By Emily Wax
Friday, August 13, 2010; A01

HISAR, INDIA -- Inside a crowded rural hospital, gray-haired Nananki Rohtash rested on a cot, her swollen legs elevated while her sister-in-law paced nearby. Rohtash is a 60-year-old mother of five and a grandmother of eight.

She's also nine months pregnant, the result of an in vitro fertilization clinic, one of hundreds that have opened recently in India, urging clients to "Come alone. Leave as a family. Age no bar.''

With 1.2 billion people, India is still growing rapidly, and there are few efforts to control population growth, in sharp contrast to China's one-child policy. Some planning advocates argue that India's population is stalling development, adding to unemployment, and overwhelming roads, schools, water supplies and other basic infrastructure needs.

There are no government regulations for IVF clinics, especially in rural areas of northern India, and women older than 50 make up a surprising number of their patients, in a country where giving birth to many children defines a woman's worth and is considered parents' best chance for financial security.

Rohtash was awaiting a Caesarean section in the private National Fertility Center in Hisar, a middle-class frontier farming town in the northern state of Haryana, more than 170 miles outside the capital of New Delhi.

In the past 18 months, the doctors at this clinic have helped 100 women older than 50 become pregnant. About 60 were able to carry those pregnancies to full term. Some of the women received eggs donated by younger relatives. Their husbands' sperm was used to fertilize the eggs in a lab, and the embryos were then inserted into the women's wombs.

"The women come to us and say, 'Even if I die, at least I won't face the stigma of being barren,' " said Anurag Bishnoi, the center's lead IVF specialist. "These women are like soldiers:, They are on the front lines for their family, their country. They may die, but their family and country will live."

Many fertility experts say performing IVF on women older than 45 can be dangerous for the mother, a stress on her heart and blood pressure. Many must have their uteruses removed immediately after birth, because they are weaker and rupture, doctors said. The baby is also more likely to be born premature and to face health problems. The average life expectancy in India is 63, according to World Bank data.

"We are talking about bringing another human being into the world," said Sonia Verma, a doctor at Indraprastha Apollo Hospital, one of the country's leading centers, which discourages the procedure after age 55. "What happens when the parents die? We shouldn't only worry about what the patient wants. We could get a prepubescent girl pregnant with the same technology. Should we also do that?"

More than 40 years ago, Rohtash gave birth to five daughters and one son. But seven years ago, her son died in a car accident. Now she wants to try again for a male heir, a powerful cultural preference in India that many population experts say contributes to women having babies until a son is born.

"The risk for a son and a balanced family is my destiny," she said. "I consider this place to be God."

Many other older Indian women agree. In another case at the Hisar center, Bhateri Devi, 66, in May became the world's oldest woman to give birth to triplets. She was unable to bear children throughout her married life.

Fertility experts here say India is facing a unique problem because there is so much pressure for women to have children and the technology is relatively affordable.

One IVF attempt at this clinic costs about $2,500, while in the United States it can run up to $15,000. Although the fees in India are high for middle-class families earning a typical $15,000 to $20,000 a year, they are often able to get money from relatives or a bank loan. Rohtash's family of farmers did both.

India is expected to surpass the United States and China in the number of IVF cycles, said Hrishikesh Pai, one of the country's leading IVF experts and vice president of the 900-member Indian Society of Assisted Reproduction.

About 150,000 cycles were performed in the United States last year and about 80,000 in China, Pai said. No data were collected for India because many new clinics are not reporting numbers, but some experts think the number could reach 600,000 in the next three years, Pai said. Many doctors will try up to four rounds of IVF.

India has more than 550 registered IVF centers, according to Pai's studies, and he estimates that one new clinic is opening every 15 days.

There are two main client categories. About 20 percent are older and want to shed the stigma of being unable to conceive. Others are similar to many profiles in the United States, where upper-middle-class couples often spend time developing their careers and wait until their late 30s and early 40s to have children.

"The need of the hour is regulating these clinics," said Pai, who worked on a new law that calls for no age limit for IVF. The United States has no age limit for the procedure, but doctors advise against IVF after 45 and can refuse in situations in which it is considered too risky.

"There's an argument that says that if a man of 70 years and can have a child, why can't a woman of 70 have a child," said Pai, who works in Mumbai at several fertility clinics. "But what we need in India, because of our cultural pressures, is a policy to advise against it. It's not safe."

At the Hisar clinic, hundreds of worried-looking couples -- ranging from those in their 20s to senior citizens -- clutched scans and medical forms.

M.R. Bishnoi sat in his medical office under a poster of the Hippocratic oath and photographs of happy babies.

"Better late than never," said Bishnoi, who works with his son, Gyanwati Bishnoi. "Reproduction is a civil right -- nobody can bar you from bearing a child. We are not violating any laws of the land. Is it a home without children? In India, there is no woman who doesn't want a child. Without taking a risk, no one would accomplish anything in this world."

On a recent afternoon, he offered evidence that his procedures are safe by introducing Rajo Devi Lohan, 72, who gave birth to a daughter, Naveen, 18 months ago. Lohan is thought to be one of the oldest mothers in the world.

But Lohan has several health problems. Her husband, Balaram, is a farmer who always wanted a child. He even married a second wife but was unable to impregnate her.

He asked Lohan to try IVF after he read about the clinic in a Hindi newspaper. A relative donated an egg. His sperm was used.

Lohan said she worked through her pregnancy, milking cows, making chapatti bread and cleaning the house.

After Naveen was born, she was even able to breast-feed. Bishnoi said his clinic bought life insurance for Lohan and her husband so their daughter will receive money when they die.

"They are old parents," Bishnoi said, watching as Naveen played on her mother's lap, yanking at her dress. "They won't live for that much longer anyway. But now they have done a noble thing."

Special correspondent Ayesha Manocha contributed to this report.

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