Anoop Gupta slumps in his swivel chair and surveys what the day has brought his Delhi fertility clinic: a rich housewife who wants to check on the pregnancy of her 21-year-old peasant surrogate; a rural farming couple, both past middle age and seeking an heir after their son was killed in an accident, who need an egg donor; a mother of a developmentally delayed teenager shepherding the surrogate carrying the quadruplets that will maximize her chance for a "normal boy;" a British IT consultant who needs a hormone injection as part of in-vitro fertilization that would cost five times more back home; a Montreal woman who wants profiles of egg donors; and a Toronto mother of two toddler girls who wants a male embryo implanted.
It's a regular day in his packed and humming clinic, where poor women in bright saris and tribal jewellery wait beside women whose vast Louis Vuitton handbags spill over the sides of their chairs.
When 60-year-old Ranjit Hayer gave birth to twins in Calgary two weeks ago - babies conceived with donor eggs collected, fertilized and implanted in India - the news caused an uproar in Canada.
A woman of Ms. Hayer's age would not be treated at a Canadian assisted-reproduction facility; she suffered potentially life-threatening pregnancy complications linked with her age, and her children were seven weeks premature.
But here in his thriving Delhi clinic, Dr. Gupta often sees 10 women like Ms. Hayer before lunch. His clinic literature boasts of 500 post-menopausal pregnancies; "even grandmother can be mother," it says.
Canadians may have been caught off guard by Ms. Hayer's imported embryos, but in the global community of infertility, India is the salvation destination, the country where an unregulated reproductive-technology sector makes anything possible. Mr. Gupta's practice is just one of an estimated 150 clinics across India offering assisted reproduction.
"Total madness is prevailing," said Imrana Qadeer, a professor of public health at Jawaharlal Nehru University and a campaigner for regulated assisted reproduction. "It is a totally unregulated thing ... in India the doctors get away with a lot of things because people trust them and also there is lot of ignorance about technologies. ... Women are vulnerable, they can be pressured, and it's spreading like wildfire."
The surrogacy business is worth an estimated $500-million a year. And while the private clinics in India do not provide any figures on the number of other procedures they perform or the income they generate, no one disputes that the baby-making business is enormously lucrative. Behind the counter at Dr. Gupta's Delhi IVF & Fertility Research Centre, a staff member sits counting huge bricks of rupees; the lineup to pay for drugs or scans or embryos snakes all the way down the staircase.
Dr. Gupta, a genial workaholic with a zealot's admiration for the possibilities of assisted reproduction, considers himself a sort of Santa Claus figure. He promises the endless stream of anxious women that his success rate is about 50 per cent, that they too will have babies. "I feel very happy, very satisfied - if you see so many happy patients who are blessed - they cannot forget you in a lifetime."
But with the babies come a passel of ethical questions. How old a mother is too old? Who looks out for the rights of surrogates, who are usually poor women, often unable to read the contracts they sign with a thumbprint? Where is the line between commissioning an embryo to avoid passing on hereditary disease, and eugenics?
Patients are drawn to Dr. Gupta's clinic, in an upscale quarter of the capital city, because they have heard he has the best success rates. But if he turns them away - too old, too poor - there are plenty of alternatives. Patients report hearing of other clinics where the doctor will inseminate a woman who is 65, will let a woman carry triplets, will find a surrogate they can afford.