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Hclre Unit 5
Hclre Unit 5
TECHNIQUES OF A.R.T
3) SURROGACY
INTRAUTERINE INSEMINATION
• The seminal vesicle is prepared in the laboratory (washed with special
media). Injected inside the uterus with catheter after stimulating the ovaries
to produce more eggs per cycle.
• The catheter used here is known as ‘TOM CAT’
INTRATUBAL INSEMINATION
• It involves injection of the washed sperm into the fallopian tube.
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• It should not be confused with the GIFT , where both the eggs are mixed
outside the women's body and then immediately inserted into fallopian tube..
• Less used than IUI
2. INVITRO FERTILIZATION
Ovary stimulation
- Different hormones are given to female in order stimulate formation of
more than one ovum.
- formation of more than one ovum for multiple zygote or embryos to
increase the probability for getting a healthy embryo.
- Drugs or hormone like Clomiphene (clomid),hMG (pergonal),FSH-
(metrodin) ,GnRH agonists (lupron)-FSH/LH first promoted, then inhibited
hCG-acts like LH
Oocyte retrieval
– it is a technique used to remove oocyte from the ovary of the female
enabling fertilization outside the body
PROCEDURE:
– Under ultrasound guidance, the operator inserts a needle through the
vaginal wall and into an ovarian follicle, taking care not to injure organs
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located between the vaginal wall and the ovary. – The other end of the
needle is attached to a suction device.
– Then the follicular fluid and cellular material is suctioned with the needle.
– The procedure usually lasts 10-20 minutes
Sperm retrieval
– Approximately three hour before the procedure ,a semen sample from the
male donor is obtained . The sperm is then washed and prepared for loading
into the same catheter into which several of the female’s best eggs will be
placed .
– The eggs are obtained by transvaginal needle aspiration(no surgical
incision) via an ultrasound
Fertilization
– After retrieval of sperm, eggs and sperm are brought together in a
laboratory glass dish to allow the sperm to fertilize an egg . If sperm
parameters are normal, approximately 50,000 to 100,000 motile sperm are
transferred to the dish containing the eggs. This is called standard
insemination. Once fertilization takes place one or more healthy embryos are
transfered to the uterus
– The ICSI technique is utilized to fertilize mature eggs if sperm parameters
are abnormal. This procedure is performed under a high-powered
microscope
ADVANTAGES
– There is no much human intervention in the actual fertilization of the
eggs.
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– Because fertilization takes place within the fallopian tube, GIFT offers an
option for people whose religious beliefs prohibit conception outside the
body.
DISADVANTAGES – Can be performed only if woman have at least one
normal fallopian tube. – GIFT does not allow for visual confirmation of
fertilization. – GIFT involves a laproscopic surgery.
ADVANTAGES
– Fertilization can be confirmed before they are implanted into the fallopian
tube.
– Allows a developing embryo to travel into the uterus on its own, which
may be important to those who wish their baby to develop as naturally as
possible
DISADVANTAGES
– Can be performed only if woman have atleast one normal fallopian tube.
– It is more expensive than GIFT. – ZIFT involves a laproscopic surgery
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DISADVANTAGES Altering the nature’s selection process for sperm can
lead to an increase risk of developmental and health issues for ICSI children,
as well as a higher risk of miscarriage because of the poorer genetic material
involved.
SURROGACY
The word ‘surrogate’ has its origin in Latin term “Surrogatus” which means
a substitute, that is, a person appointed to act in the place of another.
Surrogacy is a method of reproduction whereby a woman( surrogate) agrees
to carry a pregnancy and give birth as a substitute for the contracted parties
THE SURROGACY (REGULATION) BILL, 2016 Section 2(zb)
“surrogacy" means a practice whereby one woman bears and gives birth to a
child for an intending couple with the intention of handing over such child to
the intending couple after the birth; Section 2(ze) “surrogate mother" means
a woman bearing a child who is genetically related to the intending couple,
through surrogacy from the implantation of embryo in her womb and fulfils
the conditions as provided in sub-clause (b) of clause (iii) of section 4
Section2(b) “altruistic surrogacy" means the surrogacy in which no charges,
expenses, fees, remuneration or monetary incentive of whatever nature,
except the medical expenses incurred on surrogate mother and the insurance
coverage for the surrogate mother, are given to the surrogate mother or her
dependents or her representative; Section2(f) “commercial surrogacy"
means commercialization of surrogacy services or procedures or its
component services or component procedures including selling or buying of
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human embryo or trading in the sale or purchase of human embryo or
gametes or selling or buying or trading the services of surrogate motherhood
by way of giving payment, reward, benefit, fees, remuneration or monetary
incentive in cash or kind, to the surrogate mother or her dependents or her
representative, except the medical expenses incurred on the surrogate mother
and the insurance coverage for the surrogate mother
TYPES ON THE BASIS OF METHODS Traditional or Partial Surrogacy
Gestational Surrogacy or Total Surrogacy TYPES ON THE BASIS OF
MONEY Commercial surrogacy Emotional surrogacy
TRADITIONAL SURROGACY
Known as Partial surrogacy
In the traditional case, the surrogate mother will be artificially inseminated
with the sperm of the intended father or the sperm from a donor when the
sperm count is low.
Here the mother would be genetically related with the baby because in
either case the surrogate’s own egg will be used.
Due to this reason the two parties’ i.e. infertile couple and surrogate mother
enter into a contract where surrogate mother is artificially inseminated with
the sperm of male partner of that couple.
GESTATIONAL SURROGACY
Known as total surrogacy
In order for a pregnancy to take place, a sperm, egg, and a uterus are
required. In case of gestational surrogacy, the eggs are extracted from the
intended mother or egg donor and mixed with sperm from the intended
father or sperm donor in vitro.
In case of total surrogacy an embryo created by the process of In-Vitro
fertilitsation is implanted into the surrogate’s uterus.
One thing is worthy to mention in context of gestational surrogacy is that
here the mother is not genetically related to the child.
The gestational surrogacy comes under the ambit of assisted reproductive
technologies. Gestational surrogacy can be described as “Womb leasing
Process”.
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The reasons to call it so is that the surrogate mother merely allows her womb
to be used for carrying further the reproductive process.
COMMERCIAL
In commercial surrogacy arrangements the surrogate mother enters into an
agreement with the commissioning parents or single parent to bear the
burden of pregnancy.
In return of her agreeing to carry the term of the pregnancy, she is paid by
the commissioning parents for that.
The usual fee is around $ 25,000 to $ 30,000 in India which is around 1/3 rd
of that in developed countries like the USA.
EMOTIONAL
It is that form of surrogacy in which the surrogate mother does not receive
any financial reward for the pregnancy or for the pain to be undertaken by
her or for the handing over of the child to the commissioning parents. It is
also known as Altruistic Surrogacy
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Like any other pregnancy, surrogate pregnancies involve the same medical
risks of carrying a child and giving birth. These can include nausea from
morning sickness, weight gain, swelling, back pain, heartburn and other
uncomfortable side effects. Some more serious side effects are conditions
that can develop during the pregnancy like gestational diabetes,
hypertension or potential damage to your reproductive organs.
As with any pregnancy, there is also the risk of a surrogacy miscarriage or
preterm labor. To reduce these risks, it’s important to keep in close contact
with your doctor, take the proper medication, get the right amount of rest
and follow their recommendations precisely.
With gestational surrogacy, there are also some minor medical risks
associated with IVF treatments. Because you do have to take medicine for
IVF with surrogacy, including injecting yourself with fertility medications
at home, you can expect anything from slight needle bruising to temporary
allergic reactions. As you take medicine to regulate your menstrual cycle
and increase your chances of becoming pregnant, you may also
experience increased pre-menstrual syndrome effects, like headaches or
mood swings.
There are few risks associated with the embryo transfer process. You may
experience slight cramping or bleeding from the procedure. As always, it’s
important to stay in touch with your doctor; in rare cases, you may develop
an infection that can be treated with antibiotics.
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the easiest things you can do to reduce the risks of being a surrogate
mother.
SOCIAL ISSUES
New reproductive technology claim to help human beings through creative
interventions that reduce suffering and have the potential to transform the society.
The commercialization of surrogacy however creates several social conflicts rather
than resolving a few. It generates the family pressure on pure women to offer their
wombs for a price. In the other part in the world like in India the debate is focus on
the ethics of surrogacy rather than on the economic advantage of any particular
region. On the other hand the economic advantage is the main criteria behind going
for surrogacy. Majority of the women becoming surrogates are extremely
vulnerable due to poverty, lack of financial resources, low educational levels. For
them the financial gain is the key factor. This makes their economic exploitation
much easier for the agents for commissioning parents.
The surrogates often face the dilemma that being a surrogates is socially
unacceptable when the frankly accept monetary consideration. So rather than tell
their neighbours that they gave away their child, they tell them that the baby died.
There are cases where the surrogate mothers have refused to part with the baby. In
other cases the commissioning parents have refused to accept the child with the
deformity. Baby Manji’s case as there was divorce between the commissioning
couple the problem arose as to the custody of the new born baby. In many cases,
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the caesarean delivery needs to be performed. For such surgery the consent of
surrogate mother is to be obtained. Her refusal may imperil the life of the child.
Confusion also exists where a surrogate mother fails to take standard care and
precaution during pregnancy as a result of which harm is caused to the foetus. The
high aspirations of the intending parents are ruined because of this.
Surrogacy can also affect the children’s perception of the values and integrity of
their family. Secrecy and anonymity create a negative environment that affects
human relations within and outside families. It also involves the issues of
children’s right to information about the identity of their parents. Secrecy and
anonymity are routed in the social value of the primacy of ‘blood relations’. The
present practices push such children into a search of identity, a sense of shame and
anger against their social parents.
Commercialization of surrogacy creates several social conflicts. Given the extreme
vulnerability, one-third of the Indian women due to poverty, exclusion from and
marginalization in labour and job markets, patriarchal social and family structures
and low educational levels, the financial gain through surrogacy become a key
push factor. Since most surrogate mothers are not from well-off sections and the
motive primarily is monetary so they are easily exploited by the agents working for
commissioning parents. Secrecy and anonymity creates a negative environment
that affects human relations within and outside families.
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TECHNIQUES (Procedures & Tests)
1. Prenatal diagnostic procedures-
• USG
• Fetoscopy
• Sampling of amniotic fluid, chorionic villi, blood, any tissue, fluid of a
man or woman pre or post conception for sending to genetic Lab or Clinic
2. Pre natal diagnostic test-
• USG
• Test or analysis of:
- amniotic fluid
- chorionic villi
- blood
- any tissue
- fluid of any pregnant woman or conceptus conducted to detect:
→ genetic disorders
→ metabolic disorders
→ chromosomal abnormalities
→ congenital anomalies
→ haemoglobinopathies
→ sex-linked diseases
3. Sex selection-
• Procedure
• Techniques test
• Administration
• Prescription
• Provision of anything for the purpose of ensuring or increasing the
probability that an embryo will be of a particular sex.
PLACES:
1. Genetic Counselling Centre means-
• An institute
• Hospital
• Nursing home
• Any place by whatever name called which provides genetic counseling
to patients.
2. Genetic Clinic means:
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• A clinic
• Institute
• Hospital
• Nursing home
• Any place by whatever name called which is used for conducting pre-
natal diagnostic procedures. It also includes “vehicle” portable
equipments.
3. Genetic Laboratory
• a laboratory; and
• Includes a place where facilities are provided for conducting analysis or
tests of samples received from Genetic Clinic for pre-natal diagnostic test
QUALIFIED PERSONS
Gynecologist – post graduate qualification in obs & gyn For genetic
counselling centre, additional qualification- 6 mth experience in genetic
counselling OR
4 weeks training in same
For genetic clinic, gynecologist should have performed at least 20
procedures in chorionic villi aspirations, biopsy, amniocentesis,
cordocentesis, fetal blood sampling etc. under supervision of an
experienced gynecologist in these fields Other criteria for Pediatrician,
Registered medical practitioner, Medical genecist, Lab technician,
Radiologist, Sonologist are also included in the Act.
• Conceptus- any product of conception at any stage of development from
fertilization until birth including for membranes, embryo or fetus.
• Embryo-after fertilization till the end of 8 weeks (56 days).
• Fetus-period of its development beginning on the 57th day following
fertilization or creation (excluding any time in which its development has
been suspended) and ending at the birth
Registration
• All bodies under the PNDT Act namely Genetic Counselling Centre,
Genetic Laboratory or Genetic Clinic as defined in the preceding chapters
cannot function unless registered.
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• The Act enumerates Procedure, Minimum requirements, Process of
certification, Rejection, Cancellation, Suspension of registration, Appeal
against it & Renewal of registration.
Prohibitions
On PLACESNo genetic counselling centre or genetic clinic or genetic
laboratory shall
• conduct; or
• associate with; or
• help in conducting pre-natal diagnostic techniques unless registered.
Moreover the Registration certificate has to be displayed prominently on
a board in such place.
• employ or cause to be employed or take services of any person, whether
on honorary basis or on payment who does not possess prescribed
qualifications.
A qualified person could be:
- Gynaecologist
- Medical Geneticist
- Paediatrician
- Registered Medical Practitioner
- Radiologist
- Sonologist
- Imaging Specialist
Who fulfils the requirements laid down under the Act conduct or cause to be
conducted a pre-natal diagnostic
technique except for the purposes specified in the Act conduct or cause
to be conducted a pre-natal diagnostic
technique including an ultrasonography for the purpose of determining
the sex of the foetus.
• Every genetic counseling centre or genetic clinic or genetic laboratory
is required to display prominently a notice in English and in the local
language or languages that conduct of sex-determination tests/disclosure
of sex of the foetus is prohibited.
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On PERSONS:
No person shall open any genetic counselling centre, genetic clinic or genetic
laboratory including clinic, laboratory or center having ultrasound or imaging
machine or scanner or any other technology capable of undertaking determination
of sex of foetus and sex selection unless such centre, clinic or laboratory is duly
registered separately or jointly.
Prescriptions & Regulations
• The Central Supervisory Board has laid down a representative list of indications
for ultrasound during pregnancy.
• The conduct of pre-natal diagnostic techniques is further permissible if the person
qualified is satisfied for reasons to be recorded in writing that any of the following
conditions exist:
• age is above 35 years;
• has undergone two or more spontaneous abortions or foetal loss;
• has been exposed to potentially teratogenic agents such as drugs, radiation,
infection or chemicals;
• woman or her spouse has a family history of mental retardation or physical
deformities such as, spasticity or any other genetic disease;
• any other condition specified by the Central Supervisory Board
• The doctors conducting pre-natal diagnostic techniques should maintain proper
documentation.
• Under the amendments it has been made mandatory that the person conducting
ultrasonography on a pregnant woman shall keep complete record thereof in the
clinic in such manner, as may be prescribed, and any deficiency or inaccuracy
found therein shall amount to contravention of provisions of section 5 or section 6
unless contrary is proved by the person conducting such ultrasongraphy
• Under the amended Rules, a distinction has been made between invasive and
noninvasive techniques for the purpose of obtaining consent and the consent is
required in the case of invasive techniques.
• However, in case of ultrasonography, other documentation is now required.
• Any person conducting ultrasonography/image scanning on a pregnant woman
shall give a declaration on each report on ultrasonography/image scanning that
he/she has neither detected nor disclosed the sex of foetus of the pregnant woman
to any body
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. • The pregnant woman before undergoing ultrasonography/image scanning
declare that she does not want to know the sex of her foetus
• PNDT Act has an important link with the Medical Termination of Pregnancy Act,
1971 (hereinafter referred to as the MTP Act).
• Under the Act, termination of pregnancy is possible where: the length of the
pregnancy does not exceed 12weeks; the length of the pregnancy exceeds 12
weeks but does not exceed 20 weeks: in this case the opinion of two registered
medical practitioners in favour of the termination of the pregnancy is essential.
if the continuance of the pregnancy would involve a risk to the life of the
pregnant woman or of grave injury to her physical or mental health; or
if there is a substantial risk that if the child were born, it would suffer from such
physical or mental abnormalities as to be seriously handicapped
• The MTP Act further provides that the pregnancy cannot be terminated except
with the consent of the pregnant woman.
• The Regulations provide for all the documents i.e. the consent given by a
pregnant woman for termination of her pregnancy, the certified opinion recorded
under the above provisions and the intimation of termination of pregnancy: to be
put in a sealed envelope; the envelope to be sent by the registered medical
practitioner to the head of the hospital or owner of the approved place; safe-
custody of the same by the latter; a weekly statement of cases where medical
termination of pregnancy has been done is required to be sent to the Chief Medical
Officer by the head of the hospital or the owner of the approved place.
an admission register is to be maintained for recording therein the admissions of
women for the termination of their pregnancies.
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LIMITATION ACT 1963
In the explanation of Section 6 of Limitations act 1963 a infant in the womb is
considered as minor
“Section 2(e) minor means any person subject to the Indian Majority Act,
1875 (9 of 1875) who has not attained his majority within the meaning of that Act,
and any other person who has not completed the age of eighteen years
and minority means the status of any such person”
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THE HINDU SUCCESSION ACT, 1956
The “Hindu Succession Act, 1956” Section 20 acknowledge the right of the child
in the metra. It treats the child in the womb in the same way as a born child for the
inheritance of intestate of a dead person. So we can assume from here that an
unborn child should have the same right that a born child has.
“Section 20 Right of child in womb.— A child who was in the womb at the time of
the death of an intestate and who is subsequently born alive shall have the same
right to inherit to the intestate as if he or she had been born before the death of the
intestate, and the inheritance shall be deemed to vest in such a case with effect
from the date of the death of the intestate.”
If a baby not yet born can be transferred a property then why not the fundamental
Right to life.
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