for me, a combination of estrogen, progesterone, and testosterone.

33:32Diaa Hadid:And I felt very relieved that I had this care and I also had a lot of sadness that I had spent such a long period of time going through this and not getting the right care. And so essentially what we really want to do at Midi is democratize access to this type of care.

33:45Shweta Desai:Midi Health. Committed to helping women in midlife with paramenopause and menopause care. Accessible via telehealth visits. At joinmidi.com. This message comes from the International Rescue Committee. In Gaza, Sudan, and crisis zones around the world, the IRC is working to deliver emergency aid to those who need it most. Donate today by visiting rescue.org slash rebuild. This message comes from Capella University. That spark you feel? That's your drive for more. Capella University's FlexPath Learning Format lets you earn your degree at your pace, without putting life on pause. Learn more at capella.edu.