The term Assisted Reproductive Technologies encompasses a diverse array of methodologies, ranging from the comparatively straightforward procedure known as Intra-Uterine Insemination (IUI) to various iterations of In-Vitro Fertilization And Embryo Transfer (IVF-ET), typically denoted as IVF and colloquially recognized as technology for the conception of offspring via laboratory-assisted means. Over the past few years, ART has expanded dramatically.

There are several reasons why ARTs have grown in India into a veritable fertility business. In terms of a number of cycles, India will very soon hold the top position in the ART industry. Even in tier II and tier III cities in our nation, techniques are still readily available, but the outcomes still vary greatly.

This article demonstrates a concise overview of the ART field in India with an emphasis on its fundamental principles, characteristics, and development. By focusing on the societal pressure on a woman to have children, the new Assisted Reproductive Technology (Regulations) Act, and the difficulties associated with ART, it seeks to investigate the industrial dimensions of ARTs. The paper also examines the adoption of ART by LGBTQ+ people, and it concludes by talking about the impact of assisted reproduction on the ageing population.

Introduction
New genetic technology and globalization-related privatization practices are interdependent. The government concurrently extols biotechnology as an avant-garde contribution to the healthcare sector and as a technologically advanced remedy for issues such as the deleterious consequences of globalization. Nevertheless, contention arises regarding the feasibility of rendering these technological advancements accessible within the framework of public health. The number of technologies that aid reproduction has rapidly increased during the past 20 years, improving the likelihood of conception and extending pregnancy.

Assisted Reproductive Technologies (ARTs) encompass a spectrum of medical procedures, ranging from the uncomplicated intrauterine insemination (IUI) to diverse iterations of in-vitro fertilization and embryo transfer (IVF-ET), colloquially known as IVF and legally recognized as 'test-tube baby technology.' In the latter half of the 20th century, significant advancements in technology have swiftly progressed, exerting a profound influence on societal perspectives concerning maternity, procreation, and gestation.

It's believed that Louise Brown, the world's first IVF baby, was delivered in the UK in 1978, just a few months before the first IVF child was born in India. The second IVF child ever born, Durga, was credited to Dr. Subhas Mukherjee of Kolkata. In the annals of assisted reproductive technology, a historic milestone was achieved in India on August 6, 1986, with the birth of a child purportedly conceived through in vitro fertilization (IVF). However, the veracity of this claim was subjected to rigorous scrutiny, leading to its dismissal due to insufficient substantiation.

Subsequently, through a collaborative research endeavor between the esteemed King Edward Memorial Hospital, a distinguished public healthcare institution in Mumbai, and the eminent Indian Council of Medical Research's (ICMR) Institute for Research in Reproduction, a legally and scientifically validated precedent was established. This groundbreaking study culminated in the birth of Harsha Chawla, marking a significant legal and medical triumph in the realm of assisted reproduction.

Numerous technologies are frequently invasive to women's bodies, frequently medically risky for both the woman and the child born as a result of ART, occasionally experimental, and not always backed by solid proof of success and safety. In India, most ART clinics and banks are in the private sector and contribute to a multi-million dollar business that has exploded without any regulation or set standards for care and services. In a setting where unrestrained commercial interests drive reproductive services, these risks and harms-especially to women-are exacerbated.

In the context of state restructuring and privatization, it is apparent that the state's goals concerning healthcare have transitioned from safeguarding public interests to promoting corporate interests, thereby establishing an environment where healthcare operates as a platform for corporate financial gain.

History
It might be argued that the history of ART in India predates that of ART overall. Louise Brown, who was born in 1978 and will always be remembered as the first human born by in-vitro fertilisation (IVF) therapy in the world, served as the catalyst for the field of assisted reproduction's enormous advancements over the preceding 40 years.

In 1978, Kanupriya alias Durga, the nation's first test-tube child, was born in Kolkata, commencing India's complex and drawn-out relationship with assisted reproduction technology (ART). With it, a prosperous reproductive tourism industry began to grow. Without an appropriate regulatory or legal framework to restrain it, the sector grew significantly.

Utilizing a conservative approximation, the nation hosts over 40,000 Assisted Reproductive Technology (ART) clinics, leading to a plethora of legal, moral, and societal issues necessitating standardized protocols. In response to this, the Indian Council of Medical Research (ICMR) introduced the National Rules for Accreditation, Supervision, and Regulation of ART Clinics in India in 2005.

These guidelines, serving as India's inaugural national surrogacy directives, were established to mitigate the prevailing legal discrepancies in the field. Regulations on surrogacy have also occasionally been released by the Ministry of Home Affairs. The Law Commission advocated for legislation to be passed in 2009's 228th report, which would have made surrogacy legal and facilitated the proper use of ART.

On December 8, 2021, the legislative body ratified the Assisted Reproductive Technology (Regulation) Act, 2021, a measure subsequently sanctioned by the President on December 18, 2021, thereby affirming its legal enactment. The Act aims to establish comprehensive regulatory frameworks for Assisted Reproductive Technology (ART) clinics and banks, ensuring diligent oversight and prevention of misuse, while promoting the ethical and secure delivery of ART services.

Simultaneously, the Surrogacy (Regulation) Act, 2021, is introduced, exclusively sanctioning altruistic surrogacy as the sole legally permissible form. Although the Acts eventually control the industry, they also present a variety of legal questions, including as rights, technical developments, international surrogacy, obligations, and ethical dilemmas.

Challenges Of Societal Expectations On Women To Have Children

Public Perceptions of the Challenges Confronted by Women
Everyone acknowledges the strong social pressure that couples-particularly women-experience when considering having children. They experience a lot of psychological stress in these situations, as some have noted, "There is sometimes a lot of pressure on the lady to become pregnant immediately away," and another has said, "Women frequently arrive with a lot of despair owing to the public scorn they are exposed to."

These public declarations indicated that the existence of this societal pressure was a justification for the fast spread of ARTs. They talked about how the methods helped women. Another provider stated, "These technologies provide answers to those couples who are anxious to have their children and are willing to do anything to have a kid.

The rise of assisted reproductive technologies (ARTs) has provided some relief for women struggling with infertility, allowing them to conceive and have children even when traditional methods are not successful. However, the use of these technologies can be costly, emotionally draining, and physically demanding, and not all women have access to them.

They said that because women are more likely to experience infertility and childlessness than males, they would be prepared to undergo any type of medical intervention to become pregnant, regardless of the potential financial, emotional, or physical implications. By doing this, they support the socially created image of womanhood, which assumes a straight path from marriage to parenthood. Alternative parenting arrangements or deliberate childlessness are not acceptable in this ideal.

Unfortunately, infertility and childlessness are still seen as a "failure" on the part of women, despite the fact that these issues can stem from a variety of factors that are often beyond their control. This emphasis on traditional motherhood also overlooks the many alternative parenting arrangements that can be just as fulfilling and meaningful.

Adopting a child, becoming a foster parent, or choosing to remain childless are all valid choices that should be respected and supported. It is crucial to acknowledge that there is no universally mandated standard for womanhood or parenthood, and that every individual is entitled to exercise their autonomy in determining their own path in matters of family and personal life.

Challenges Through a Woman's Perspective
Globally, fewer women of childbearing age are giving birth to children. There is a lot of pressure on Indian women to have children. The pressure on women to have children is deeply rooted in societal expectations and gender roles. Women are often expected to prioritize motherhood over other aspects of their lives, including their careers and personal goals.

This pressure can be particularly intense for women in heterosexual relationships, who are often viewed as incomplete without children.This societal pressure can take a toll on women's mental health, as they may feel inadequate or like they are failing if they are unable to conceive. Furthermore, women who choose not to have children or who experience infertility may face discrimination or judgment from others.

The major reason for getting married is to have children, and women are expected to start having kids not long after being married. Children bring social prestige, emotional fulfilment, and economic benefits by helping with domestic and subsistence tasks. They also aid with home chores. Children constitute a significant source of elder assistance when parents age.

Because children are highly valued, infertility can have negative societal repercussions. For instance, infertile women typically endure severe humiliation, emotional distress, and a potential rise in marital violence. Studies have shown that many women describe feeling as though their relationships are in danger because of their infertility.

The enormous pressure women experience to have children is a significant element that has been recognized. These obligations become internalized in addition to being externalized in the behavior of family members and neighbors, making it challenging for women to fulfill what is seen to be their inherent responsibility as mothers after marriage.

It might be challenging to tell the difference in such circumstances between a woman's deliberate desire to become a mother and socialization that makes married women feel incomplete without having children. Being a mother is seen as a woman's destiny. Even when the guy is the one with a reproductive issue, women frequently blame themselves for their infertility. The fast expansion of the ART sector in India has been made possible by the social pressure on women to have children.

Some LGBTQ+ people will face infertility in addition to "situational" infertility and social pressure, much like heterosexual couples do. Some LGBT individuals who identify as intersex may also be infertile or have limited fertility.Discrimination persists as LGBTQ+ individuals pursue parenthood, despite the fact that it should not hinder or prevent them.

Statistics suggest that in the United States, approximately 3 million members of the LGBTQ+ community have become biological parents, and around 6 million children have an LGBTQ+ parent. In contrast to heterosexual couples, same-sex couples exhibit a fourfold higher likelihood of parenting legally adopted children and a sixfold higher probability of nurturing children placed in their care through the foster care system.

Art (Regulation) Act, 2021

In 2005, the Indian Council of Medical Research (ICMR) established regulations for clinics performing Assisted Reproductive Technology (ART) procedures, including surrogacy. These guidelines permit single women and couples to access ART services, authorize ART banks to compensate donors, and mandate the registration of clinics offering these services. The rules also specify the circumstances under which surrogacy may be opted for, outlining conditions alongside surrogate compensation.

In July 2019, the government introduced the Surrogacy (Regulation) Bill, which outlines specific requirements for individuals seeking to commission surrogacy services and for those willing to become surrogates. It also allows for the registration of surrogacy facilities and mandates the establishment of advisory boards to assist in formulating surrogacy-related legislation. During the review of this Bill, the Committee suggested the development of comprehensive regulations to govern clinics and banks offering various reproductive services, including Assisted Reproductive Technology (ART) and surrogacy services.

In October 2020, the Assisted Reproductive Technology (Regulation) Bill, 2020, was referred to the Standing Committee on Health and Family Welfare for examination after being presented in the Lok Sabha in September 2021. The ART Bill was approved by Lok Sabha on December 1, 2021, with a few modifications. ART Bill, 2021's most important clauses and the most important problems still up for debate are covered in this note.

The Indian Act mandates all Assisted Reproductive Technology (ART) clinics and banks to register with the National Registry of Banks and Clinics. This Registry serves as the primary database for all facilities offering ART services in India, including scientific and technical professionals. State governments are required to appoint officials to facilitate the registration process.

The Act also establishes the National Reproductive Technology and Surrogacy Board, tasked with setting a code of conduct for employees in ART clinics and banks. It specifies minimum standards for their physical facilities, laboratory equipment, diagnostic tools, and staffing levels. The Board is entrusted with overseeing the functioning of the Registry.

The Act delineates the duties of ART banks and clinics, including verifying the eligibility of commissioning couples, women, and donors for ART services. Clinics must source donors' gametes from banks ensuring medical examination for diseases. The Act mandates offering counseling to commissioning couples and women about ART implications and safeguarding children's rights. Breaching these terms results in severe penalties.

Repeat offenders face imprisonment for 8 to 12 years and fines ranging from 10 to 12 lakh rupees, while first-time violators may be fined between 5 lakh and 10 lakh rupees. Operators of clinics or banks that provide or advertise sex-selective ART may be subject to a 5- to 10-year jail sentence, a fine of 10 to 25 lakh rupees, or both.

Identifying Deficiencies In The Regulation Of The Art Industry

The assisted reproductive technology (ART) industry has grown rapidly in recent years, leading to new opportunities for individuals and couples to conceive. However, this growth has also led to concerns about the regulation of the industry. While some countries have established laws and guidelines to govern the use of ART, others lack comprehensive regulations, leading to potential ethical and safety issues.

Common concerns include the use of unproven treatments, inadequate screening of donors, and the lack of oversight for clinics and providers. Addressing these deficiencies in regulation is crucial to ensuring the safety and efficacy of ART treatments and protecting the rights of patients.

The Act represents a significant effort to mitigate the risks posed by unauthorized and unlawful Assisted Reproductive Technology (ART) facilities. It aims to protect both donors and women undergoing ART from the health hazards associated with unsafe and illegal treatments. However, the Act lacks comprehensive measures to effectively tackle various crucial issues in this context.

The Act prohibits transgender people and gay couples (whether married or cohabiting) as well as single males, divorced men, widowers men, unmarried but cohabiting heterosexual couples, and unmarried but widowed men from utilizing ART services.

The exclusion of certain individuals from the scope of the Surrogacy Act has been a topic of debate among legal and medical experts. While some argue that the Act should be inclusive of all individuals who wish to pursue surrogacy as a means of reproduction, others contend that certain limitations are necessary to ensure that the practice is not abused or exploited.

The Surrogacy Act also prohibits the aforementioned individuals from using surrogacy as a means of reproduction, hence this exclusion is pertinent. Only commissioning couples who have been trying to conceive for a year without protection from coitus are covered by the Act. Its applicability is therefore restricted, and individuals who are excluded have much fewer options when it comes to getting pregnant.

The absence of cost regulation in surrogacy services poses a significant obstacle, especially for financially disadvantaged individuals. Therefore, policymakers should contemplate enacting measures to enhance the accessibility and affordability of surrogacy for those in need.

Assisted Reproduction In Relation To Reproductive Decline

Although demography and population studies still play a significant role in many respects, the link between age and fertility goes beyond how it is conceptualised in those fields. Women's age-related reproductive illnesses, according to Daly and Bewley, include decreased egg production, decreased fertility, an increase in miscarriages, ectopic pregnancies, pre-eclampsia, caesarean sections, stillbirths, neonatal deaths, maternal deaths, and a decline in uterine receptivity.

By attempting to comprehend the connections between social positions and ageing in various cultural contexts, this relationship has shaped discussions on the life cycle in anthropology. The concept of the "biological clock" has been the most influential one regarding age and fertility.

Media coverage and portrayals in popular culture have encouraged its current significance. The idea of the ticking clock concerning decreased fertility has emerged as a topic of current research in anthropology and sociology.

The concept of aging and falling fertility is ingrained in Western medical discourse that situates it within the confines of eggs and their decrease. The concept of age is increasingly linked to medical processes and technological interventions, departing from the traditional natural representation of menopause. According to Friese in 2015, within ART, eggs serve as the storage locations for reproductive aging. This finding is crucial since menopause was often thought to be the final sign that female fertility had died.

In the Gambia, for example, elder women who have given birth are viewed as having accomplished an important societal role and wear the badge of mothering and caring with great pride. This is what Bledsoe in 2002 observed in this situation. In Japan and India, menopause signifies the end of a woman's reproductive life but not her social life.

As a result, the reproductive decline is marked in a gendered form on the female body even if its expressions may differ among cultures. We are forced to think of the early loss of fertility as solely impacting women as a result of this conceptualization, which also has an impact on the linkages to the biological clock.

But when reproduction rates decline, more and more men are also under the critical spotlight. In doing so, there is a deliberate shift in focus from worries about impotence and sexual performance to worries about infertility. The later males have children, the more likely it is, according to new medical research, that they would have children who have specific genetic problems.

Reproduction and its connections to finite time play a significant role in medical and anthropological encounters, and they are framed by age and ageing. However, the idea of temporal vicissitudes on reproduction appears to be restricted to the IVF procedure for overcoming infertility.

Way Forward
The path towards technologically curated families in India has been fraught with years of misdiagnosis, neglect, and invasive treatments targeting the uterus. While ART management has made strides in addressing the reproductive system of younger women, there is still much progress to be made in ensuring ethical and equitable practices.

The Act marks a significant milestone in the quest to tackle the unethical practices that have plagued the field of assisted reproductive technologies in India for years. However, the road ahead remains long and winding, and constant vigilance will be required to ensure that this legislation keeps pace with the changing times and evolving moral and technological landscapes.

Years of infertility, misdiagnoses, and unaddressed issues in older women led to a focus on the uterus, assuming ovarian decline due to menopause. In younger women, assisted reproductive technology (ART) management addresses the entire reproductive system incrementally, including menstrual cycles, uterus, tubes, and ovaries.

This complex treatment approach has been criticized for its intrusiveness and aggressiveness. The Act represents a positive step forward, especially in India, a significant hub for such reproductive abuses, as it aims to address these issues. To guarantee that the law keeps up with social changes, moral requirements, and technology's rapid advancement, there must be a dynamic monitoring system.

As we reflect on the impact of this historic legislation, we must remain vigilant in evaluating its effectiveness and weighing its benefits and drawbacks. The future of technologically curated families in India is being shaped before our very eyes, and it is up to us to guide it towards a more just and compassionate path.

End-Notes:

1. What is Assisted Reproductive Technology?, CDC (Oct. 17, 2022) - https://www.cdc.gov/art/whatis.html
2. Meaghan Jain and Manvinder Singh, "Assisted Reproductive Technology (ART) Techniques", NATIONAL LIBRARY OF MEDICINE (Oct. 17, 2022) - https://www.ncbi.nlm.nih.gov/books/NBK576409/
3. Anuradha Mascarenhas, "India@75: She was India's first test test-tube baby. Kanupriya Agarwal, 45, now champions IVF", INDIAN EXPRESS (Oct. 17, 2022) - https://indianexpress.com/article/lifestyle/health-specials/india75-kanupriya-agarwal-45-now-champions-ivf-8091458/
4. Sama Team. "Assisted Reproductive Technologies in India: Implications for Women." 42(23) ECONOMIC AND POLITICAL WEEKLY, 2184–2189 (2007).
5. Supra note. 2
6. Supra note. 3
7. Narendra Malhotra, Duru Shah, et al., "Assisted reproductive technology in India: A 3-year retrospective data analysis", 6(4) J HUM REPROD SCI (Oct. 17, 2022) - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3963305/
8. "Law Commission Report No. 228- Need for Legislation to Regulate Assisted Reproductive Technology Clinics as Well as Rights and Obligations of Parties to a Surrogacy," LATEST LAWS (Oct. 17, 2022) - https://www.latestlaws.com/library/law-commission-of-india-reports/law-commission-report-no-228-need-legislation-regulate-assisted-reproductive-technology-clinics-well-rights-obligations-parties-surrogacy.
9. "Assisted Reproductive Technology (Regulation) Act, 2021: A timely legislation for a timeless problem", BAR AND BENCH (Oct. 17, 2022) - https://www.barandbench.com/columns/assisted-reproductive-technology-act-a-timely-legislation-for-a-timeless-problem.
10. Diksha Tekriwal, "Lacunae in the Surrogacy (Regulation) Act, 2021", THE LEAFLET (Oct. 17, 2022) - https://theleaflet.in/lacunae-in-the-surrogacy-regulation-act-2021/
11. How society puts pressure on women to have children, NEWS 24 (Oct. 17, 2022) - https://www.news24.com/parent/Fertility/Fertility_problems/how-society-puts-pressure-on-women-to-have-children-20170328
12. Supra note. 11
13. Therese Shechter, "A Brief History of Bullying Women to Have Babies", TOPIC (Oct. 17, 2022) - https://www.topic.com/a-brief-history-of-bullying-women-to-have-babies
14. LGBTQ Family Building, Virginia Fertility and IVF (Oct. 17, 2022) - https://www.vafertility.com/lgbtq-family-building/
15. Clara Moskowitz, "An L.G.B.T.Q. Pregnancy, From D.I.Y. to I.V.F.", THE NEW YORK TIMES (Oct. 17, 2022) - https://www.nytimes.com/2020/04/15/parenting/fertility/lgbtq-pregnancy-ivf.html
16. Lok Sabha passes Assisted Reproductive Technology (Regulation) Bill 2020, NEWS SERVICES DIVISION (Oct. 17, 2022) - https://newsonair.gov.in/News?title=Lok-Sabha-passes-Assisted-Reproductive-Technology-(Regulation)-Bill-2020&id=430670.
17. Assisted Reproductive Technology (Regulation) Bill, 2021, NEXT IAS (Oct. 17, 2022) - https://www.nextias.com/current-affairs/02-12-2021/assisted-reproductive-technology-regulation-bill-2021.
18. Supra note 10
19. The Assisted Reproductive Technology (Regulation) Bill, 2020, PRS LEGISLATIVE RESEARCH (Oct. 17, 2022) - https://prsindia.org/billtrack/the-assisted-reproductive-technology-regulation-bill-2020
20. Ibid.
21. Supra note. 9
22. Anindita Majumdar, "Ageing and Reproductive Decline in Assisted Reproductive Technologies in India: Mapping the 'Management' of Eggs and Wombs", 13(1) ASIAN BIOETH REV. 39–55 (2021).
23. Henri Leridon, "Can assisted reproduction technology compensate for the natural decline in fertility with age? A model assessment", 19(7) HUMAN REPRODUCTION, 1548–1553 (2004)
24. Margaret M. Lock, "Reproductive Disruptions: Gender, Technology and Biopolitics in the New Millennium", 200-224 (New York, Berghahn Books, 2007).
25. Supra Note. 22
26. Caroline H. Bledsoe, "Contingent lives: fertility, time, and aging in West Africa" (Chicago: University of Chicago Press, 2002).
27. Supra Note 22
28. Maria C. Inhorn and Daphna Birenbaum-Carmeli, "Assisted reproductive technologies and culture change". 37 ANNUAL REVIEW OF ANTHROPOLOGY 177–196 (2008).