THIS IS THE PRESENTATION OF OUR ORATION AT AMU ON 2ND OCT(GOLDEN JUBILEE OF JNMC ,ALIGARH AND AT SMS JAIPUR ON THE 3RD NOV(FAROOQ ABDULLA ORATION AWARD).......

1. PROF.NARENDRA MALHOTRA
M.D., F.I.C.O.G., F.I.C.M.C.H
Prof. Dubrovnick International University
President FOGSI (2008-2009)
Dean I.C.M.U. (2008)
Senior V. P. of FOGSI (2003)
Vice Dean Indian College of Medical Ultrasound (2006)
Director Ian Donald School of Ultrasound
National Tech. Advisor for FOGSI-G.O.I.—Mc Arthur Foundation EOC Course
Practicing Obstetrician Gynecologist at Agra. Special Interest in High Risk Obs., Ultrasound, Laparoscopy and
Infertility, ART & Genetics
Member and Fellow of many Indian and international organisations
FOGSI Imaging Science Chairman (1996-2000)
Awarded best paper and best poster at FOGSI : 5 times, Ethicon fellowship, AOFOG young gyn. award, Corion
award, Man of the year award, Best Citizens of India award
Over 30 published and 100 presented papers
Over 50 guest lectures given in India & Abroad
Organised many workshops, training programmes, travel seminars and conferences
Editor 8 books, many chapters, on editorial board of many journals
Editor of series of STEP by STEP books
Revising editor for Jeatcoate’s Textbook of Gynaecology (2007)
Very active Sports man, Rotarian and Social worker
MALHOTRA NURSING & MATERNITY HOME PVT. LTD.
RAINBOW HOSPITALS
84, M.G. Road, Agra-282 010
Phone : (O) 0562-2260275/2260276/2260277, (R) 0562-2260279, (M) 98370-33335; Fax : 0562-2265194
www.malhotrahospitals.com,www.rainbow hospitals.org
drnarendra@malhotrahospitals.com,jaideepmalhotraagra@gmail.com
Visiting consultant:DHAKKA,KATHMANDU AND 12 OTHER IVF CENTRES in INDIA

2. PROF.JAIDEEP MALHOTRA
M.D., F.I.C.O.G., F.I.C.M.C.H.
Prof.Dubrovinck International University,Crotia
President Elect ASPIRE(ASIA PACIFIC INITIATIVE)
vice president FOGSI 2010
Chairperson International Academic Exchange Committee FOGSI 2002-2007
Governing council member of ICOG ,ISAR,IMS.ISPAT(VP)
Indumati Zhaveri Award, Jagdeshwari Misra Award three times, Ethicon
Fellowship, Outstanding Achievement Award 1999, Chorion Award
Over 50 published and 100 presented papers
Co-editor of step by step series of books
Co-editor of manual of operative obs gyn
Editor of “Fetus Our Other Patient”
Credited with producing firsts of U.P. : IVF birth, ICSI birth, IVF Twins, ICSI
Twins, IVF Triplets, TESA-ICSI Pregnancy etc.
Credited for producing first hundred Test Tube Babies of Nepal
Awarded Corion Prize for best original research in “Improving endometrial
receptivity and blood flows.”
Consultant IVF specialist Maulana azad medical college Delhi
Consultant IVF specialist at Ludhiana, Jalandhar, Ambala,
Gorakhpur,Delhi,Sirsa,Bhiwani, Bariely, Allahabad & Kathmandu , Dhakka
MALHOTRA NURSING & MATERNITY HOME PVT. LTD.&RAINBOWHOSPITALS,AGRA
84, M.G. Road, Agra-282 010
Phone : (O) 0562-2260275/2260276/2260277, (R) 0562-2260279, (M) 98970-33335; Fax : 0562-2265194
www.malhotrahospitals.com,www.rainbowhospitals.org

3. jnmc,amu
our life’s tarana
the sunrise of our lives
What ever we are today and what ever we
have achieved , both of us owe it to JNMC
,AMU
Salaam jnmc….yeh mera chaman hai hum apne
chaman ke bul bul hain………………………….

4. we are indebted to our
teachers
Prof mehdi hassan,prof.wasiur
rehman,prof j n prasad,prof shaila raza
Prof sami hameed,prof tyagiji,prof kc
singhal,prof bal,prof badrul hassan,prof pn
saxena,prof kn ahamad,prof abida malik
Prof arif siddiqui,prof Prof ansari,prof
sadiq,prof abu kamar,prof lakhtakia,prof
sant kumar,prof mohd ahmad,Prof ashraf
malik
Prof shahista mohsin,prof kusum
saxena,prof kamlesh tiwari,prof rajyashree
sharma,prof noor afshan,Prof imam bano
All the lecturers,registrars and colleagues

5. Thank you sms,jaipur
My father passed out from here(4 th
batch)
My brother & bhabhi are profs here
I finished my tenure of president FOGSI
in jaipur in 2009
Deptt of ob gyn is a great friend of ours
We both provide technical support to
the IVF deptt of SMS,Jaipur
And today this ORATION has been
awarded to me….

6. HUMAN REPRODUCTION
where we are headed……………..
NARENDRA MALHOTRA
drnarendra@malhotrahospitals.com
09837033335/0989703335
JAIDEEP MALHOTRA
jaideepmalhotraagra@gmail.com
09897033335

7. origin of repr oduction
So, God created man in His own image, in the
image of God created He him; male and female
created. And God blessed them and God said
unto them. Be fruitful and multiply and
replenish the earth and Subdue it.
(Genesis 1:27-28)

8. BIBILICAL TIMES
Rachel’s desperate plea to her
husband Jacob
“Give me children or else I will die”
Anguish or Cry of female

9. nor mal need for
r epr oduction
One man ----One woman
One sperm and one oocyte
AND “THE STORK”
AND THE SCIENTIFIC ROMANCE
&
THE MIRACLE OF LIFE

10. HUMAN REPRODUCTION

12. HUMAN REPRODUCTION
has become a major health
problem
humans are the most
infertile of all mammals
15% couples are infertile
almost 50 % are due to
male factors
reproduction has now shifted from the
story of
bird and the bees to inside labs.
HAVE SEX FOR FUN
FOR REPRODUCTION THERE IN A.R.T. hai na…..

13. Sar ah & Abr aham
Sarah considered the problem and asked
Abraham to go in unto my maid; it may be that I
may obtain children by her. Abraham honoured
Sarah’s request and Hagar conceived
Irresistible Desire to have Child

14. CLONING HISTORY

15. INDIAN ANCIENT TIMES
dhristrarastra 101 children out of
a mass with cells nutured in vitro
by vyas into 100 karuva and
dusheela
sage gautam produced kripa and
kripi only from his sperms
the 7th child of devki was
transfered to womb of
rohini(surrogate mother )

16. MAHABHARAT HAS
MANY STORIES
BIRTH OF KARNA
BIRTH OF DRONA
AND BIRTH OF
DRITDYUMN AND
DROUPADI FROM
KING DROPAD
SPERMS BUT IN
ARTIFICIAL WOMB

17. Human Repr oduction –
changed
25th July, 1978
Louise Joy Brown
World’s First Successful Test Tube
Baby
Landmark Event in Reproductive Revolution Science Proves Wonders

18. YESTERDAY
in 1956 the first works on superovualtion
in mice was done by ruth fowler and robert
edwards
human oocyte maturation in vitro was first
described by edwards in 1962/1965
world’s first embryo stem cell was
introduced by edwards,john paul and
robin cole
gardner then introduced preimplantation
genetics in mice and was successful in
getting the first fertilization in human eggs
in vitro in 1960’s

19. YESTERDAY
landmark paper read and
published by patrick steptoe on
visualisation of fallopian tubes
(lancet)
Edwards heard this and the
possibility of getting eggs out for
IVF dawned
these two joined hands and
history was written
birth of ART

20. EARLY HUMAN STUDIES
slices of ovaries from cases of stein
leventhal syndrome studied by robert
edwards provided by molly rose
early 60’s first embryo genetic testings for
xx and xy were reported(lancet)(nature)
first attempts to inject gonadotrophins
into intact ovaries in vitro,using different
culture media
first meiosis was classified and timed
predicting of ovulation 37 hrs after the hcg
was done (edwards)

21. HUMAN STUDIES IN UK
early embryos were flushed out from uterus and
oviduct after intercourse(beginning of early
embryology studies)
ethical questions started arising
in 1969 all stages of human fertilization in vitro
were visualised and documented and reported by
edwards
trophectoderm biopsy and genetic diagnosis
study was experimented
patrick steptoe and robert edwards got together
attempt to aspirate oocytes from ovaries thru
laparoscopy
the oldham years began

22. EARLY CRITICISM
pope and church
james watson scientist testified in us senate that abnormal babies
will be born
the first book on ethics came out written by a theologist gordon
dunstan
oldham ethical committee approval and patient support
the earliest indications were blocked tubes ,male factor and
endometriosis
the need for luteal support
and the biggest mistake was made here for 2 years primolut was
used and no pregnancies
causes of failures were analysed(in three years it was found that
primolut was the cause)
the critisism was intense here
hcg was used as luteal support and progesterone and the levels of
primolut depot were reduced
they also started replacing two embryos
the first ivf pregnancy was established but turned out to be an
ectopic and was operated at 10 weeks gestation

23. EMBRYOS CULTURED
BY EDWARDS THE
FIRST PICTURES

24. EARLY EXPERIMENTS AND
THE FIRST TEST TUBE BABY
4 types of stimulation protocols
gift and orti
cryopreservation was tried
natural cycle ivf was tried and 7 years after work
began at oldham lesley and john brown were
recruited as second case for the natural cycle ivf
four cases concieved and lousie brown continued
and delivered as the world’s first ivf baby,one
aborted as a triploidy and one was misscaraige
who went on a mountain climbing holiday and
then alistair was born as second ivf baby
critics called us fakes(edwards)
but science and medicine had entered human
reproduction and conception….reporduction was
moving from berooms to labs

25. History
1st human pregnancy and
birth by in-vitro
fertilization (IVF).
 Louise Brown
 July 25th, 1978
 Planned cesarean
section.
 2.61kg
Oldham General
Hospital in Oldham, UK.
Reported by Steptoe
and Edwards

26. BOURN HALL CLINIC
WORK IN IVF CAME TO A STAND STILL FOR 2
YEARS IN UK AFTER LOUISE BROWN WAS
BORN DUE TO THE ESTABLISHMENT OF
BOURNHALL CENTRE(OPENED IN 1980)
THE WORLD JOINED IVF
IVF BABY WAS DELIVERED IN AUSTRALIA BY
ALEX LOPATA
IN BOURNHALL NATURAL CYCLE IVF WAS
DONE
WHILE IN AUSTRALIA ALAN TROUNSAN GROUP
USED CC HMG PROTOCOLS AND 2-3 EMBRYOS
15% PREGNANCY RATE WAS ESTABLISHED

27. OBJECTIONS
life/society for the unborn
child/gynaecologists etc
regular pregnancies were reported from all
over
simon fischel/jacques cohen/howard
jones/jean cohen/peter in vienna/matts in
sweden/paul devroy
legal action by life group against robert
edwards
edwards gave a lecture on cryo freezing
and all news papers /bbc and other carried
damaging stories, he fought a legal battle
againt all 7 of them and won
all papers , notes and lecture recording
were legally reviewed in courts

28. History
1st successful IVF in US
 1981
 Reported by Jones and Seager-Jones
 Norfolk, Virginia

29. FIRST KEPT ON
HAPPENING
FIRST FROZEN BABY FROM
HOLLAND(KNOWN AS THE ICE
BABY)
SCANDINAVIANS USED TVS FOR
FOLLICLE ASPIRATION FIRST
ICSI WAS DISCOVERED IN
BELGIUM
A LIBERAL IVF LAW WAS PASSED
BY UK GOVT 10 YEARS AFTER
LOUISE BROWN
JEAN PURDY DIED IN 1986
PATRICK STEPTOE DIED IN 1988

30. IVF BABIES
louise brown and ivf has turned 34 this
year(her mother died aug 2012)
louise brown has produced a normal
healthy naturally conceived baby( the last
fear of ivf is gone) alistar the first male
test tube baby still has to reproduce
tesa babies will be infertile due to y
-deletion ??
BBC News - Five millionth 'test tube baby'
www.bbc.co.uk/.../health-1864958... - इस पृष्ठ का अनुवाद कर े
1 Jul 2012 – Five million "test tube babies" have now been born around
the world, according to ... put the total number of test tube babies
born at five million

31. History of ART
1978- first successful
birth using In Vitro
Fertilization
1984- first successful
birth using Gamete
Intra Fallopian
Transfer
1986-first successful
birth using Zygote
Intra Fallopian
Transfer
1993 ICSI Accidently
discovered

32. INDIAN SCENARIO
CLAIMS FROM KOLKATA BUT NOT
DOCUMENTED
THE FIRST DOCUMENTED IVF BABY
IS FROM MUMBAI KEM BY INIDRA
HINDUJA AND HER TEAM
NARI REGISTERY SHOWS THAT
THERE ARE 250
CENTRES(UNOFFICIALLY OVER 500)

33. Dr Subash Mukerjee
16-1-31 to 19-7-81
1. Medical Graduate, Calcutta
2. PhD in Biochemistry,
Calcutta.
3. Second PhD in bioassay of
urinary reproductive
hormones, Edinburgh.
4. Varied research interests
ranging from Contra-
ception to Conception
Technologies.

34. The Agarwals 2001
KANUPRIYA

35. WORLD’S FIRSTS BY
MUKERJEE
 HMG to induce follicular growth in an IVF cycle.
Credited to Howard Jones (Human Reproduction.
11 SUPPL. 1 1996).
 Used
TV route for OPU. Credited to Gleicher et al.,
(LANCET. 2:508-9. 1983)
 Successfully froze and thawed human embryos.
Credited to Trounson & Mohr (NATURE.305: 707-9.
1983).

36. Recognition of Mukerjee’s contribution
to IVF
1. S.M. Mukerjee ‘Architect of IVF in India’. TCAK in
Current Science
2. West Bengal Govt. establishes a Chair named
after Mukerjee in NRS Medical College.
3. Placed a memorial plaque at NRS Medical College
4. WB Govt. proposes to established an Institute in
Reproductive Medicine named after Mukerjee
5. Work Cited in Encyclopedia of World Medicine
6. Rotunda’s Subash Mukerjee’s Orations

37. IVF initiated in 1983 at ICMR Institute for
Research in Reproduction, Bombay
•Collaboration between Institute for
Research in Reproduction and KEM
Hospital, Bombay.
•Project Approved by Scientific Advisory
Committee of IRR and KEM Ethics
Committee for Human Experimentation.
•Progress reported to ICMR Scientific
Advisory Committee periodically.
•Transparency of work at all stages.

38. The IVF Team in
Bombay
IRR KEM HOSPITAL
• Chander Puri
• Harbans Juneja • Indira Hinduja
• J.V. Iyer • Several rotating
• Geetha Ranga Housemen.
• T.C. Anand Kumar

39. HARSHA BORN 8th
AUGUST 1986
IRR AND KEM the first centers from India to be
included in the INTERNATIONAL REGISTRY
OF IVF CLINICS published in the J. OF IN
VITRO FERTILISATION AND EMBRYO
TRANSFER IN 1988.

40. PUBLICATIONS FROM IRR
ANNOUNCEMENT OF DETAILS IN ICMR BULLETIN.
I.N. HINDUJA AND T C ANAND KUMAR: THE IN VITRO
FERTILIZATION AND EMBRYO TRANSFER AND GAMETE
INTRAFALLOPIAN TRANSFER PROGRAM AT THE IRR AND
KEM HOSPITAL BOMBAY. J. in vitro Fertilization & ET 5
-376-7 1988.
I.N. HINDUJA AND T C ANAND KUMAR: IVF-ET IN INFERTILE
WOMEN. the Natl. Med. J. India 1:10. 1988.

41. On the 7th November 2007 Dr. Roger
Abdelmassih (Brazil) offered a dinner
party to his friends in order to celebrate 30
years of sucess of the first IVF.
Louise Brown and her family was present
as well the Indian and the British
consulates, among 300 people.

42. 1960’S TO THE 2000

43. TODAY SCENARIO
ART WIDELY
ACCEPTED
WORLD OVER
MANY CENTRES
PGD
STEM CELL
CLONING
HYBRID EMBRYOS

44. THE ALL POTENT MALE
DETORIATING SPERM COUNTS
AND QUALITY

45. DETORIATING SPERM
QUALITY
BANE OF MODERN SOCIETY
POLLUTION
WIDE SPREAD PESTICIDE USE
CHEMICALS
STRESS
SMOKING AND EXCESS ALCOHOL
STD
INCREASED INFLUENCE OF ESTROGENS
(DIETARY FADS,FASHIONS,DAIRY
PRODUCTS,SOYA,ADDITIVES)
INDIAN MALE SPERM COUNT HAS FALLEN
FROM 60-110 TO 20 MILLION/ML

46. NEW FRONTIERS IN ART
evaluation
drugs
management
assisted reproduction
preimplantation diagnosis
genetic manipulations
stem cell culture
cloning

47. EVALUATION
dedicated infertility specialists
tvs,color doppler and
3 d & 4 d usg
hormone analysis
laparoscopy
hysteroscopy
casa and other auto sperm
analysis
trial fertilization
genetic tests ,enzyme tests
survival tests etc etc

48. AUTOMATIC SPERM
ANALYZERS

49. NEW
FRONTIERS IN
ULTRASOUND
EVALUATION
COLOR DOPPLER 4 D USG
3 D USG

50. NEW FRONTIERS IN
DRUGS FOR THE
MALE
MICRONUTRIENTS & HOLISTIC

51. NEW FRONTIERS
IN DRUGS AND
DRUG DELIVERY
SYSTEMS FOR
ART
DERMAL DELIVERY SYSTEMS

52. IMPROVED DRUG
DELIVERY
SUB CUTANEOUS INJECTIONS
NASAL SPRAYS
GONADOTROPHIN SOLUTIONS
PRELOADED SYRINGES
GONADOTROPHIN PENS
SOFTER STIMULATION PROTOCOLS

53. NEWER METHODS OF DRUG
DELIVERY OF F.S.H.
LONG ACTING FSH/LH
TRANSDERMAL
ORAL FSH PILL
FUTURE OF STIMULATION

54. RECOMBINANT
TECHNOLOGY
*purity
*response
*quality
oocytes
*batch to
batch
variabilty

55. GnRH ANTAGONISTS
‘Drug of the Millennium’
Ganorelix
Cetrorelix
OVERCOME THE SHORT
COMINGS OF LONG PROTOCOL
NOW BEING MADE IN INDIA
(EFFECTIVE AND CHEAPER)

56. The ideal Indian
protocol
10000 hCG
0.25 mg Cetrorelix/day
225 hMG / 225 IU rec FSH
100 mg CC / day
Tamoxifen/letrazole
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

57. Long acting r ec-
FSH
• The first baby after stimulation with long acting
rec-FSH has been delivered by the Belgium
group
(Beckers, Macklon,Devroy fertil steril 2003)

58. Long acting r ec-FSH
Relatively short half life of FSH
preparations(32+/-12 hrs)requires
daily injections.
Attempt to create long acting FSH
agonist,chimeric genes containing
CTP of beta-hCG fused with beta-
FSH were constructed
Half life of 95 hrs

59. Long acting FSH
Ovarian hyperstimulation was initiated
with single subcut injection of 180mcg of
recFSH-CTP
Normal follicles developed & estradiol
levels rising normally
On 9th day largest follicle exceeded 14mm
cotreatment with antagonist
Cycle day 10, 150 units of FSH given till
follicle size >18mm obtained
hCG 10,000 units given ,36 hrs later
oocytes retrieved)

60. Or all y Long acting
LH a gonists
extensive research is on, on this
molecule also,make life easier for ivf
pts by reducing number of injections

61. ORAL FSH…. THE
FUTURE

62. NEW FRONTIERS IN
MANAGEMENT TODAY
operative endoscopic procedures
drugs for endometriosis,pid,etc
iui
ivf-et
icsi-et
assisted hatching
blastocyst culture
tesa,tese,mesa-icsi
blastomere biopsy and pgd
genetic manipulations
cloning

63. Operative Endoscopy in
Infertility
ENHANCE ART
RESULTS

64. LAPAROSCOPIC
ULTRASOUND

65. 25TH JULY 1978 11.25PM

66. INVITRO
FERTILIZATION
ABSENCE OF FUNCTIONAL FALLOPIAN
TUBES
REFRACTORY ANOVULATION
UNEXPLAINED INFERTILITY
ENDOMETRIOSIS
PCO
POOR SPERM QUALITY
ANTISPERM ANTIBODIES
FAILED IUI

67. IVF

69. HAS TRANSFORMED THE TT OF
SEVERE MALE INFERTILITY
NOW OFFERS HOPE TO MEN
WITH VIRTUALLY NO SPERMS
NO MOTILE SPERMS
MALFORMED SPERMS
IVF WITH POOR FERTILIZATION
SEVERE OBSTRUCTIVE
ICSI
OLIGOZOSPERMIA
NON OBSTRUCTIVE
OLIGOZOSPERMIA
ROUND CELLS AND SPERMATIDS
INJECTED
RESCUES ONE DAY OLD UNFERT
EGGS

70. IMSI -2005
choose the right sperm

71. SPERM RETRIEVAL
TECHNIQUES

72. STATE OF THE
ART LABS

73. Modular automatic hand
free labs

74. state of the art labs

75. MICROMANIPULATION
1.ENHANCING FERTILIZATION
ZONA DRILLING OR CUTTING
INJECTING SPERM IN PERIVITTILINE
SPACE
INJECTING SPERM IN OOPLASM
2.EXPERIMENTAL EMBRYOLOGY
DESTROYING BLASTOMERES
ISOLATING BLASTOMERES
3.GENETIC DIAGNOSIS IN
EMBRYO(pgd)AND OOCYTE
4.ASSISTED HATCHING

76. Cultur e Systems
Conventional culture media
Human tubal fluid
Co-cultures
Sequentional complex
supercomplex media
(IVF – S0-S2, G1.2 &G2.2)
(Medicult-IVF/M3Scandinavian/Quins)
G1.2 TM And G2.2 TM
G 3 SERIES & EMBRYO GLUE

77. Blastocyst Cultur e
Day 4
↓
Priority to highest 2 PN score
Prepare one ET dish, one freeze dish
& day 6 growth dish (Overnight incubate)
↓
Day 5
Blastocyst assess & scoring
Transfer good Freeze spare Slow growing
2 blastocysts blastocysts ↓
(Zona intact) Fresh G2.2 media
↓ ↓
Zona free transfer Day 6
↓ ↓
100 µl droplet of IOIU pronase Freeze
for 1-1½ hrs
↓
Wash 4 times
↓
Transfer zona free blastocyst

79. Embryo quality
assessments
Proteiometic tests/spectrophotometry/bioanalysis

80. Assisted Hatching
W her e & W hy ?
Women age > 35
Yrs.
Thick Zona
Before P.G.D.
Previously failed
implantation
Basal FSH high

81. Success Package
Producing quality Recovering
quality
oocytes
sperms
Quality Lab Set Up
State of the art equipments,
Consumables
Timed oocyte retrieval
↓
Insemination/ICSI
↓
Culture Systems

82. CRYO
PRESERVATION
1. GAMETES
SPERMS
OOCYTES
2. OVARIAN TISSUE
3. TESTICULAR TISSUE
4. EMBRYOS

83. CRYOPRESERVATION OF
EMBRYOS
WIDELY USED WITH
GOOD RESULTS
THAWED EMBRYOS
ENABLES COUPLE TO
HAVE TWO OR MORE
SUCCESSIVE
REPLACEMENT CYCLES
AFTER SINGLE OPU
REDUCES THE COST OF
CYCLE

84. BIO FREEZER SYSTEMS

85. CRYOPRESERVATION OF
OOCYTES

86. IVM
IMMATURE OOCYTE PICKUPS
MATURING OOCYTES IN VITRO
OOCYTE BANKS
GIVES HOPE TO PTS WITH POF AND
PCOS

87. PREIMPLANTATION
GENETIC DIAGNOSIS
BLASTOMERE
BIOPSY
FISH AND PCR
(PENTA PROBE)
ET OF ONLY DISEASE
FREE EMBRYOS
HOPE FOR HEALTHY
BABIES

88. PGD
FISH FOR CHROMOSOMAL RELATED ANEUPLOIDY
PCR IS FOR SINGLE GENE DEFECTS

89. POLAR BODY BIOPSY
FIRST AND SECOND POLAR BODY BIOPSY

90. PRECONCEPTIONAL SEX
SELECTION AND
PREIMPLANTATION SEX
SELECTION
POSSIBLE NOW
ETHICAL ASPECTS
SOCIAL ASPECTS

91. DESIGNER BABIES
BLUE EYES
GOLDEN HAIR
FAIR SKIN
TALL
INTELLIGENT
WELL BUILT
LIKES OF PRIYANKA
AND HRITHIKS
POSSIBLE FOR A
PRICE

92. party reproduction & parenting how ?
 Oocyte donation
 Sperm Donation
 Embryo Donation
 IVF with gestational carrier
 Traditional surrogacy
 Adoption
 Ovarian Transplantation

95. donor sper m
SPERM
BANKS
IN CHINA
FOR DONORS

96. embr yo donations

97. IVF with gestational carrier
surrogacy

98. SURROGACY
WHERE UTERUS IS AT
FAULT
NO UTERUS BUT OVARIES
WOMB FOR HIRE
GOOD RESULTS
ETHICAL ASPECTS
COSTS

99. HUMAN RIGHTS

101. The laws that currently exist are
a poorly constructed patchwork quilt,
that can be confusing even to legal
practitioners

103. Ethics - Definition
Code of moral principles derived
from a system of values and beliefs
that helps define the correctness of
our actions.

104. Ethics in Repr oductive
Medicine
Who is the actual patient
 Many participants involved
Spectrum of Patients
 From couple to single to homosexuals
Impact of our decision on unborn child –
Crucial
Commercialisation of the Profession
Pregnancy at any cost – Pregnancy at whose cost ?

105. Ethical Dilemmas in
Reproductive Medicine
Fertility preservation & reproduction in cancer patients
Fertility treatment when the prognosis is very poor or futile
Child rearing ability & the provision of fertility services
Informing offspring of their conception by gamete donation
Family members/friends as gamete donors & surrogates
Donating spare embryos for embryonic stem cell research
HIV & Infertility Treatment
Preconception gonadal selection for non-medical reasons
Financial incentives in recruitment of oocyte donors
/surrogates
Reproduction in single partner, lesbians & gays

106. IVF TOURISM IN INDIA
According to a study in 2004,India could earn
as much as two billion dollars annually by
2012,through medical tourism including fertility
services.
India spends just 1.2% of GDP on health, but
takes care of foreign patients
It ranks second in medical tourism in
2007,only next to Thailand
Indian hospitals treated 4.5 lakh patients as
compared to 12 lakhs by Thailand

107. Acr oss the bor der laws
Laws all over the world are
different, even different states in
US have different laws,.
Difficult to keep track
Till the demand is there,
providers are available
Lets not forget the safe waters
for abortions and cloning

108. IVF Tourism in
India
A Boon or a threat ?
Why is India such a favourite
destination for ART ?

109. Human Reproduction – Future
Reproductive Bazar
Designer Babies
Your Comments… ?

110. Homosexual Man
Lesbians
Single Partner
Right to have babies ???
Bearing or Rearing ???
Legal & Moral Status ???
Production or Reproduction ???
Changing Society – Changing Concept

111. First Gay couple to have a
baby thru surrogate in
India

113. INDIAN REGISTRY OF
CENTRES

114. STEM CELL CULTURE
EMBRYONIC STEM CELLS
ADULT STEM CELLS
UMBILICAL CORD CELL

115. STEM CELLS
EMBRYONIC STEM CELLS ARE
PLURIPOTENT
CAN DERIVE ALL TISSUES OF BODY
DERIVED FROM EMBRYOS NO
LONGER REQUIRED FOR IVF
CAN BE CONTINUOUSLY RENEWED
MAY BE USED TO PRODUCE
DIFFERENT CELL LINEAGE

116. CLINICAL ASPECTS OF
STEM CELLS

117. STEM CELLS
INTEREST STILL REMAINS IN
ES FROM SOMATIC CELLS OF
PTS TO HAVE COMPATIBLE
TRANSPLANTATION
RESEARCH ON HUMAN ES
WILL INCREASE THERAPEUTIC
OPTIONS FOR REGENERATIVE
MEDICINE AND TREATING
COMMON AND CURRENTLY
INCURABLE DISEASES IN
FUTURE

118. GENE THERAPY AND
GENE MANIPULATION

119. where are we headed
from here………..

120. TOMMORROW IS HERE
ALARMING?
SCIENTIFIC
ADVANCES IN
HUMAN
REPRODUCTIO
N

121. DESIGNER BABIES

122. Chromosome—6
SHORT ARM HAS
HISTOCOMPABILITY GENES
If we could translocate short
arm of Chromosome-6 and
locate it on a animal’s embryo
we could produce animals for
spare parts (Liver, Heart,
kidneys)
(Monkeys, Apes, Pigs,
Baboons)

123. This is what has happened on 27/9/12
………………

125. THE FUTURE IS
BORN FROM
PLASTIC WOMB
1997
A sheep is reared
in vitro from 17
weeks onwards
by Japanese

126. HUMAN SPERMS IN
MICE
JAPANESE SCIENTISTS HAVE MANAGED
TO IMPLANT TESTICULAR TISSUE OF
HUMANS INTO MICE TESTIS AND THESE
MICE ARE NOW PRODUCING HUMAN
SPERMS
SCIENTISTS HAVE APPLIED FOR
PERMISSION TO USE THESE SPERMS
FOR FERTILIZATION CAPABILITY
TREATMENT OF MALE INFERTILITY ??

127. Perfect Husband
Gene Discovered
(Hindustan Times 25 Aug. 99)
Steve Connor
London : Scientists have discovered a
genetic basis for monogamy and believe the
findings could shed light on the brain
chemistry of love and attachment.
By transferring a single gene, the
researchers have been able to convert
naturally polygamous males with anti-social
tendencies into paragons of fidelity and
sociability.

128. Age of cloning
A line has been crossed, and
reproductive biology will now never
be the same for people or for sheep
(Time, March 97)

129. T he Making of
Doll y DNA
Cloning depends on
Step 1: Take the Nuclei out of a sheep egg
Step 2: Transfer nuclei from the Mother
Empty
DNA DNA
Sheep Egg Mother’s Egg

130. Cloning Depends on
DNA Nucleus
Chromosome

131. Cell
Nucleus
Its all about DNA

132. Other Cloned
Animals
Cloned
mouse
July 1998
cloned calves Cloned
mule

133. Other Cloned
Animals
December 2001
Five cloned
December 2001
female piglets,
named Noel, The world's first
Angel, Star, Joy cloned kitten,
and Mary named Cece

134. WHAT IS CLONING?
means duplication
embryonic cloning has been
known and practised since a
long time
adult cloning from differentiated
cells
stem cell culture and cloning
may be accepted

135. HUMAN
CLONING
REPRODUCTIVE CLONING : MAY NOT
BECOME SOCIALLY POPULAR
CELLULAR CLONING : MORE
PROMISING:UNDERSTAND MECH.OF
GENETIC DISEASES
BETTER PRODUCTION OF TRANSGENIC
ANIMALS
PROVISION OF STEM CELL OR TISSUE
AS THERAPEUTIC MODALITY OF CLONED
PERSON

136. WHAT ARE WE
AIMING AT WITH CLONING……
DUPLICATES ?
SPARE PARTS ?
JUST FOR FUN ?
SCIENCE FICTION ?
PROVING SCIENCE ?
RESURRECTING THE DEAD?
BRINGING ALIVE THE PAST?
LIVING FOREVER?
DEFYING DEATH?
We still are not sure

137. No sperms needed
No males needed
No sex to reproduce
Children without intercourse
Literally single parent

138. My cell
Your empty follicle
My embryo
Her womb
Or Even an animal womb

139. FIRST HUMAN CLONE IS
BORN ?

140. EXPERIMENTAL
EMBRYOS HAVE BEEN
MADE
THREE PARENTS
NUCLEUS,CYTOPLASM
AND FOLLICLES
HYBRID EMBRYOS
PERMISSION FOR
IMPLANTATION

141. Hybrid embryos
HUMAN AND COW
IS THIS WHAT YOU
WANT(HALF COW
AND HALF HUMAN)
(LIKE
MYTHOLOGICAL
FIGURES
THESE EMBRYOS
HAVE BEEN
CREATED AND
NOW ONLY THE
IMPLANTATION IS
TO BE TRIED

142. OBJECTIONS AGAIN
CRITICISM AGAIN
may be valid
objections
today
but tomorrow
we don’t know

143. Chr omosomes
16
6 24 78
40
46

144. Good-Bye Doll y
 At age 3 Dolly showed signs of premature
aging.
 Dolly died at 6 years old from progressive
lung disease (symptom of old age)
Dolly’s DNA was already 6 years old
when she was born - WHY?
It’s all about DNA

145. Doll y and Cloning
Dolly’s experimenters used 277 cloned
embryos to produce one sheep, meaning
276 failed.
Question
How many failures will it
take to produce a
human

146. Chromosome—6
SHORT ARM HAS
HISTOCOMPABILITY GENES
If we could translocate short arm
of Chromosome-6 and locate it on
a animal’s embryo we could
produce animals for spare parts
(Liver, Heart, kidneys)
(Monkeys, Apes, Pigs, Baboons)
`

147. Futur e Experiments
Hybrid Animal cr eating new
life
Catrilla

148. Future
Experiments
ButterCat
CatCow
SparrowBoxer
TigerOwl

149. Ovarian tissue
transplant
Imagine ovarian tissue transplanted on
your fore arm
Oocyte retrieval from just under skin

150. Stem cells to produce
gametes -2007
Sperms and occytes from same
person(THEORETICALLY YOU WILL
BE THE GENETIC FATHER AND
MOTHER OF YOUR CHILD)
Sperm from one palm
Oocyte from the palm of other hand
A shake hand will produce a baby

151. Stem Cell Researchers’
Discovery Will Allow Gay
Couples To Create Their
Own Eggs
My two dads may soon be a genetic reality.
Scientists have discovered how to create a baby with
the DNA of two fathers without the need for a
donated egg.

152. Doctors claim first mom-
daughter uterus transplant
STOCKHOLM — Two Swedish women
are carrying the wombs of their mothers
after what doctors called the world's first
mother-to-daughter uterus transplants.

153. Lab-Made Eggs Raise New Fertility
Options
Early-Stage Cells Used to Produce
Healthy Mice; Could the Dead
Become Parents?
Japanese scientists have made viable
mouse eggs in a laboratory dish, an
advance that may offer a new route for
treating infertility in people.
The experiment completes a long-sought
quest in reproductive biology: to make
sperm and eggs in a lab dish. A year ago,
the same core group of scientists at Kyoto
University created healthy mouse sperm in
the lab.
In the latest experiment, the dish-created
eggs were fertilized with natural mouse
sperm to create healthy, fertile mice. The
research appears in the journal Science

154. It will be even tougher to
repeat the trick in people. But
if it can ever be done, it has
the potential to transform
reproductive medicine by
enabling both infertile men
and women to conceive their
own genetic offspring.
Any such advance would
also raise thorny ethical
questions. In theory, at least,
it would allow a man or
woman of any age—or even
someone who is dead but
whose tissues are preserved
—to become a parent.

155. Japanese stem cell
resear ch inspir es US
scientists to cr eate a
lab human sper m
A team of Japanese scientists
at Kyoto University has
successfully created fertile eggs
through the use of stem cells.
Their experiment resulted in
mice having healthy babies.
Taking the research forward is
Dr Renee Pera, of Stanford
University in California, who
hopes to soon create human
sperm using stem cells.

156. NORMAL SEX &
FERTILIZATION MAY BE
FORGOTTEN SOON

157. Future of ART
Immature oocyte pick ups & injections.
Ovary banks & injections to ovaries.
Oocyte cryopreservations.
Spermatic injections for ICSI. (Germ cell
I.C.S.I.)
Gene manipulation.
PGD with blastomere biopsy & fish & PCR.
Embryonic cloning & PGD.
Designer babies.
Blastocyst cultures.
Advances in stimulation :— GNRH
antagonists &
analogue uses.
Plastic wombs?
Cloning of adult humans?

158. ART GUIDELINES AND
ART LAWS 2008
TO BE TABLED IN THE
PARLIAMENT WHEN ??
REGULATION
SOME POINTS NOT
FAVOURABLE
BY ICMR AND GIVT OF INDIA
ISAR HAS STARTED WITH
ACCREDITAION OF INDIAN
CLINICS AND CENTRES

159. Have sex to enjoy…
for pregnancy
ART hai na
How do you want
Your Child
Naturally
Timed
IUI
IVF
ICSI
Genetically Engineered
Designer
Cloned

161. HORACE WROTE
OF VARIOUS THREATS,---
THOU…..
ART ANXIOUSLY INQUISITIVE TO
KNOW:
BUT GOD HAS,WISELY,HID FROM HUMAN SIGHT
THE DARK DECREES OF FUTURE FATE;
AND SOWN THEIR SEEDS IN DEPTH OF NIGHT;
HE LAUGHS AT ALL THE GIDDY TURNS OF STATE;
WHEN MORTALS SEARCH TOO SOON,AND FEAR
TOO LATE.

162. thanks for hearing me
out on this issue of
Advances in human
reproduction ,I hope in a
few year s this does not
lead to this……………

163. SALUTE TO THE 34 YEARS OF ART AND TO THE PIONEERS

164. Greeting From
ART TEAM MTTBC