‘Emotionally, physically and financially distressing’: What women are not told before IVF treatment

[This article has been updated to note that no medical negligence was found on part of Gunjan IVF World and that the Ghaziabad district court dismissed the complaint filed by Hemant Gambhir after he failed to show up for the hearings.]

Hours after undergoing a supposedly safe procedure to retrieve her eggs at a fertility clinic in Ghaziabad in Uttar Pradesh, Ruchika Gambhir suffered cardiac arrest and died on March 6.

The Delhi resident and her husband, Hemant Gambhir, had taken a chance on in vitro fertilisation or IVF treatment after trying unsuccessfully for five years to have a baby. The couple underwent a battery of tests and investigations. On March 5, they went to Gunjan IVF World in Ghaziabad, where the doctors would surgically retrieve Ruchika Gambhir’s eggs and Hemant Gambhir’s sperm, which would then be fertilised in a laboratory to make embryos that would later be transferred into her uterus. But Ruchika Gambhir developed medical complications during the procedure and was shifted to a bigger hospital, where she died in the intensive care unit.

Accusing the doctors at Gunjan IVF World of medical negligence, Hemant Gambhir said they never once mentioned the risks associated with IVF treatment. “We were assured that it is a safe procedure,” he said. “We didn’t even take family members along because we were told by the doctor that it is a daycare procedure and we will be completely fine.” He said that had he known about the risks, he would never have opted for the treatment.

“My wife was healthy and we walked into the clinic together,” he added. “I came out with her body.”

In his complaint filed at the Indirapuram Police Station, Hemant Gambhir also alleged the fertility clinic was not equipped to handle the emergency after his wife developed complications:

“It was only when my wife was shifted to Atlanta Hospital in [the] evening, I was informed that my wife had suffered a cardiac arrest during the course of the procedure and due to non availability of the appropriate arrangements she could not be revived, which resulted in my wife slipping into a coma.”

Dr Gunjan Gupta Govil of Gunjan IVF World refuted the allegations of medical negligence. “I am a qualified specialist,” she said, but refused to say anything further. Scroll.in has emailed her a list of questions and the story will be updated if she responds.

Eight months on, Hemant Gambhir said a first information report was yet to be filed. Ghaziabad Assistant Superintendent of Police Ravi Kumar said the case would be referred to the medical board, the district authority that looks into cases of medical negligence, after which a first information report would be filed.

[Update: In February 2019, a medical committee constituted by the chief medical officer of Ghaziabad district found no medical negligence on part of Gunjan IVF World. The Uttar Pradesh Medical Council reiterated this in August 2019, saying, “Patient management after unknown complication after anesthesia/ procedure was satisfactory.” In October 2019, the Ghaziabad district court dismissed the complaint filed by Hemant Gambhir after he failed to show up for the hearings.]

Rarely discussed risks

In India, no records are kept of fatalities during in vitro fertilisation or serious side-effects not leading to death. In 2014, media outlets reported the death of a 23-year-old egg donor in Delhi from Ovarian Hyperstimulation Syndrome. This is a condition in which the ovaries of a woman undergoing fertility treatment swell up painfully. This is a possible side-effect of a common fertility treatment in which the woman is injected with any one of a family of hormones called gonadotropins to induce her ovaries to produce multiple eggs instead of the single egg normally released in a menstrual cycle. Severe Ovarian Hyperstimulation Syndrome can lead to shortness of breath and sometimes, death.

The various procedures performed during IVF treatment come with other risks, including headache, nausea and respiratory distress, ectopic pregnancy (where the fertilised egg remains in the fallopian tube and can cause its rupture), and ovarian cancer. In vitro fertilisation can also affect the child resulting from the treatment, with premature delivery and birth defects listed as risks. Then there are the risks associated with anaesthesia.

“As most egg retrieval procedures in India are performed under general anaesthesia, all the complications linked to general anaesthesia hold true here,” said Dr Anjali Malpani, an IVF specialist in Mumbai.

Egg retrieval, commonly called egg pick-up, is conducted with the help of ultrasound imaging. “The most common complication is an injury caused to the bladder and bowel while the doctor is trying to reach the ovaries to retrieve the eggs,” said Malpani. “There is also a possibility of infection and haemorrhagic bleeding.” Malpani explained that the ovaries sit close to vital blood vessels and any injury to these vessels can lead to cardiac arrest.

Dr Anant Bhan, a researcher of bioethics and global health, pointed out that since India’s large IVF industry is mostly unregulated, the onus is on the medical community to inform couples seeking treatment about its side-effects, complications and other options. They should also be informed of the expenses and failure rates, he said.

But several women who have undergone IVF treatment spoke of a great disparity between what they were led to expect and what they experienced.

“I knew that these medical procedures come with risks but all the doctors I met downplayed or didn’t even mention them,” said a 36-year-old resident of Mumbai who did not want to be identified. She said her egg retrieval procedure left her bedridden for a week. “I couldn’t pass stool for a week and the doctor said it is okay,” she said. “I was taken to a local hospital after the pain became unbearable and underwent a procedure to clean my bowels.”

Fertility treatment is “emotionally, physically and financially distressing”, she warned.

Neelam, who also underwent IVF treatment, agreed that its side-effects are rarely discussed. The 31-year-old assistant manager at a private company took a year off work to have a baby after two miscarriages. However, her treatment did not result in pregnancy.

“I was prepared because I had read enough to know that IVF success rate is less than 50%,” she said. “What I wasn’t prepared for is the frustration associated with the daily hormone injections and the tests. There was a point during my treatment that there was no place left in my body which wasn’t pricked by a needle.”

She added, “Having a baby is completely worth the pain but I wish we knew what we were getting into.”

Now back at work, Neelam has put her plans of having a baby on hold.

‘We were so sure’

The Gambhirs, too, did not worry much about the procedures they were to undergo at Gunjan IVF World on March 5. “We were so sure about the procedure that we just took a day’s leave from office,” said Hemant Gambhir. “We were supposed to go to work the next day.”

Instead, Ruchika Gambhir was wheeled out of the operation theatre in an “emergency state”. Hemant Gambhir said the doctors simply told him she needed to be taken to a larger hospital.

He still does not know whether his wife developed complications before, during or after the egg retrieval procedure. “I was told her blood pressure shot up during the surgery,” he said. “I didn’t think it was serious until the doctor took me inside the operation theatre and asked me to look at the monitors attached to her body to verify that she is alive before we could take her to another hospital.”

At Atlanta Hospital, where she was shifted, the death summary says Ruchika Gambhir died of “cardiogenic shock”, an often fatal condition in which the heart suddenly fails to pump enough blood to meet the body’s needs. Her death certificate, issued by the Ghaziabad city corporation, does not indicate a cause of death.

This is the third story in a series on fertility treatments. Read the first part here and the second here, both of which focus on the risks that women who donate eggs undergo.