To see Manjeet Kaur around her little daughter is to see joy at its purest.
The 15-month-old toddles about the sprawling courtyard of her parents' farm, her oily curls tied up in a top knot, her rubber-soled shoes squeaking. Kaur's eyes don't miss a thing, and they often mist up with tears.
Gurjeet is the child Kaur yearned for desperately, after 40 years of being that thing which a rural Indian woman dreads more than almost anything else — barren.
She gave birth at 58 years old, with help from a controversial IVF clinic in Hisar that specialises in fertility treatments for women over 50.
Such treatments have become more common across the world, and they strike a cultural chord in India, where a woman is often defined by her ability to be a wife and mother.
While there are no reliable statistics for how many Indian women undergo fertility treatments each year at what age, tens of thousands of IVF clinics have sprouted up in the country over the last decade.
A Worrying Trend
Fertility specialists say pregnancies like Kaur's are troubling because of the potential health risks and the concern that the parents may not live long enough to raise their babies to adulthood.
Legislation is pending in the Parliament setting 50 as the legal upper age cap.
But Dr Anurag Bishnoi, the driving force behind the National Fertility and Test Tube Baby Centre in Hisar, harbours no such worries.
His clinic's website home page is dominated by photographs of patients who carried babies to term at ages well beyond what most other doctors anywhere in the world may permit. At least two of his patients gave birth at 70.
Kaur married her husband, Gurdev Singh, when she was 18 and he was just a little older than 20. She simply assumed that children would follow marriage, and there was no question of waiting. But no children came. She felt worthless.
The couple tried IVF twice in their 40s at two separate clinics in north India. It didn't work. For the vast majority of married Indian women, the inability to produce a child, preferably a son, can result in the taboo of divorce or abandonment by their husbands.
For years Kaur begged her husband to take another wife.
I wanted to marry him off myself. I was willing to do anything for this family. I said to him, this property, this house needs an heir. I haven’t been able to give you a childManjeet Kaur
It was Kaur's nephew who first heard of Bishnoi, the doctor in the nearby town of Hisar, who had built a prosperous medical practice and tidy little business empire by helping aging women across north India have children through in-vitro fertilisation.
The couple was at first hesitant, thinking about all the problems of such a late pregnancy. But meeting the doctor changed all that.
He treated us with so much respect and love. Doctor sahib was like a god to us.
Playing God?
Dr Anurag Bishnoi is called many things. God and quack top the list.
His harshest critics in the medical community accuse the embryologist of making money off the dreams of the desperate, and of taking wildly unnecessary risks with older women.
When Bishnoi helped a 70-year-old woman to give birth last April, Dr Hrishikesh Pai, who heads a federation of Indian gynecologists and obstetricians, called him a "rogue doctor" and "repeat offender" who ignores the self-imposed guidelines that most other fertility specialists follow.
Dr Narendra Malhotra, who heads the Indian Society For Assisted Reproduction, says Bishnoi is driven by a quest for records and has been attempting to "play God."
We don’t endorse making mothers out of grandmothers. It’s too risky for the women. Their bodies are not designed to bear children after 50.
Vague Laws
Malhotra notes that if a woman gets pregnant at age 70, her child may be an orphan before the age of 10. He says his association has requested that Bishnoi stop his extreme practice of working with significantly older women, with no success.
He’s not breaking any law because there is no law. But there are ethical and moral guidelines.
Most medical ethics guidelines around the world recommend a cut-off between 45 and 50 for treatments like IVF, and the Indian Medical Council sets 45 as the recommended age limit.
Across the United States and most parts of western Europe, insurance companies usually stop paying for IVF treatment after 45. In the United Kingdom, the limit for fertility treatments under the National Health Service is 42.
Bishnoi complains that the doctors who criticise him don’t ask about his clinic’s success rate, which is 30 percent for mothers above 50. It’s an average that is low when compared to IVF success rates for women under the age of 45. But for older women, it’s an average that Bishnoi considers “decent.”
A Child of Your Own At Any Cost?
The packed waiting room at Bishnoi's clinic bears witness to the fact that working-class families across the country are willing to spend their limited savings for a child of their own.
The cost of IVF treatment in the country is relatively low, even though many families have to pay on their own. At Bishnoi's clinic, one cycle of IVF costs about Rs 1,10,000, compared to over Rs 700,000 in the US.
“This treatment costs as much as buying a buffalo,” says Bishnoi, whose patients are largely from farming families.
But for Kaur and Singh none of this matters. "One day when she is older, she will share my joys and sorrows," Kaur says. "She will ask me, 'Mummy, how did you pass the days before I came?'"
(The article has been edited for length.)
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