When Padma was 22, she was diagnosed with cancer. What followed were three brutal cycles of chemotherapy—each necessary, each taking something from her. Doctors warned that the radiation would damage her ovaries. But Padma was fighting to stay alive. Freezing her eggs felt like a problem for another time, one she hoped she would have.

She survived. Her ovaries did not.

Now 27, Padma—whose name has been changed to protect her privacy—needs a donor egg to conceive. Under normal circumstances, that option would have been available in Nepal. But last August, Nepal's Supreme Court issued an interim order banning the extraction and storage of women’s eggs entirely, directing the government to form regulations before any clinic could resume the services. The order came after Hope Fertility and Diagnostic Pvt Ltd in Babarmahal was found to have been illegally extracting eggs from teenage girls and selling them commercially. The court’s intent was protection. But for women like Padma, the protection arrived too late, and the wait for what comes next has no clear end.

‘‘I did everything right,’’ she said. ‘‘I treated my cancer. And now I am being told to wait for the government to write a law.’’

Nepal’s Supreme Court order, issued on August 19, 2025, by a single bench led by Justice Tek Prasad Dhungana, was the result of a writ petition filed by advocates Nirab Gyawali, Dhruva Bhandari, and Ankita Tripathi. The petitioners argued that egg extraction should only be permitted under a clear legal framework. The court agreed and, in the absence of a law, banned it altogether.

The ban was not without reason. The Hope Fertility case had exposed what many in the medical community had long known: Nepal’s rapidly expanding fertility industry was operating with little or no oversight. Agents recruited donors, many of them young women who needed money and had little understanding of the procedure. Clinics multiplied. And behind those clinics was a system built on concealment.

A young woman—referred to here as Sita, a pseudonym—was 17 when an agent named Justina Pradhan first approached her. The pitch was simple: donate your eggs, get paid. ‘‘She said this is how it works and this is how you get money,’’ Sita recalled. ‘‘She told me many people had done it, even girls younger than me.’’ The money promised was Rs15,000. What Pradhan collected from the clinic on her behalf was between Rs70,000 and Rs80,000.

No one told Sita she would be put under anesthesia. No one explained what the injections were for. When she was asked to sign documents, the agent signed them herself, listing herself as a guardian. Sita does not know what those documents said. She was never given a copy.

‘‘They said there were no risks,’’ she said. ‘‘They didn’t mention injections or being unconscious. They just called it egg donation.’’

Sita donated once, though she knew girls who had donated twice within two months, far shorter than the four-to-five-month gap that medical standards require between donations. Her periods have been irregular ever since—sometimes late, sometimes early. That had never happened before.

The clinic did not follow up. Her parents only found out when they saw messages on her phone. She was, by then, already gone from the clinic's records—replaced by a false name and a false age. When her father—identified here by his last name, Tamang—later obtained the files, his daughter’s age had been changed to 25. The names listed were not hers.

‘‘All the documents were totally fake,’’ Tamang said. When he tried to fight the case, a clinic-linked official warned him: ‘‘I am a judge-like person, you cannot fight against us.’’ Tamang pushed back regardless, eventually approaching the Central Investigation Bureau. Even after the CIB arrested the doctors and agents involved, they were released quickly. Political pressure, Tamang said, ran through the entire process. ‘‘Because of high-level connections, the legal process was constantly obstructed.’’

Today, Sita is clear about what happened to her. ‘‘Yes, I was exploited,’’ she said. She is just as clear on bodily autonomy. ‘‘I think doing this under the age of 25 is very risky. If I had been more mature and had more information, I wouldn’t have done it. If a younger girl asked me today if she should donate, I would say: “A definte ‘No’!”

Nutan Sharma, an IVF specialist at Norvic Hospital, does not dispute what Sita experienced.

‘‘A 17-year-old girl has hardly any knowledge and can be easily swayed for a little bit of money,’’ she said. ‘‘The reason we have this problem is that the system was being misused.’’

But Sharma’s concern now is what the ban means for the other side of that same system—the women who are not donors, but who cannot conceive without one.

Sharma supports the ban—conditionally. ‘‘I obey and support the recent suspension because our government should come up with clear regulations that are good for everyone,’’ she said. But she is also clear about what is at stake in the interim. “Forty to fifty percent of IVF patients cannot become mothers without donor eggs. They have a right to achieve motherhood.’’

Lawyer Shreena Nepal, who has been involved in legal advocacy around Nepal’s Assisted Reproductive Technology (ART) framework, explains that the court’s order exposed a fundamental problem: there is no statute in Nepal that specifically defines or regulates egg donation. The Civil Code addresses the paternity of children born through artificial insemination but says nothing about ova. The Criminal Code is similarly silent. ‘‘As there is no law, there is no crime—but that also means there is no protection,’’ she said.

The classification of what the clinics involved in the Hope Fertility case actually did has proven legally difficult. Nepal’s Human Trafficking Act focuses largely on sexual exploitation, and it is unclear whether extracting and selling eggs from a minor fits that definition. ‘‘These are new and developing concepts in Nepal,’’ the lawyer said. ‘‘The law has not caught up.’’

She is among those pushing for a comprehensive ART law—one that would set age limits for donors, require that donors have at least one child of their own, cap the number of times a person can donate, mandate citizenship verification to confirm age, standardise compensation across both public and private hospitals, and require mandatory health screening for donors. India passed its own ART Act in 2021, and Nepal’s fertility advocates have pointed to it as a model, however imperfect.

Lawyer Nepal is not optimistic that such a law will come anytime soon. ‘‘It can take decades,’’ she said. She points to surrogacy—the Supreme Court ordered its regulation in 2016, and Nepal is yet to enact a law governing it. Egg donation, she fears, risks the same fate.

In government hospitals, the queues say what the policy documents do not. Since the ban, the demand for fertility services has not disappeared, but it has simply backed up. Geeta, a doctor at one such hospital who asked to be identified by a pseudonym, has watched it happen.

‘‘Egg donation is needed when women have low ovarian reserves. Any woman of any age can have low ovarian reserve—I have seen it in women who are 20, 25, 30, and 40,’’ she said. ‘‘If a woman is 40, she may need a younger woman’s eggs. As a doctor, what should I do now that it has been banned?’’

She is not opposed to the ban itself. ‘‘The government acted as minors were being used as donors, and the same persons were donating multiple times.” But she wants the government to move quickly. The age criteria, the health checks, the limits on repeat donations, the standardised pricing—all of it, she said, needs to be codified. ‘‘They should check citizenship cards to confirm age. India has already started doing this. Our government can do the same.’’

She has also seen the cross-border effect. ‘‘Many people are going to India, especially to Delhi, because egg donation is allowed there. But many of them are not financially stable or fully aware of how the process works. IVF is not a guarantee. I have seen people return after three cycles, three months, three attempts—unable to conceive. It is a waste of money for them.’’

Preeti Bista, a clinical embryologist at Angel Fertility Clinic and Maya IVF, says that before the ban, her clinic would see an average of 15 to 20 patients seeking fertility services. That figure has since then dropped to 7 to 8 cases, and that too only self-implantation. ‘‘This has affected all the clinics,’’ she said. Those who genuinely need donor eggs are left with two options: either to join the waitlist or to cross the border for the service.

Sharma’s view on cross-border care is less about cost than quality. ‘‘I would always recommend against going abroad,’’ she said. ‘‘We provide very good quality service here. We have patients coming to us from Bangladesh, China, the US, the UK, and Australia.’’

The cross-border movement for fertility services was already underway before the Supreme Court order and Nepal’s regulatory crackdown has accelerated it. Several IVF clinics in Delhi and other Indian cities openly market themselves to patients from Nepal, offering packages that include flights, medical visa assistance, and accommodation. After the ban, some clinics in Nepal that had offered donor-egg services scaled back or paused entirely, pushing more couples across the border.

In April this year, Nepal Medical Council Registrar Satis Kumar Deo moved to stop an unauthorised IVF consultation camp run by Indian doctors at a Kathmandu hotel, underscoring both the existing demand and the vacuum that has formed to fill it.

The Supreme Court’s intervention was framed as a form of protection. But who was consulted before that protection was put in place?

Sumitra Poudel, Program and Research Coordinator at WOREC Nepal—an organisation that has conducted sustained field research on infertility through an Sexual and Reproductive Health and Rights lens—says the absence of consultation with women’s rights groups and civil society before the ban reflects a familiar pattern.

“Policies affecting women's bodies and reproductive choices are often shaped through moral, legal, or institutional perspectives without adequately hearing from those most impacted,” she said. “This is especially concerning in areas like infertility, where stigma already prevents open discussion and where women frequently suffer in silence.”

Infertility, WOREC research found, becomes a trigger for domestic violence, social exclusion, and mental health distress, not because of medicine but because of social meaning attached to a woman’s inability to conceive.

The problem, Poudel argues, was never the transaction itself, it was the absence of any framework that would make it safe and ethical. ‘‘If women voluntarily choose to support intended parents through egg donation, the government should not criminalise or silence those decisions,’’ Poudel said. ‘‘It should ensure dignity, informed consent, fair compensation, medical safety, and protection from exploitation.’’

A blanket ban, she warned, risks pushing practices underground—reducing accountability rather than eliminating harm. ‘‘Bans alone rarely eliminate exploitation. They often increase risk.’’

The women WOREC works with, Poudel said, are not asking only for access to technology. ‘‘A recurring message was that women should not be forced to suffer silently because of policy gaps, stigma, or the absence of state responsibility.’’ She was as direct on what the state owes all women involved. ‘‘Women should not have to choose between exploitation and complete denial of reproductive options. The state’s responsibility is to create rights-based regulation that protects all women involved—donors, recipients, and intended parents—rather than relying solely on prohibition.’’

The egg donation ban sits at the centre of a broader tension in how Nepal and many countries legislate around women’s reproduction. For Shreena Nepal, who was part of the legal team behind the writ petition, that right was never in question. Article 38 of Nepal's Constitution guarantees women a fundamental right to bodily autonomy—one she says the ban does not negate.

‘“The right exists,” she said. “The issue is the lack of regulation around how those rights are exercised.” The ban, while it is permanent for the minors, she said, is a temporary measure for others—as a way to prevent exploitation until proper rules are in place. But temporary, in Nepal’s legislative history, can mean a very long time.

For Sita, there is at least a partial reckoning. The CIB acted. The case reached court. The agent and the clinic have been named. The system that failed her has been, however imperfectly, interrupted.

For Padma, the wait continues. She is not the person the Supreme Court was trying to protect. She is someone who needed the system to function ethically so that she could use it, and the ban that came to stop Sita’s exploitation is the same ban that now stands between Padma and the only medical option she has left.

“I understand why they stopped it,” she said. “But I wish they had a plan for people like me.”