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Garbhadana and Its modern applicability- FINAL.pdf

  1. 1. Garbhadana & its Modern Applicability 1
  2. 2. PRESENTER Dr. Bhavana. G 1st Year PG Scholar Dept. of Prasuti Tantra & Stree Roga GUIDE Dr. Papiya. Jana Professor Dept. of Prasuti Tantra & Stree Roga 2
  3. 3. CONTENTS - The following points need to be discussed under the wide spectrum of Garbhadana 1)Suitable age of conception. 2)Based on recent studies, impact of age on conception. 3)Suitable postures during coitus for conception. 4)Factors essential for conception गभोर्त्पादक सामग्री 5) ऋतुकालः 6) Role of क्षेत्र in outcome of conception 7) अम्बु - its contribution in attaining conception . 8) बीज - its significant role in conception. Its Modern applicability. 3
  4. 4. 9) Role of पञ्च महाभूत and ित्रदोष in Garbhadana 10) Importance of वायु in Garbhadana 11) मनो गुणा - Psychological compatibility of the couples initiating Garbhadana. 12) Role of राजस्वलाचायर् based on ayurvedic texts & its contribution in Garbhadana. 13) Contraindicative conditions and adverse effects. 14) गभर्धान िविध – Ahara vihara & Behavioral changes 15) पुत्रेिष्ट यज्ञा and संयोग िविध explained in our classics. 4
  5. 5. 13) Artificial Reproductive techniques of Garbhadana when conception fails naturally. Ø Ovulation Induction Ø IUI Ø IVM Ø IVF - Vitro fertilization-embryo transfer (IVF-ET), gamete intrafallopian transfer (GIFT), zygote intrafallopian transfer (ZIFT), and frozen embryo transfer (FET). 14) Surrogacy 16) Code of Practice, Ethical consideration & Legal issues 17) Discussion 18) Conclusion 5
  6. 6. Introduction q Garbhadana is the ritual which is followed through ages in order to achieve healthy conception and in todays modern world, couple seek conception usually after 25 years of age and have 1 or 2 children and most of them end up suffering from infertility. q One of the cause of infertility being iatrogenic with everything from toxins in the environment to high levels of stress being suspected as possible causes, Hence solutions are needed to strengthen the reproductive capacity of women who wish to conceive. Garbhadana is one such solution. q Women's fertility peaks in the early 20s and drops considerably after 35 years. Women's fertility concerns are also on the rise, and the world wide general fertility rate is lower than ever before. q In this way, it is understood that fertility is equally spiritual and emotional as it is physical. The regimen followed during pre pregnancy period to achieve conception is called “Garbhadana Vidhi”. Specific guidelines have been laid in Ayurveda for Pre conception care. q Conception or fertilization means the fusion of gametes to produce a new organism, and there are various modern technologies which are using the same methods in vitro. The success rate of such technologies is 50% and less. But this has got its own disadvantages and side effects. Moreover, all couples cannot afford that and here as an Ayurvedic practitioner we can advice the patient to follow the Garbhadhana vidhis. 6
  7. 7. Garbhadana • Garbhadana samskara was described for the first time in Grhya sutras. • Later Dharma shastras & smritis added certain rules & regulations like time & days for conception keeping astrological considerations in mind . • All the shastras anonymously agree that ( Rutukala ) is the most important factor when a woman is physically prepared to conceive . Acc to Acharya Charaka Acharya Charaka explains about the upliftment of human race by getting !"यस% &जा a baby meant for social & self ( spiritual) welfare. स्त्रीपुंसयोर व्यापन्न शुक्रशोिणत गभार्शययोः श्रेयसीं प्रजा िमच्छतोस्तदथार्िभिनवृर्ित्तकरं कमोर्पदेक्ष्यामः||३|| 7 पुरुषस्यानुपहतरेतसः िस्त्रयश्चाप्रदृष्टयोिनशोिणतगभार्शयाया यदा भवित संसगर्ः ऋतुकाले यदा चानयोः तथैवयुक्तयो संसगेर् तु शुक्रशोिणत संसगर्मन्तगर्भार्शयगतं जीवोऽवक्रामित सत्वसंप्रयोगात् गभोर्ऽिभिनवर्तर्ते। (च.शा 3/3) When the man with shuddha sukra and a women with apradushta yoni, artva, and garbhashaya cohabit during the period of Rutu (period of fertilization), the jiva along with satva descends into the combination of sukra and sonita and lodge inside the garbhasaya.
  8. 8. 8 According to Acharya Sushrutha, तत्र स्त्रीपुंसयोः संयोगे तेजः शरीरखायुरुदीरयित, तत्स्तेजोिनलसिन्नपाताच्छु क्र ं च्युतं योिनमिभप्रितपद्यते संसृज्यते च आतर्वेन ततोऽिग्नषोम संयोगात संसज्यमानो गभार्शयमनुप्रितपद्यते …….नामिभरिभदीयते दैव संयोगादक्षयो ऽव्ययोऽिचन्त्यो भूतात्मना सहान्वक्षं सत्वरजस्तमोिभदेर्वासुरैरपरैश्च भावैवार्युनाऽिभप्रेयर्माणो गभार्शयमनुप्रिवश्यावितष्ठते(सु.शा 3/4) Ø During copulation when man and women come together vayu augments the teja in the body, this combination of teja and anila cause the ejaculation of sukra in to yoni which then combines with artava. Ø This combination of agni (artava), soma (sukra) then moves upwards into the garbhasaya. In the garbhasaya it combines with bhutatma.
  9. 9. Suitable age of conception Sushrutha पञ्च िवं शित वषार्य षोडश दशवषार्ं पत्नीमावहेत् Su.S.Sh. 10/54-56 Vagbhata 1 A.H.Sh 1/9 Charaka C.S.Sh. 8/6 Vagbhata 2 A.S.Sh. 1/5 Male - 25 years Female - 16 years They are fully mature, hence they should attempt for conception A very young or very old woman should not be impregnated Man – 21 years Female – 12 years As the partners are full of valor & vigor at this age , the born child will also poess the same qualities . ”Veeryavantham sutam soothe” पञ्चिवं शे ततो वषेर् पुमान्नारी तु षोडशे। समत्वागतवीयौर् तौ जानीयात् क ु शलो िभषक ् ॥ सु.सु 35/13) Bhela B.S Sha. 3/1 इह समानगोत्रं वै रुतुस्नातं िस्त्रयं वजेर्त्। मेधािद नामरोगं सा पुत्रमेव प्रसूयते || Women should be of different gotra only then an intelligent and a healthy son is born. प्राप्तवीयर्ं वीयार्िऩ्वतं अपत्यम् जनयतः॥(अ.स्ं.शा 1/5) A woman < 16 years is impregnated by the male <25 years then it will lead to IUD or fetus may not live long or will have weak organs , ill health deformed body parts . As well as same applies to elderly woman A male < 25 years impregnates a woman <16 years it would result either in IUD or short lived fetus deficient in strength , health & sense organs . If a woman <16 years is impregnated , Due to immaturity of reproductive organs the woman will either not conceive or the resulting garbha will be diseased or short lived or ill health & will have deformed body 9
  10. 10. § Delayed childbearing is currently a major challenge in reproductive medicine as increased age has an important impact on successful conception, both in natural and in assisted reproduction. § Delayed child bearing is more common among women and men with higher education. § When a woman is younger than 30, she has an 85% chance to conceive within 1 year. Impact of age on fertility Reasons Investment in education Development of a professional career and for difficulties in finding the right partner. 10
  11. 11. AT age 39 (66%) chance to conceive At the age of 40 (44%) chance to conceive At Age 35 (75%) chance to conceive in first 12 months This is due to effect of aging on the ovary & eggs. 11
  12. 12. Normal & Abnormal postures of coitus & their effects Acc to (C.S.Sha.8/6) POSTURE DOSHA EFFECTS उत्थान (lying on back) (Normal posture ) Tridosha यथा स्थानमवितष्टिन्त दोष ऩ्युब्जां(prone) वायु aggravates योनीपीडयित दिक्षणपा्श्वार्(Right side) कफ aggravates िपडयित गभार्शय वाम पाश्वर्(left side) िपत्त aggravates िवदहित रक़्त्ं शुक़्र्ं 12
  13. 13. According to Sushrutha & Dalhana tika Sushrutha describes 4 factors essential for conception • Rtu( rutu kala ) • Kshetra ( Garbhashaya) • Ambu (Nourishment) • Bija ( Shukra & Artava) Acharya Kashyapa has given importance to Rtukala & Bija. SUSHRUTA Equates = “Germination of seed” with achievement of “conception” As how sprout comes out by the aggregate action of rutu (season), ksetra (soil), ambu (water), and bija (seed), the conception occurs by the combined action of all these factors. गभोर्त्पादक सामग्री Factors essential for conception ध्रुवं चतुणार्ं सािनध्यात् गभर्स्यात् िविधपूवर्कम्। ऋतुक्षेत्रांबुबीजानां सामग़्र्य़ादङगुरो यथा॥ (सु.शा.2/33) 13
  14. 14. ऋतुरङ्गनाया रजःसमयः, क्षेत्रं गभार्शयः, अम्बु पुनराहारपाकजो व्यापीरसधातुः, बीजं स्त्री पुंसयोरातर्वशुक्र े ||३३|| (Su.S. Sha 2/33- Dalhana Tika ) • RITHU- अङ्गनाय रजः समय • KSHETRA- गभार्शय • AMBU- पुन आहार पाकजो रस धातु • BEEJA- स्त्रीपुंसयोःआतर्व शुक्र े • MARGA- अपत्त्यमागर् • HRIDHI- दोषानिधिष्टते असंतप्ते, • VATA Ashtanga Hridaya - added 3 other factors § मागर् ( Disease free Tubes and Passage) § ह्रिद - ( A sound mind ) § वात - (unvitiated vata in formation of fetus) 14
  15. 15. ऋत# कला – Fertile Period ऋतुस्तु द्वादशरात्रं भवित दृष्टातर्वः; अदृष्टातर्वाऽप्यस्तीत्येक े भाषन्ते ||६|| Su.Sha 3/6 The rutu is that period in which raja (female gamete) is expelled. The period rutu is of twelve days, it is counted by considering first sixteen days of menstrual cycle, among them first three and sixteenth day must be excluded. § The timing of sexual intercourse in relation to fertile period or ovulation strongly influences the chance of conception, although the actual number of fertile days in a women's menstrual cycle is uncertain. § As our acharyas stated , theoretical period of fertile days based on estimates of the survival of sperm and eggs. § A multicentered study by the WHO estimated that there are 10 presumable fertile days per cycle, on the basis of the characteristics of the cervical mucus. § Whereas Ayurvedic texts have defined rutukala up to 12 to 16 days . िनयतं िदवसेऽतीते सङ्कु चत्यम्बुजं यथा | ऋतौ व्यतीते नायार्स्तु योिनः संिव्रयते तथा ||९|| Su.S.Sha 3/9 15
  16. 16. There is a beautiful reference explaining how to understand the end of Ritu kala – stated by A/c Su.S.Sha 3/9 & A.H.Sh 1//22 पद्मं सङ्कोचमायाित िदनेऽतीते यथा, तथा||२१|| ऋतावतीते योिनः, सा शुक्र ं नातः प्रतीच्छित| िववृतािववृतमुखत्वं िह योनेगर्भर्ग्रहणाग्रहणहेतुः| तच्च वायोः िक्रयावतः कालसहायस्यायत्तिमत्याह मासेनोपिचतं रक्तं धमनीभ्यामृतौ पुनः||२२||A.H.Sh 1//22 Just like a lotus flower which closes after sunset ; similarly the cervical opening closes after rutukala , hence its hostile to sperm entry . However, According to Dalhana – The duration of Rutu kala can be anywhere between 12 days to 16 days. Ø While taking 16 days into consideration , the first 3 days of menstruation & last 1 day if excluded due to yoni sankocha , it is 12 days Ø Whereas Acharya Vagbhata opines that rutukala can persist anytime in the month. 16
  17. 17. 1. Menstrual Dates A quick and simple way to find out ovulation is to keep track of menstrual cycle of each month. 2. Basal Body Temperature (BBT) BBT is the temperature of the body under resting conditions. BBT should be measured each morning .Writing down the temperature each day is helpful as a test of ovulation because the BBT increases after ovulation. It is usually low, fluctuating between 97 and 98 degrees Fahrenheit. Just before ovulation, the BBT falls to its lowest level and then rises by 0.4 to 0.8 degrees about 2-4 days after ovulation. 3. Ovulation Predictor Kits/ LH kits These kits can be found at the local drug store and can be useful for testing ovulation. The kits work by measuring Luteinizing Hormone (LH), which is produced just before ovulation. Most of the kits are designed like home pregnancy tests, and use urine to measure LH. Ovulation usually occurs 14-24 hours after the test turns positive. The most fertile day is the day the test turns positive. Methods to test ovulation 17
  18. 18. Acc to Su.S.Sha 3/7-8 पीनप्रसन्नवदनां प्रिक्लन्नात्ममुखिद्वजाम् | नरकामां िप्रयकथां स्रस्तक ु क्ष्यिक्षमूधर्जाम् ||७|| स्फ ु रद्भुजक ु चश्रोिणनाभ्यूरुजघनिस्फचाम् | हषौर्त्सुक्यपरां चािप िवद्यादृतुमतीिमित [१] Acc to C.S.Sha 4/7 गते पुराणे रजिस नवे चाविस्थते शुद्धस्नातां िस्त्रयम व्यापन्नयोिन शोिणत गभार्शया मृतुमतीमाचक्ष्महे| Charaka says that after the completion of previous menstrual bleeding and beginning of the new menstrual cycle, the women after taking the bath , possessing healthy yoni, garbhashaya & shonita ( healthy reproductive system & ovum ) is termed as ruthumathi. 18 ऋत#म%त ल'ण
  19. 19. ØWoman in rithukala is healthy, bright ,happy, sexually excited due to hormonal influence. ØRuthu and its specific importance in conception denotes ovulatory time including proliferative phase under the influence of FSH, ESTROGEN & LH. Ø30 DAYS or 1 month is required for completion of Ruthu chakra. Ø3 phases of ruthuchakra - 1. Rajasrava, 2. Rithu kala 3. Ruthuvyatita kaala The woman in fertile period is advised to take jeevaniya drugs and contra indicated for kshara karma & nasya karma. Ruthu kala ACHARYAS DAYS Sushrutha & Vagbhata 12 days Kashyapa & Bhavamishra § Brahmana- 12 days ( Probably based on the nourishment basis) § Kshatriya – 11-10 days § Vaishya- 8-10 days § Kshudra – 6-9 days 19
  20. 20. Phases of menstrual cycle Duration Condition of reproductive system Dominant dosha Rajasrava kala (Menstrual phase) 3-5 days Menstrual bleeding Vata Rtukala (proliferative phase including ovulatory phase) 12 or 16 Days Establishment of navina raja(new cycles) Optimum chances of fertilization, increased sexual desire. Kapha Rtuvyatita kala (Secretory phase) 9-13 days Presence of purana rajas, constriction of yoni and hence less chances of conception. Pitta 20
  21. 21. A Brief Explanation about Menstrual Cycle 21
  22. 22. **LH surge increases intrafollicular proteolytic enzymes, weakening the wall of the ovary and allowing for the mature follicle to pass through. 22
  23. 23. Hormonal Cycle 23
  24. 24. िस्त्रणं गभार्शयो अष्टम इित (Su.s.Sha 5/7) Garbhashaya is the 8th Ashyaa in the stree िपत्त पक्वाशयोमर्ध्ये गभार्शया यत्र गभर्िस्तष्ठा ित (Su.s.Sha 5/39) ( A.S.Sha 5/46) The garbhashaya is situated between pittashaya & pakwashaya where garbha grows. तस्यास्तृतीये त्वावतेर् गभर्शय्या प्रितिष्ठता ||४३| Su.S.Sha 5/43 The garbhashaya is situated in 3rd avarta. यथा रोिहतमत्स्यस्य मुखं भवित रूपतः तत्संस्थानां तथारूपां गभर्शय्यां िवदुबुर्धाः ॥ ( Su.S.Sha5/44 and B.P Pu 3/32) Dalhana says that it is hollow inside just like mouth of rohita fish . स्त्रीणान्तु विस्तपाश्वर्गतो गभार्शयः सिन्नक ृ ष्टः ॥ ( Su.S.Chi 7/33) The Uterus is above the urinary bladder. Kshetra/Garbhashaya 24
  25. 25. ACHARYAS DEFINITIONS REFERANCE BHAGAVADGIT A Kshetra denotes our body in general Vyasa Acharya DALHANA TIKA To be very specific in Prasooti tantra , kshetra in stri sharira is garbhashaya Dalhana tika MANUSMRITI Kshetra refered to woman ; Bija refered to man. Manu has compared woman to a field , where a seed sown sprouts yielding vrihi dhanya; like wise, shukra implanted in garbhashaya leads to a progeny. Manusmriti 9/33 CHAKRAPANI क्षेत्रिमव क्क्षेत्रिमव क्षेत्रं, तत्र शुक्ररूपबीजप्ररोहणात्’ या स्त्री प्रहिषर् णी तत् क्षेत्रम् Cha.S.C 2/1/4, Chakra. CHARAKA Shudda Shukra – Shonita and a healthy uterus can produce a heathy progeny Cha.S.Sh8/3 BHELA Ø Sukrushta kshetra (Decidua) I:e, endometrium which is well prepared for conception. Ø Bija when embedded in well prepared, unvitiated, healthy uterine cavity results in pregnancy, like the paddy or barley sown in well ploughed field sprouts readily . Bhe.Sam.Sh 8/2 25
  26. 26. The embryo is initially fertilized in the fallopian tube and must evade the immune system, grow and move into the Healthy uterus before interacting with the endometrium for implantation. The process of implantation is divided into 4 key steps: The immune system & Uterus plays a role in each step of the embryo's development through the delivery of a live healthy foetus. A perfect relationship between the uterus and the embryo is mediated by a tightly controlled interaction between the embryo and the endometrium which is required for successful implantation. Any factors affecting this communication, such as altered microbiome may lead to poor reproductive outcomes. Eg - Chronic endometritis - including Gonorrhoea, Chlamydia, Escherichia coli, Streptococcus, Staphylococcus, Enterococcus fecalis Immunological Role of the Maternal Uterine Microbiome in Pregnancy 26
  27. 27. Current theories suggest that NLD (non-lactobacillus dominant) microbiota may trigger an inflammatory response in the endometrium that affects the success of embryo implantation, as inflammatory mediators are closely regulated during the adhesion of the blastocyst to the epithelial endometrial wall. Endometritis has been hypothesized to alter the endometrium through increased inflammation and progesterone resistance which can affect implantation, increase risk of miscarriage, poor pregnancy outcomes including pregnancy induce hypertension and preterm birth . It would appear that increased inflammation at the endometrial level regardless of the cause may affect implantation and pregnancy outcomes. Hence, Kshetra Plays a very important role in conception. 27
  28. 28. अप#यम&ग/यो)न Birth canal / Fallopian tubes न शुक्र ं धारयत्येिभदोर्षैयोर्िनरुपद्रुता| तस्माद्गभर्ं न गृह्णाित स्त्री गच्छत्यामयान् बहून्||३८|| गुल्माशर्ःप्रदरादींश्च वाताद्यैश्चाितपीडनम्|३९| (C.S.Chi.30/38) When Yoni is afflicted with the vata dosha, the women is unable to retain the Sukra as a result she does not conceive and remain infertile and becomes vulnerable to diseases like Gulma, Arsha and Pradara. 28 'प्रिवष्टमात्रं बीजं िह रक्तेन पिरवेष्ट्यते’ (K.Sha. Asamanagotriya 1:2) Kashyapa indicates about implantation – Here he refers Beeja to the fertilized ovum, which soon after entering into uterine cavity is encircled by Rakta.
  29. 29. • Fertilization is defined as the union of two gametes. During fertilization, sperm and egg fuse to form a diploid zygote to initiate prenatal development. In mammals, fertilization involves multiple ordered steps, including the acrosome reaction, zona pellucida penetration, sperm–egg attachment, and membrane fusion. Fertilization 29
  30. 30. Ambu- Nutrition / Nourishment ACHARYA S DEFINITIONS REFERANCE SUSHRUTHA ØFrom rasavaha srotas of mother the nutrition is passed to the fetus via garbhanadi. By circulation of these potent nutrients the fetus grows. ØConception to conspicuousness of the body parts the fetus is nourished by उपस्नेहा & उपस्वेदः through the dhamani which travel obliquely throughout the body. (Su.S.Sha.2/33 Dal Tika) CHARAKA The gametes are nourished by rasa ( ahara rasa) which provides mahabhuta also. Cha.S.Sha. 2/34 SUSHRUTHA • ति#मन् सव)शरीरावयवदोषधात3मलाशयान3सा5रिण र7 िज9ासा| • अ;ब3 प3नराहारापाकाजो @यापी रसधात3॥ Su.S.Su 14/3 (स3.शा.2/33) CHARAKA Rasa is predominately Ap mahabhuta, hence this factor is called Ambu. Qualities of rasadhatu are द्रव, सर,मन्द ,िस्नग्ध,मृदु,िपिच्छल by which it causes the functions of प्रीणनम्, स्नेहन, रक्त पुिष्ट, धारणम् and तुिष्ट thus helps in fetal nourishment. 30
  31. 31. Ambu is the rasa dhatu derived as the end product of food digestion with reference to implanted ovum & zygote. Growth of the fetus is the result of ahara rasa of mother because the rasavaha srothas of mother are connected to nabhi nadi of garbha through which potent nutrients are circulated to fetus . Clinical Importance – The blood, intercellular fluid of endometrium & secretions of endometrial glands with required nutrients without any abnormality is helpful for growing fetus . Appropriate in utero growth is essential for offspring development and is a critical contributor to long-term health. Foetal growth is largely dictated by the availability of nutrients in maternal circulation and the ability of these nutrients to be transported into foetal circulation via the placenta. Uterine milk- Uterine milk is secreted in the uterus for embryo nutrition in several elasmobranch species and may contribute to rapid embryonic growth. 31 अम्बुपुनराहारपाकजो व्यापी रसधातुः।
  32. 32. Uterine Glands Provide Histotrophic Nutrition for the Human Fetus during the First Trimester of Pregnancy. Two principal pathways have evolved to transfer nutrients from the mother to her fetus. These are termed as Histotrophic • Histotrophic is an extracellular material derived from the endometrium and the uterine glands that accumulates in the space between the maternal and fetal tissues. It is phagocytosed initially by the trophectoderm of the blastocyst, and later by the trophoblast of the placenta or the endoderm of the yolk sac. Hemotrophic • By contrast, hemotrophic nutrition is the exchange of blood-borne materials between the maternal and fetal circulations. This is facilitated by the extensive and intimate apposition of the maternal and fetal tissues that occurs within the placenta The Journal of Clinical Endocrinology & Metabolism, Volume 87, Issue 6, 1 June 2002, Pages 2954–2959 32
  33. 33. Before implantation, nutrition of the mammalian conceptus is therefore essentially histotrophic. Once the placenta is established, hemotrophic nutrition becomes predominant, although the two pathways may coexist for much of gestation in certain species. 33
  34. 34. Bija/Shukra-Shonita (Gametes) ACHARYAS DEFINITIONS REFERANCES CHAKRAPANI बीज इित शुक्रशोिणते । C.S.Sha 3/17, Chakra pani KULLUKHA VAGBHATTA तथािप तदिधकरणत्वात् पुरुषो बीजिमत्यिभधीयते । Bija means Gametes (क ु ल्लूकभट्टः) MANUSMRITHI बीजभूतः स्मृतः पुमान्। (मनुस्मृित) DALHANA बीजं स्त्रीपुंसयोरातर्वशुक्र े । Su.S.Sh 2/33, Dalhana tika CHARAKA स्त्रीपुंसयोरव्यापन्न शुक्रशोिणत....श्रेयसी प्रजािमच्छतः। C.S.Sh 8/3 KASHYAPA ...ॠतुबीर्जकालमवेक्षत.... K.S.Sh. 5/5 34
  35. 35. • Beeja considered as male & female gametes • Mother & father by providing gametes can be claimed as chief contributors for te formation of fetus • Stree Bija – • Human Ovum is the largest cell of the body & have specific name for its parts • Cytoplasm – ooplasm / yolk/vittelus • Nucleus- Germinal vesicle • Nucleolus – Geminal Spot • Cell membrane – Vitelline membrane • Coverings – Outer- Corona radiata, Inner – Zona pelucida • Fertile life of ovum – 12-24 hours • Time of Ovulation – Day 14, After initiation of menstrual cycle. 35 Mature Ovum
  36. 36. • Purusha beeja – Sperm • Sperm has 2 parts – Head & Tail • Head - Consists condensed nucleus & acrosomal cap • Tail - Divided in 4 zone – Neck, middle piece, principle piece & end piece • Estimated fertile life of sperm = 48-72 hours 36 Mature Sperm
  37. 37. The days of coitus for having a male and female child DAYS CHILD CAUSE OF BIRTH OF FEMALE/MALE CHILD EVEN DAYS-4th ,8th ,10th,12th day MALE CHILD IN yugma ratri,” Alpi bhavati artavam” (A.S.Sha.1/50) ODD DAYS-5th ,7th ,9th ,11th day FEMALE CHILD IN Ayugma ratri,”Apyayate artava” (A.S.S.1/50) The child conceived on successive days of rutukala has long life, good health and fortune, power of supremacy, energy, complexion and better specific motor or sensory organs. In further delay all these qualities gradually decline. (Su.Sha.2/29) 37
  38. 38. Role of Panchabhuta, &Tridoshas in Garbhadana गभर्स्तु खल्वन्तिरक्षवाय्विग्नतोयभूिमिवकारचेतनािधष्ठानभूत । (च.शा 4/6 ) The garbha is formed by the collective action of five mahabhuta, and it serves as asraya (shelter) for atma. गभ+,य च.व0र चत34वधा0न भ7ता0न माता0पत:स;भवा0न आहारजा>या.मक@ता0न चAव सव+,य सव+िण भवि>त DE ॥ (च.शा 2/26) There are four set of panchamahabhuta involve in the formation and development of garbha, first set is from sukra, second from artava, third from atma, and fourth set is from ahara. All these four factors namely sukra, artavą, atma. and ahara carry panchmahabhuta, except akasha, which omnipresent. 38 शुक्र शोिणत संयोगे योभवेशेष उत्कटः । प्रक ृ ितजार्यते तेन तस्या में लक्षणं श्रृणु। (सु.शा 4/63) Whichever the dosha that is predominant at the time of union of sukra and sonita, the prakrti of person get formed from that dosha. Thus it can be stated that the tridosha at their normalcy offer the formation and development of healthy garbha, where are abnormal doshas are responsible for abnormality in garbha.
  39. 39. Role of Panchamahabhutas in organogenesis तं चेतनाविस्थतं वायुिवर् भजित, तेज एन पचित, आपः क्लेदयिन्त, पृिथवी संहिन्त, आकाशं िववधर्यित । (सु.सं.शा. 5/3) In a live garbha, vāyu divides, teja metabolizes, jala moistens, prthvi solidifies and akasa increases the size. 39
  40. 40. 40 AKASHA Shabda Shrotendriya Laghava Saukshmya Viveka Laghava Srothas Chidras VAYU Sparsha roukshya Prerana Chesta Dhatu vyuhana Ucchwasa Prana Apana Unmesha nimesha JALA Rasa Shaitya Mardava Sneha Kledha Asrik Shukra Mutra Sweda PRITHVI Gandha Gourava Sthairya Murti Kesha Loma Asthi Nakha Danta Dhairya AGNI Roopa Darshana Prakasha Pittairushma Tejus Santapa Shourya Varnya Krodha Ø आन्तिरक्षा:- शब्दः शब्देिन्द्रयं सवर्िच्छद्रसमूहो िविवक्ता च; Ø वायव्यास्तु स्पशर्: स्पशेर्िन्द्रयं सवर् चेष्टासमूहः सवर्शरीरस्पन्दनं लघुता चः Ø तैजसास्तु– रूपं रूपेिन्द्रयं वणर्ः सन्तापो भ्रािजष्णुता पिक्तरमषर्स्तैक्ष्ण्यं शौयर्ं च; Ø आप्यस्तु- रसो रसनेिन्द्रयं सवर्द्रवसमूहो गुरुता शैत्यं स्नेहो रेतश्च; Ø पािथर् वस्तु- गन्धो गन्धेिन्द्रयं सवर्मूतर्समूहो गुरुता चेित ॥ (सु.शा 1/19)
  41. 41. Dalhana clarifies that it is because of chetana, the garbha remains alive and stable till Term and without chetana the garbha would putrify or degenerate. § Vāyu is responsible for division of dosa, dhātu, mala and division of all body parts. § Teja gives shape providing human features, color, complexion owing to its metabolic function. § Jala renders moistening quality to the garbha counteracting the dryness/absorption caused by vayu and tejas. § Prthvi solidifies/stabilizes giving shape to the embryo. § Akasa increases the size by adhmäpana inflation of srotases running in all direction (up, down, oblique) which have been created by splitting or division done by vayu and agni. 41
  42. 42. Importance of Vata ACHARYAS DEFINITIONS REFERANCES Sushrutha Ø Vayu molds the shape of the embryo’s and indicates continuity of life . वायुस्तन्त्रयन्त्रधरः...कतार् गभार्क ृ तीनाम्, आयुषोऽनुवृित्त प्रत्ययभूतो भवत्यक ु िपतः। Ø Cell division ( Conjugation & disjunction ) is brought about by vayu. (वायुिवर् भजित) Ø Garbha grows due to rasa & proliferates due to vayu. Ø From agnistana situated at umbilicus the vayu casuses distension, pitta driven by vayu opens up the srotas in all directions & gradually grows . S.Su 12/8 ØVayu plays a very important role , from maturation of gametes, fertilization to foetal nourishment. ØMaturation & ejaculation of semen per se function takes place. ØVayu is responsible for cell division and formation of cellular structure called embryo. ØFetal nourishment, growth and development is carried by vata . 42
  43. 43. ACHARYAS OPINIONS REFERANCES VAGBHATTA • Most essential factor for conception • In Which ever type of a son woman desires, she must think of people of that pace or race and follow the diet & regimen. • सौम्नस्यं गभर्धारणं श्रेष्ठतम..... Arunadatta tika 13/3 Ch.Sam.Su. 25/40 SUSHRUHA • Which ever type of diet , behavior & conducts followed by the couple at the time of coitus/fertilization the born child will be so. • With all the garbha sambhava samagri the born child will possess beauty, satwa, longevity and will be beneficial to his or her parents. (एवं जाता रूपवन्तः सत्त्ववन्तिश्चरायुषः। भवन्त्यवृणस्य मोक्तारः सत्पुत्राः पुित्रणे िहताः ॥ • The mental state of the parents during conceotion, mental state of mother during pregnancy & the deeds of previous life of an embryo or desires of garbha in previous life decides the mental state of the progeny . Su.Sam Sha 2/46 B.P 3/62 Su.Sam.Sha.2/36 Hridi/Hridaya – Psychological compitability of the couple initiating Garbhadana 43
  44. 44. Queen Satyavati requests her son, Ved Vyasa, to cohabit with her widowed daughter-in- law, Ambika, and Ambalika, to sire progeny. As history states, Ambika closes her eyes at the sight of the bearded Ved Vyasa, and a blind son, Dhritarashtra, was born. The other daughter-in-law, Ambalika, turns pale upon seeing Ved Vyasa, and a son with pallid complexion, Pandu, is the result. The next time, Ambalika sends a confident palace maid in her place, and a perfectly healthy son, Vidura, is the result of this contact. Whether environmental factors have a role to play in intrauterine development is an important debate in the medical circle today. The birth of sons with varied limitations, linked to maternal “psychosocial” environment at the time of conception, is perhaps the first recorded case of maternal psychological impact on the progeny . Kalra B, Baruah MP, Kalra S. The Mahabharata and reproductive endocrinology. Indian J Endocrinol Metab. 2016 May-Jun;20(3):404-7. doi: 10.4103/2230- 8210.180004. PMID: 27186562; PMCID: PMC4855973. HISTORICAL REFERANCE 44
  45. 45. गभ#धान प(व*क,म Preconception care 45
  46. 46. Purva Samyoga Vidhi अथाJKतौ Mीप3;सौ O"ह,PदाRयाम3पपाS, वमन0वTचनाRयU स;शोWय, XYण &क@0तमापादKत्| स;श3[ौ चा,थापनान3वासनाRयाम3पाचTत्; उपाचT]च मध3रौषधस;,क@ताRयU घ:त`ीराRयU प3aष; , िMय; त3 तAलमाषाRयाम्||४|| C.Sha.8/4 Ø The Couple must follow Bhramacharya for 1 month and undergo snehana & Sweda followed by VAMANA, VIRECHANA & BASTI before coitus . Ø Here psychological make up plays a very important role as SOUMANASYAM is the best instrument for achieving pregnancy . Ø Depression, negative emotions, stress & strain may hinder the pregnancy. 46
  47. 47. Maintainance of sadvritta SADVACHARA • Devata,Brahmana pujana • Shaucha • Achara • Hitorata • (Ch.Sha.8/21) • (Ch.Sha.3/35) Negative emotions to avoid (C.Sha8/24) • Krodha • Shoka • Asuya • Irshya • Bhayatrasa • Samskhobha varjana Soumya, manonukula katha shravana (C.Sha8/24) Vtasalyadibhitwam (jalpakalpataru) Exposure to brahma ghosha. Worship god, Vishnu, skanda, sun, moon & brahmanas (K.S.Sha5/12) Suvadya gosha (C.Sha. 8/14) 47
  48. 48. Brahmacharini Adhah shayayini- sleeping on ground Ajarjabhojana patra- eating in unbreakable vessels Darbha samstara shayini- sleeping on bed made of darbha Havishya bhojini- intake of payo yukta yavanna,saghrita saali anna for karshana and koshta shodhana Trayaham bhatri samrakshana – avoid seeing her husband for this 3 days Kalyana kamini- thinking only of auspicious things Rajaswalacharya Observing rajaswalacharya before garbhadana ततः पुष्पात् प्रभृित ित्ररात्रमासीत ब्रह्मचािरण्यधःशाियनी, पािणभ्याम न्नमजजर्रपात्राद्भुञ्जाना , न च कािञ्चन्मृजामापद्येत| Ch.Sa.Sha. 8/5 ऋतौ प्रथमिदवसात् प्रभृित ब्रह्मचािरणीिदवास्वप्नाञ्जनाश्रुपातस्नानानुले पनाभ्यङ्गनखच्छेदनप्रधावनहसनकथनाितशब्दश्रवणावलेखनािनलाया सान् पिरहरेत् | भर्संस्तरशाियनीं करतलशरावपणार्न्यतमभोिजनीं हिवष्यं, त्र्यहं चभतुर्ः सं रक्षेत् | Su.Sa.Sha 2/25 48
  49. 49. Days of menstruation Effect on progeny 1st day No progeny/intra uterine death ,death immediately after delivery. Ayush ( life span)of husband also deteriorate “vata garbham achakshate viphalam vata pushpamivodbhavaan” (k.sha.5/5) 2nd day Abortion,within few days after delivery “sramsate chyavate va”(ka.sha 5/5) 3rd day Short lived,defective body parts “Sootikasane mriyate, na va deerghayu bhavati ,heenangascha jayate” 4th day Normal ,healthy ,mature baby “sampoornangho deerghayuscha bhavati” (su sa 2/31) Effect of intercourse observed in rajakala on progeny 49
  50. 50. Contraindicative Conditions for coitus in woman There are certain physical & physiological conditions where coitus is contraindicated in woman . SUSHRUTHA CHARAKA Su.S.Sha 10/56) and Su.S.Chi. 24/110-111, 113-117, 119,123 ( C.S.Sha. 8/6) ØVery old woman & man afflicted with chronic diseases. ØShould cohabit on 3rd day in all ritus & on 15th day in summer season Ø Excessive food intake, fasting, thirst, fear, dejection, grief, anger, desire for another man, excessive desire for intercourse all these factors in woman during coitus prevents conception and produces a deformed child . ØMan should avoid indulging in excessive coitus ØAvoid coitus with rajaswalacharya ,uninterested female, unhygienic unloving, elderly, higher status woman, diseased , pregnant woman , woman with deficient body parts , jealous, who has yoni doshas and of same gotra Avoid cohabitation during twilights, festive days, early morning, midnight, midday, improper place, open place, embarrassing place & in unhygenic / uncomfortable environment . Ø One should avoid indulging in woman / man who is too young or too old, who is suffering from chronic disease/ disorders. Ø Vagbhatta – Opines same as Acharya Charaka 50
  51. 51. BHAVAPRAKASHA BHELA (B.P. Pu. 3/26) B.S.Su. 7/5-7 Ø Advices to avoid coitus with rajaswala, diseased, suffering from yoni roga, aged, uninterested & unhygienic, garbhini, deficient body parts, hatred & of same gotra . Ø Advices that coitus with elderly woman, satwa hina woman, diseased, unhygienic, deformed body parts, different caste, infections in yoni should be avoided as it will lead to destruction of strength, health, longevity and teja Ø Thus one should indulge in ritu kala with a healthy female . Lets corelate – Considering all the contra indications & specifications regarding impregnation advices a/c to various acharyas can be corelated as – üEarly pregnancies increases the risk of NTD’s IUGR, Preterm birth & Still birth üLate pregnancies increases the risk of downs syndrome , eclampsia, macrosomia & hydramnios 51
  52. 52. üChronic diseases like hypertension and diabetes, increases the maternal & perinatal mortality & morbidity. üBala kshaya causes IUGR & missed abortions üThe concept of Atulyagotra stree, was to discourage consanguineous marriages in those days, the same is being adviced till date by the medical community to avoid hereditary/genetic defects, as the chance of recessive traits becoming dominant is quite high . üAccording to Indian Parliament “child marriage prohibition act – 1978 – legalized age for marriage is 21 and 18 years for male & female respectively . üIn Revised - The prohibition of Child Marriage (Amendment) Bill 2006- the bill amends to increase the minimum age of marriage in females to 21 years . 52
  53. 53. Garbhadana Vidhi üFrom the day of onset of menstruation female should follow brahmacharya for 3rd or 4th day she should take bath with washing her head also, & wear white garments then enter the place of god & should offer oblation with rice & ghritha üTo get male child even days of ritukala should be selected & for female child odd day of ritukala should be selected. Even days the quantity of arthava is less & on odd days quantity of arthava increase thus leading to birth of male or female child respectively. üBorn child acquires similar characters of that type of diet, behavior & conduct followed by couple at time of intercourse. 53
  54. 54. Ahara & Vihara (C.Sha 8/4) MALE FEMALE üShould have food containing Ghritha, rice & milk üGHRITHA – Pitta anilharam rasa sukhra ojasam hitam- With these property ghritha increases the quality of sukra. üAll these having madhura rasa & sheeta virya property which promotes the production of shukra dhatu üShould consume the food containing of tila & masha. üTila & masha are ushna virya which increases the quality & quantity of arthava 54
  55. 55. Behavior : üSoumanasya & Kalyana kamana – She should remain with peaceful mind & positive thoughts, relatives & husband have tender words & behavior with her . .(C.Sha.8/5) üAnyony – Abhikamat – Psychological intimacy of couples. üWhite color clothing – Unique vibration of each color could have specific effect on the psyche, white probably indicates tranquility pacification & sattva guna .(C.Sha.8/5) üTime - An appropriate auspicious period of night facilitate Garbhadana 55
  56. 56. Putresthi Yagna तd ॠि.वक् प3्dीयिमिf 0नव+gत।0स[्मUसौदना वातiनौ वाjयभगौ.............(क.शा.1/8) श3kा त3 नम,कारYव कlयmत्॥( Putreshti yajna will be done for fulfillment of desired sex of the baby by the couple by stabilizing Prajapati to yoni of the woman and reciting hymns and oblation should be given with charu mixed with milk and ghrita which is already treated with mantras by the method indicated in vedas. The water pot already sanctioned with mantra is given to woman for use. They should take left over ghee and then participate in intercourse. 56
  57. 57. स"जात हष()थ+, च अन+क1ल3व5ग7ध" 9वा9तीण<म् स+ख"शयन" उपकDEय मनोG" 3हत" अशनमिशIवा नाIयािशतौ दिLण पाMन प+मानारोOत् वामपाMन Pी॥( च.शा.8/7) Samyoga Vidhi The couple having feeling of carnal relation, should avoiding over eating and only consume desirous beneficial food , should go to comfortable cot which is spread with soft mattress and sprinkled with pleasant fragrance. The man should go to the bed by keeping his right leg while the woman with her left leg. After coition they should irrigate genitals with cold water. 57
  58. 58. त" म$"% &य($जीत् "अ.हर.स आय(र.स सव4तः &.त6ा.स धाता 9वआ दधात( ;<वच4स भव इ.त॥ (च.स%.शा.8/7) • Mantra chikitsa is unique to ayurveda and great importance has been laid upon enchanting specific mantras on specific occasions. The mantra to be enchanted before coitus is; “O garbha you are like sun, you are my longevity, my prestige by all means. Dhata and Vidhata (God of creation) should protect you; you should have Brahma in you” MANTRA TO BE CHANTED BEFORE SAMYOGA 58
  59. 59. When conception fails naturally… Artificial techniques of Garbhadana 59
  60. 60. There are few references in our mythology that indicate artificial techniques of garbhadana . The Indian epic, the Mahabharata, is an encyclopaedic coverage of ancient history. The Epilogue to the Mahabharata exclaims with pride (18:56-33). “Whatever is here, may be found elsewhere; what is not ,cannot be found anywhere else,” 60
  61. 61. Induction of Ovulation Other means of assisted reproductive technology (ART) have been described in the epic. The King Brihadratha, who had infertility, was given a mango by the sage Kaushik, to give to his queen. Brihadratha divided the mango into two, giving one-half to each of his two queens. Each queen gave birth to a “half- child” As the products of conception were presumed still-born, they were disposed of in the garbage. A rakshasi who came by, search for food, found that the two halves merged to create a living child, who was named Jarasandha. This child grew up to be strong, but harsh, king, who remained undefeated until Bhima tore his body into two halves and threw them in opposing directions. This episode suggests administration of an oral agent for induction of ovulation, similar to those used in gynaecological practice. 61
  62. 62. Extra-uterine Manipulation: In vitro Fertilization Gandhari's story did not end with a “still birth.” As the legend goes, the “fetus” was divided into a hundred pieces, which were put in jars to which ghee (clarified butter) was added, and incubated. Finally, 101 children were born, one by one. This narrative is strongly reminiscent of in vitro fertilization (IVF), with the multiple pregnancies that commonly occur with it.[ In Gandhari's case, however, the description mirrors an extra-uterine gestation, a scientific feat that future researchers may be able to achieve. 62
  63. 63. ART procedures involve surgical removal of eggs known as egg retrieval. IVF is the most common ART procedure. Assisted reproductive technology comprises a group of procedures that have in common - the handling of oocytes & sperms outside the body in the lab. The gametes or embryos are replaced into the uterine cavity to establish pregnancy . These procedures , although benefited many infertile couples (20-40 % pregnancies), are stressful & very expensive with complications such as OHSS , multiple pregnancies , abortions & ectopic pregnancies. Assisted Reproductive Technology 63
  64. 64. Indications In FEMALES In MALES 64
  65. 65. There are no absolute contraindications to the procedure of IVF. Ø However, it should not be performed in women who have a significant risk of morbidity and mortality of pregnancy if IVF were successful. Ø Some examples of these high-risk conditions include but are not limited to Marfan syndrome, New York Heart Association (NYHA) class 3 or 4 heart failure, Eisenmenger syndrome, severe valvular stenosis, pulmonary hypertension, or coarctation of the aorta. Ø For women with these significant medical issues who desire a biological child, they can undergo IVF with oocyte aspiration, fertilization with their partner’s sperm, but the embryos will be transferred to a gestational carrier. Contraindications 65
  66. 66. Ovulation Induction Ovulation induction is to alleviate infertility due to anovulation in females of reproductive age. This activity reviews the ovulation potential of a reproductive female and assisted ovulation in anovulatory females. After Medications for 5 days From 5th day of the menstrual cycle (5Th- 10Th day) . The woman is asked for a repeated follicular study day after day to evaluate Follicle size and on the day when the corpus luteum ruptures the couple is instructed to have sexual intercourse . Success rate 40%. 66
  67. 67. IUI – Intrauterine insemination Ø Intrauterine insemination (IUI) is an assisted conception technique that involves the deposition of a processed semen sample in the upper uterine cavity, overcoming natural barriers to sperm ascent in the female reproductive tract. Ø It is a cost-effective, non invasive first-line therapy for selected patients with functionally normal tubes, and infertility due to a cervical factor, anovulation, moderate male factor, unexplained factors, immunological factor, and ejaculatory disorders . ØClinical pregnancy rates per cycle ranging from 10 to 20%. 67
  69. 69. Gamete intrafallopian transfer (GIFT)- Ø This involves Ovarian stimulation & egg retrieval followed by laparoscopically guided transfer of a mixture of two ova & sperms into each of fallopian tubes –Low success rates. Zygote intrafallopian transfer (ZIFT)- Ø This involves the laparoscopic transfer of day 1 fertilized eggs (zygotes) into fallopian tubes – Low Success rates IVF - Vitro fertilization-embryo transfer (IVF-ET) This involves ovulation induction , oocyte retrieval & fertilization of the oocytes in the laboratory ; embryos are then cultures for 3-5 days followed by transfer of selected fertilized oocytes transfered cervically under USG guidance into uterine cavity. 69
  71. 71. ICSI – Intracytoplasmic sperm Injection Ø This Technique was developed in early 1990’s Ø It aims at helping couples with severe male factor infertility Ø One sperm is directly injected into each mature egg prior to intrauterine transfer of the fertilized eggs. Ø This method yields 50—70% successful fertilization rates . 71
  72. 72. THE EMBRYO TRANSFER Ø The fertilized eggs are monitored and embryos are formed . Ø These embryos are further preserved (freezed) or transferred into intrauterine cavity . This process is called as Embryo Transfer (ET) Ø The remaining embryos are frozen . Later when the couple are ready , these frozen embryos are thawed and transferred into intrauterine cavity . This is termed as frozen embryo transfer (FET) 72
  73. 73. What day is the embryo transfer is performed ? ET types 73
  74. 74. 74 Reasons for cancelling ET Deciding the No. of Embryos to transfer based on
  75. 75. Fate of non used embryos Embryo grading 75
  76. 76. In-Vitro Maturation Ø Retrieval of immature oocytes from unstimulated ovaries, followed by in vitro maturation (IVM) was originally proposed in order to avoid side effects of gonadotropin administration. Ø The target is to eliminate or significantly reduce the risk of ovarian hyperstimulation syndrome (OHSS) in patients with polycystic ovary syndrome (PCOS), drug cost and burden on patients. Ø This technology was also suggested in treatment of normo-ovulatory women, fertility preservation or infrequent conditions such as failure of oocytes to mature or repeated development of poor quality embryos. 76
  77. 77. EMBRYOSCOPE An Embryoscop is a new type of incubator that allows the embryologist to monitor embryo cell divisions while the embryos are still in the incubator. The incubator has a built-in camera that can take pictures of the embryos at timed intervals. 77
  80. 80. IVF –Donor Sperm 80
  81. 81. Requirements for a Sperm Donor ü The individual must be free of HIV and hepatitis B and C infections, hypertension, diabetes, sexually transmitted diseases, and identifiable and common genetic disorders such as thalassemia. ü The age of the donor - 18-39 yrs ü An analysis must be carried out on the semen of the individual, and the semen must be found to be normal according to WHO method manual for semen analysis, if intended to be used for ART. ü The blood group and the Rh status of the individual must be determined and placed on record. ü 4.Other relevant information in respect of the donor, such as height, weight, age, educational qualifications, profession, colour of the skin and the eyes, record of major diseases including any psychiatric disorder, and the family background in respect of history of any familial disorder, must be recorded in an appropriate proforma. ü SOURCE – SEMEN BANKS 81
  82. 82. Requirements for an Oocyte Donor ü The individual must be free of HIV and hepatitis B and C infections, hypertension, diabetes, sexually transmitted diseases, and identifiable and common genetic disorders such as thalassemia. ü The blood group and the Rh status of the individual must be determined and placed on record. ü Other relevant information in respect of the donor, such as height, weight, age, educational qualifications, profession, colour of the skin and the eyes, and the family background in respect of history of any familial disorder, must be recorded in an appropriate proforma. ü The age of the donor must not be less than 18 or more than 35 years. ü She should have minimum of 2 healthy born children ü SOURCE- OOCYTE BANKS 82
  83. 83. Reciprocal IVF 83
  86. 86. • One option that women who wish to postpone pregnancy have is to freeze their eggs & sperms (oocyte/sperm banking) -at least for those who can afford it. • If eggs are frozen before the age of 35, women have a 30–40% chance to conceive when there are 10 eggs available. • However, research points out that women interested in elective egg freezing is often at the end of their reproductive life spans (late 30 s to early 40 s). • Same is done with Male Sperms. • Oocyte & Sperm Cryo-preservation – is done in case of Ca Patients. Egg & Sperm preservation 86
  87. 87. Surrogacy Ø Surrogacy is an important method of assisted reproductive technology wherein a woman carries pregnancy for another couple. Ø Surrogacy in India has had its own journey from India becoming popular as a surrogacy centre since 2002 to the Surrogacy (Regulation) Bill, 2016, which would restrict the option of surrogacy for many. Surrogacy is an important medical service for all those couples who would otherwise not have been able to produce a child. Ø The word “surrogate” is rooted in Latin “Subrogare” (to substitute), which means “appointed to act in the place of.” It means a substitute, especially a person deputizing for another in a specific role, so the surrogate mother implies a woman who becomes pregnant and gives birth to a child with the intention of giving away this child to another person or couple, commonly referred to as the “intended” or “commissioning” parents. 87
  88. 88. INDICATIONS 88
  91. 91. Code of practice, Ethical considerations & Legal issues 91
  92. 92. Code of Practice This Code of Practice deals with all aspects of the treatment provided and the research done at registered clinics. Those areas which most affect the doctors, scientists and patients and are a part of this code are summarized below . Staff: A ‘person responsible’ shall take full responsibility for ensuring that the staff of the registered unit is sufficiently qualified Facilities: These must cover the standards expected in respect of provision of clinical, laboratory and counselling care Confidentiality: Any information about clients and donors must be kept confidential Information to patient: All relevant information must be given to the patient before a treatment is given. 92
  93. 93. Consent: No treatment should be given without the written consent of the couple to all the possible stages of that treatment, including the possible freezing of supernumerary embryos. A standard consent form recommended by the accreditation authority should be used by all ART clinics. Specific consent must be obtained from couples who have their gametes or embryos frozen, in regard to what should be done with them if he/she dies, or becomes incapable of varying or revoking his or her consent. Counselling: People seeking registered treatment must be given a suitable opportunity to receive proper counselling about the various implications of the treatment. Use of gametes and embryos: No more than three oocytes or embryos may be placed in a woman in any one cycle, regardless of the procedure/ s used, excepting under exceptional circumstances (such as elderly women, poor implantation, adenomiosis, or poor embryo quality) which should be recorded. Storage and handling of gametes and embryos: The ‘highest possible standards’ in the storage and handling of gametes and embryos in respect of their security, and in regard to their recording and identification, should be followed. 93
  94. 94. Ethical Considerations Information and Counselling to be given to Patients üThe basis, limitations and possible outcome of the treatment proposed, variations in its effectiveness over time, including the success rates with the recommended treatments obtained in the clinic as well as around the world (this data should be available as a document with references, and updated every 6 – 12 months). üThe possible side-effects (e.g. of the drug used) and the risks of treatment to the women and the resulting child, including (where relevant) the risks associated with multiple pregnancy. üPossible disruption of the patient’s domestic life which the treatment may cause. üThe techniques involved, including (where relevant) the possible deterioration of gametes or embryos associated with storage, and possible pain and discomfort. üThe cost (with suitable break-up) to the patient of the treatment proposed and of an alternative treatment, if any (there must be no other “hidden costs”). 94
  95. 95. üTo make the couple aware, if relevant, that a child born through ART has a right to seek information (including a copy of the DNA fingerprint, if available) about his genetic parent/surrogate mother on reaching 18 years . üA third party donor of sperm or oocytes must be informed that the offspring will not know his/her identity. üThere would be no bar to the use of ART by a single women who wishes to have a child, and no ART clinic may refuse to offer its services to the above, provided other criteria mentioned in this document are satisfied. The child thus born will have all the legal rights on the woman or the man. üA third-party donor and a surrogate mother must relinquish in writing all parental rights concerning the offspring and vice versa. üNo ART procedure shall be done without the spouse’s consent. üGametes produced by a person under the age of 21 shall not be used. The accepted age for a sperm donor shall be between 21 and 45 years and for the donor woman between 18 and 35 years. 95
  96. 96. üNo ART clinic shall offer to provide a couple with a child of the desired sex. üUse of sperm donated by a relative or a known friend of either the wife or the husband shall not be permitted. It will be the responsibility of the ART clinic to obtain sperm from appropriate banks; neither the clinic nor the couple shall have the right to know the donor identity and address however, shall have the right to have the fullest possible information from the semen bank on the donor such as height, weight, skin colour, educational qualification, profession, family background, freedom from any known diseases or carrier status (such as hepatitis B or AIDS), ethnic origin, and the DNA fingerprint (if possible), before accepting the donor semen. üTransfer of human embryo into a human male or into any animal belonging to any other species, must never be done and is prohibited. 96
  97. 97. Discussion 97 Garbhadhana vidhi plays a very important role in imparting the knowledge for the couple who are wanting to conceive. As stated , Age is a single biggest factor affecting a woman’s chance to conceive . The other important factors ritu, kshetra ambu, beeja plays a vital role in conception, implantation, and nourishment of a healthy fetus just like how a appropriate season , healthy soil , water nourishment & potent seeds give out a good harvest . Garbhadhana aims at both the couples to follow certain deictics and regimens and also to follow good conduct. This targets them to follow the rituals preconceptionally. Being healthy before pregnancy can help improve the chances of conception. It can also help prevent pregnancy complication. After all the main aim is to bring a Shreyasi Praja to the society. In Ayurvedic texts, Garbhadhan has been explained in detail giving due consideration to the physiology of the female and male reproductive system thus they have clearly mentioned about the age of conception, time of conception, and also included the pshychological factors related to conception.
  98. 98. 98 Age of conception refers to the fertility period where there will be presence of optimum healthy sperm and ovum and based on modern lifestyle and culture the age of marriage is getting extended which has lead to preservation of ovum and sperm for future use of fertility. There are medicines used for ovulation induction and the use of which has its own complications and side effects. The assisted reproductive technologies are performed secondary to infertility. In patients with tubal factor infertility , IVF directly bypasses the fallopian tubes . In other infertility etiology's in which IVF is employed, include male factor infertility , diminished ovarian reserve, ovarian failure and ovulatory disfunction. Garbhadana vidhis helps in improving both male & female factors which can be a cause for non-conception. To purify the individual who is yet to be born, the parents of that individual are strengthened and blessed with the help of rituals of the Garbhadana Samsakara .
  99. 99. Conclusion 99 “Pregnancy Should Be By Choice, Not By Chance” This statement holds true for having a safe pregnancy and healthy progeny. Due to competitive life, the advance generation desire only one child and willing that their child should be physically, mentally & intellectually stronger than them. Following Garbhadana vidhi can provide global solution in several ways to achieve conception for those couples seeking for a healthy child. This ensures in preventing various problems related to mother & foetus. Also provide preventive approach & promotive health care for the couples.
  100. 100. Thank You 100