Published on


Published in: Health & Medicine
  • Be the first to comment

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide


  1. 1. party reproduction beyond science-guidelines,ethics and law Is it a very muddy and dirty party ? Or is it ??? narendra malhotra jaideep malhotra www.malhotrahospitals.com acknowledgements for inputs and slidesnayna patel,kaberi banarjee,pc mahpatra,kd nayyar,rg patel,rajvi mehta and all the others involved in ART and 3rd party reproduction
  2. 2. Infertility – A Global Problem
  3. 3. normal need for reproduction One man ----One woman One sperm and one oocyte AND “THE STORK” AND THE SCIENTIFIC ROMANCE & THE MIRACLE OF LIFE
  4. 4. origin of reproductionSo, God created man in His own image, in the imageof 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 andSubdue it. (Genesis 1:27-28)
  5. 5. Rachel’s desperate plea to herhusband Jacob“Give me children or else I will die” Anguish orCry of female
  6. 6. Sarah & AbrahamSarah considered the problem and asked Abraham togo in unto my maid; it may be that I may obtainchildren by her. Abraham honoured Sarah’s requestand Hagar conceived Irresistible Desire to have Child
  7. 7. Human Reproduction – changed• 25th July, 1978• Louise Joy Brown• World’s First Successful Test Tube BabyLandmark Event in Reproductive Revolution Science Proves Wonders
  8. 8. Third-party reproduction Wikipedia• Third party reproduction refers to a process where another person provides sperm or eggs or where another woman provides her uterus so that a woman can have a child. Thus the reproductive process goes beyond the traditional father-mother model. However, the third partys involvement is limited to the reproductive process and does not extend into the raising of the child. One can separate:• Sperm donation. A third party provides sperm that can be used for insemination of the future mother or to fertilise an ovum for re-insertion of the resulting embryo into the mother, or by embryo transfer into a surrogate mother.• Ovum donation. An egg donor provides ova for fertilization in the IVF process. The embryo is placed into the uterus/womb of the future mother (embryo transfer).• Embryo donation, with unused embryos after the woman for whom they were originally created has successfully carried one or more pregnancies to term, or where embryos are specifically created for donation using donor eggs and donor sperm.• Gestational carrier. A woman carries a baby through the pregnancy for another person. This involves the use of IVF as the embryo is implanted by embryo transfer.Thus a child can have a genetic and social (non-genetic, non-biologic) father, and a genetic, gestational, and social (non-biologic) mother, and any combinations thereof.Theoretically a child thus could have 5 parents.
  9. 9. party reproduction & parenting how ?Oocyte donationSperm DonationEmbryo DonationIVF with gestational carrierTraditional surrogacyAdoptionOvarian Transplantation
  10. 10. with increasing age, the woman’s ovaries run out of eggs(limited ovarian reserve)The only option these women have for having a baby is egg donation –ivf…third party
  11. 11. there is also an increasing incidence of POF & DOR• For these women to concieve the only way out is to use donor eggs(third party)• Aged women• Oophrectomy cases• Cancer ovary and operated or irradiated• Premature ovarian failure(premature menopause)
  12. 12. there is an increasing incidence of non obstructive azospermia the only chance these couple have to have a baby is thru sperm donation……third party
  13. 13. some women have untreatable uterine abnormalityRKH,endom TB,hystrectomy, etc
  14. 14. the only chance of these couples to have babies is thru surrogacy…………third party
  15. 15. What is Egg Donation?• Egg donation is the part of third party reproduction.• Eggs are retrieved from a young woman ( < 33 yrs ) called the donor.• These eggs are then fertilized with the sperms of the recipient’s husband.• Resultant embryo is inserted into the uterus of the recipient.
  16. 16. OOCYTE DONATION Oocyte donation has been used for more than 20 years to help infertile couples become pregnant through IVF Oocyte from a donor are fertilized with male partner’s sperm & resulting embryos are transferred into the female partner’s uterus
  17. 17. oocyte donation:Indications Advanced Reproductive Age(attained Menopause) Hypergonadotropic hypogonadism Resistant Ovary Syndrome Ovarian Failure-------Malignancies, Surgical Castration,Premature Ovarian Failure Poor oocyte or embryo quality Recurrent IVF failure Recurrent pregnancy loss Genetic disorder (affected or carrier)
  18. 18. The Oocyte Donation Process The donor Donor recruitment: Who are the donors? Donor Screening: How are they tested? Donor matching: How do I pick a donor? The recipient couple Medical Screening : The Mock cycle Psychological issues Legal Issues Ethical concerns: Disclosure
  19. 19. classification of donorsThree Categories of Donors Anonymous Fertile donors Anonymous Infertile donors (shared cycles) Known donors Future: donor oocyte vitrificationPregnancy rates depend on who donates Anonymous Young (Fertile) donors Best Known donors often less fertile
  20. 20. donors IVF patients, willing to share their extra- oocytes OOCYTE SHARING PROGRAMME( COMMON ) Women with tubectomy, willing to be hyperstimulated ( MONETARY COMPENSATION) Known donors include family members who come forward to donate their oocytes ( FAMILY ) Professional donors, recruited after advertisement (MONETARY COMPENSATION) Volunteers , philanthropic enough to donate their oocytes (RARE BUT MAY FIND SUCH)
  21. 21. Matching Donors are matched as closely as possible with the recipient couple for characteristics, such as hair color, eye color, occupation Medical matching(bl.grp. And screened for other ds) Compensated for their time & effort Compensation remains the same no matter how many oocytes are retrieved
  22. 22. donor screening Suggested medical ,personal, family (genetic) & reproductive history Complete blood count with platelets Blood type Proper selection of donor.Thorough evaluation & treatment of Hepatitis screen VDRL recipient. Optimum dose of Gonadotrophins and proper HIV-1, HIV- 2 monitoring of donor.Avoid complications in egg donor. Cervical cultures for gonorrhoea and Chlamydia Pap smear Transvaginal ultrasound of pelvis Appropriate genetic tests
  23. 23. Preparation of the donor Donor preparation – Synchronize cycle with recipient & start with stimulation protocols either an antagonist -protocol or a long- protocol to yield several mature oocytes for fertilization
  24. 24. recipient screening Oocyte Recipient Male Partner CBC with Platelets  Blood Rh and type Blood Rh and type  Hepatitis Screen Serum Electrolytes, Liver &  VDRL Kidney function  HIV-1, HTLV-1 Sensitive TSH  Semen Analysis & Culture Rubella & Hepatitis Screen VDRL, HIV-1, HTLV-1 Urinalysis and Culture Cervical cultures for gonorrhea and Chlamydia Pap smear Transvaginal ultrasound Uterine Cavity evaluation (Sonohysterogram or HSG ) ECG, Chest X-ray, Mammogram GTT Cholestrol & Lipid Profile
  25. 25. algorithm oocyte donationRecipient evaluation(USG to monitor development of oocytes, blood tests to check E2 levels). ↓ Donor Recruitment ↓ Donor Screening ↓ Obtaining informed consent from recipient and donor ↓ Synchronization of donor and recipient cycles ↓ Prescription of hormones for the recipient ↓ Ovarian stimulation of donor ↓ Oocytes retrieval from donors ↓ Fertilization of oocytes ↓ Embryo Transfer ↓ Maintenance of pregnancy in recipient
  26. 26. Concerns & Complications• Ethical, legal, religious & social issues• Pre-embryo donation raises several unique issues,such as the status of pre-embryo & its well-being• Relationship between biological & social parents, &safeguarding of the interests of the offspring, may beresolved by specific legislation pertaining to eachcountry
  27. 27. concerns & complications Adequate study of the health risks of oocyte extraction, including long-term risks Medical costs for adverse effects caused by the procedure True informed consent from women who provide oocytes Exploitation of poor women No meaningful oversight
  28. 28. success rates Depends on: Age of the woman providing the oocytes & that of recipient Cause of the couples infertility Quality & Developmental stage of embryos when they are transfered Number of embryos transferred Each IVF treatment cycle using donated oocytes has a 55 % chance of success
  29. 29. Legality & telling the child• Egg donation is regulated and / or prohibited in many countries.• The egg recipient and the father of the child are the legal parents.• The father must pay child-support even if he claims a divorce before the delivery of the child.• Most egg donors express a strong desire not to be identified by the children.• ?? Should donor identity be revealed to the child resulting from egg donation once he/she reaches the age of 18 years.
  30. 30. Commodification“There exists some scaleinto which every valueinhering in a good can betranslated; . . . and thisscale is money.”“. . . Money is thesuperscale of value.”E. Richard Gold, Body Parts, p. 148.
  32. 32. SPERM DONATION• Artificial insemination using donor sperm has been practiced for over a century, although the first published reports about the practice were in 1945.• Over the past 10 years, the utilization of donor sperm has decreased as the utilization of intracytoplasmic sperm injection (ICSI) for the treatment of male• AIDS, artificial donor insemination has been performed exclusively with frozen and quarantined sperm.• Current FDA and ASRM guidelines recommend that sperm be quarantined for at least six months before being released for use
  33. 33. Indications for Sperm Donation• Currently, therapeutic donor insemination (DI or TDI) is appropriate when• the male partner has severe abnormalities in the semen parameters. (caused by a blockage of the ejaculatory ducts) and non-obstructive (due to testicular failure) azoospermia (absence of sperm), which may be congenital or acquired.• Examples of obstructive azoospermia include congenital absence of the vas deferens or previous vasectomy.• non-obstructive azoospermia include primary testicular failure or secondary testicular failure due to previous radiation or chemotherapy treatment. Severe oligospermia (decreased sperm count) or other significant• sperm or seminal fluid abnormalities are also indications for DI.• DI is also indicated if the male has ejaculatory dysfunction or if he is a carrier or affected with a significant genetic defect and would prefer not to pass this gene on to his children.• DI may be used if the female is Rh-sensitized and the male partner is Rh-positive.• DI is often used in the treatment for a single woman who desires a pregnancy but who lacks a male partner.
  34. 34. Selection of Sperm Donors• Sperm donors should be of legal age and ideally less than 40 years of age to minimize the potential hazards of aging.• Traditionally, donors have been anonymous; however, the donor may also be known or directed to the couple or single woman. The ASRM believes it is important that both anonymous donors and donors known to the recipient-though not necessarily intimate sexual partners-undergo the same initial and periodic screening and testing process.• However, the FDA only requires that anonymous sperm donors be screened for risk factors for and clinical evidence of communicable disease agents or diseases.
  35. 35. sperm donor• The donor will undergo a semen analysis and the sample will be thawed to evaluate post- freezing/thawing semen parameters.• Sperm susceptibility to damage with freezing varies between individuals, as well as between samples of a given donor. Donors are selected if the post-thaw semen parameters meet a minimum standard. In general, specimens should contain a minimum from 20 to 30 million motile sperm per milliliter after thawing. Post-thaw motility is generally in the range of 25% to 40%.
  36. 36. • In addition to the medical information that is obtained from the donor,• Donors are asked to provide detailed information about their personal habits, education,hobbies, and interests.• Sperm banks may provide pictures of the donor and video or audiotapes from the donor.• Donors may identify themselves as open to contact from any child conceived through DI once a child reaches legal age
  37. 37. embryo donations
  38. 38. EMBRYO DONATION• Embryo donation is a procedure that enables embryos either that were created by couples undergoing fertility treatment or that were created from donor sperm and donor eggs specifically for the purpose of donation to be transferred to infertile patients in order to achieve a pregnancy.• Indications for embryo donation include untreatable infertility that involves both partners, untreatable infertility in a single woman, recurrent pregnancy loss thought to be related to embryonic factors, and genetic disorders affecting one or both partners.
  39. 39. • The process of embryo donation requires that the recipient couple undergo the appropriate medical and psychological screening recommended for all gamete donor cycles.• In addition, the female partner undergoes an evaluation of her uterine cavity and then her endometrium is prepared with estrogen and progesterone in anticipation of an embryo transfer.
  40. 40. IVF with gestational carrier surrogacy
  41. 41. DEFINITIONS “Surrogacy”, means an arrangement in which a woman agrees to a pregnancy achieved through ART, in which neither of the gametes belong to her or her husband, with the intention to carry it to term and handover the child to the person or persons for whom she is acting as a surrogate. Although the treatment process is in it self straightforward, surrogacy has brought with it very complex ethical, legal and moral issues.
  42. 42. Steps in Surrogacy Proper patient selection Source of surrogate (ART bank) Proper selection & screening of the surrogate Intensive counselling – the key factor Synchronizing the cycles of the surrogate and the genetic mother Proper controlled ovarian stimulation and IVF technique Preparing the surrogate Window period for embryo transfer Taking care of the legalities and financial contracts Transparency of the whole arrangement
  43. 43. Indications Women with absence of uterus Women with hysterectomy for various reasons Women who suffer repeated miscarriages Repeated IVF failure – due to nonreceptive uterus Women with certain medical conditions – severe heart disease, kidney disease Women for whom the prospect of carrying a baby to term is very remote Single father GAY COUPLES..??? LESBIANS …???
  44. 44. CounsellingIn depth counseling of all partiesengaged in surrogacy arrangements is ofparamount importance and aims toprepare all parties contemplating thistreatment of last resort to consider allthe facts which will have an influence onthe future lives of each of them
  45. 45. Counselling for the couple A review of all alternative treatment options The practical difficulty and cost of treatment by gestational surrogacy The medical and psychological risks of surrogacy Potential psychological risk to the child The chances of having a multiple pregnancy The degree of involvement that the host may wish to have with the child The possibility that a child may be born with a handicap The possibility that the host may wish to retain the child after birth The importance of obtaining legal advice
  46. 46. Selection of SurrogateImproper selection of the surrogate can create problems at any stage of the procedureART – 2010 has defined the criterias for screening a surrogateIndian guidelines for ART ( pending for LAW)Surrogacy ,allowed in India but some “gray” areas
  47. 47. Counselling for the surrogate The full implications of undergoing treatment by IVF surrogacy The possibility of multiple pregnancy The possibility of her family and friends being against her having treatment The medical risks associated with pregnancy and delivery The implications of guilt on both sides if the host should spontaneously abort a pregnancy The possible effect on her own children of acting as a surrogate The possibility that the host may fell a sense of bereavement when she gives the baby to the commissioning couple
  48. 48. Screening for the surrogateA physical examination and pap smearInfective disease testingHysteroscopyA mock cyclePsyclogical testing and evaluation
  49. 49. Agreement /contract A legal agreement between a gestational carrier, her husband if married, and the intended parents, negotiated by an independent, separate legal counsel, is highly recommended. A gestational carrier contract should be as comprehensive as possible, setting forth for example, the parties intentions with respect to the parentage of the child, their financial arrangements, prenatal care, delivery plans, selective reduction, abortion, future contact among the parties, and cooperation on legal steps to establish parentage.
  50. 50. Signing the contract - ART 2010 Agreement of surrogacy Contract - Semen bank and surrogate - Surrogate and patient - Semen bank and ART clinic - Patient and Surrogate
  51. 51. International SurrogacyFraming international guidelines on thepractice of surrogacy is the challenge of theday. Legal advice and formal and honestcounseling to all the parties engaged in thesurrogacy contract with a clear agreement onthe terms of payment would be highlybeneficial in protecting surrogacy fromexploitation, avoiding legal, social, andpsychological complications and furtherpromoting the practice.
  52. 52. Costs for surrogacy The cost of the basic procedure are quite complex and must be discussed in detail with the patient. Over and above cost of IVF procedure and surrogate preparation cost, there can be – Ongoing psychologic counselling costs – Pregnancy complications cost – Maternal complications – Fetal complications as multiple pregnancy/ selective fetal reduction – Genetic amniocentesis if required – Medical complications
  53. 53. Problems in Surrogacy When problems arise in surrogacy it is usually because of a breakdown in communication or counselling Issues that need to be comprehensively addressed are • Medical process • Realistic expectations for all parties • Signing the contract • Potential complications • Financial and legal matters • Establishment of parameters of acceptable conduct by the parties.
  54. 54. Practical Problems ???What if – The surrogate is not traceable or refuses to hand over the child? – Anomalous baby born ? Down’s – Abortion or preterm delivery? – Contracts HIV during pregnancy? – Couple doesnot come to take the child? – Couples divorce ? – Death of comisioning parents ? – Country of commisiong parents does not allow baby to enter the country ? – If it is ED then genetically will not be a DNA match with parents ? More problems to take the baby to the counrty of commissioning parents – Death of the surrogate?
  55. 55. Realistic expectations for all Parties1. Transparency of the procedure2. Trust3. Commitment of all the people involved4. Respect for one another5. End result - healthy baby – healthy surrogate
  56. 56. Establishment of parameters of Acceptable conduct by the partiesAs a rule both the parties should meet one anotherCommunication between the two parties during the pregnancy of the surrogate should be allowedThere should be no exploitation of the surrogate or blackmailing of the couple at any stage.
  57. 57. Well being of the ChildThe best interest of the child must always bethe most important consideration in surrogacyagreements.
  58. 58. surrogacy The treatment process in itself is straightforward. The difficult aspects of the treatment concern the extreme care with which the surrogate host must be selected by the genetic couple to ensure complete compatibility and also the in-depth counseling that is required, both in the short and the long term, on all aspects of the treatment The support and advice of an independent counselor and lawyer are absolutely essential. Psychological screening and support prior to, during and following surrogacy is very important
  59. 59.  The success rates of surrogacy procedures are entirely dependent upon the overall success rates for the given ART facility At experienced centre, the process of IVF surrogate pregnancy has thus far been uncomplicated and gratifying None the less, all programs involved in this type of arrangement should adopt strict guidelines with direct evaluation and monitoring of all the procedures involved in the care of these patients for the best outcomes.
  60. 60. In the emerging world of baby-making, there’s a new player, formally called a “third party,” who can facilitate ways to conceive, or carry a pregnancy and give birth.DONOR SPERMDONOR EGGDONOR EMBRYOSURROGACY
  61. 61. When a third person—egg donor, sperm donor, or surrogate—becomes part of the baby-making processa couple’s relationship may require extra attention.
  62. 62. • Pre-treatment Counselling is a must - understanding of the ethical, moral and legal issues involved - • psychosocial, emotional and ethical complexitiesOur role is to assess whether they (patients) areready and knowledgeable psychosocially andemotionally about proceeding with treatment, be itIVF with their own gametes or using third partygametes.
  63. 63.  Recipient counselling for donor insemination Recipient counselling for oocyte donation The donor as patient: assessment and support Embryo donation: counselling donors and recipients Surrogacy-both legal and psychosocial scrutiny
  64. 64. The laws that currently exist area poorly constructed patchwork quilt,that can be confusing even to legal practitioners
  65. 65. Ethics - DefinitionCode of moral principles derived from asystem of values and beliefs that helps define the correctness of our actions.
  66. 66. Ethics & Medicine Hippocratic Oath Nightingale PledgeI will follow that system of regimen which according to my ability and judgment, I consider for the benefit of my patients and abstain from whatever is deleterious and mischievous
  67. 67. Ethics in Reproductive 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 ?
  68. 68. 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
  69. 69. • New possibilities also carry new challenges.• How to handle the fact that an “outsider” - an egg donor, sperm donor, or surrogate - has become part of what used to be a very private and personal process.• Another challenge may be to redefine ingrained ideas of how families are created, and what it means to be a family.
  70. 70. Psychological complications• Blame for the reproductive failing.• Emotional responses.• Social stigma and community ostracism.• Economic impoverishment.• Lifelong consequences (poverty in old age) .
  71. 71. Moral controversy• Infertility is not a life-threatening disease.• Is having children a basic necessity?• Is access to ARTs a reproductive right?• Ruins reputations.• Ruins marriages.• Ruins livelihoods.• Ruins mental health.• Ruins long-term security.
  72. 72. The unborn child• Instructing parents on how to handle disclosure issues to the children and kind of keeping an eye out for the child before it is conceived.• The fear is that knowledge of the actual genetic relationships among the participants could contribute to a profoundly altered view of identity and family relationships.
  73. 73. • New genetic relationships never before possible esp. with intra-familial donations.• The offspring’s genetic lineage becomes very confusing, further complicating the concept of the family. “His aunt is also his genetic mother.” ?????
  74. 74. Mr .Z - a man whodesperately wanted afamily, resisted the ideaof a sperm donor,believing this wouldmean that another mancould give his wife thebaby he could not.
  75. 75. • Couples who decide to use donor egg or sperm have to face the fact that only one of them will be a biological parent. This sticky issue may be a bit easier for women to deal with, especially if she is able to use a donor egg to carry the pregnancy herself, or use her own egg but have the pregnancy carried by a surrogate. In either of these cases the woman still has a physical connection to the pregnancy.. But when a couple uses donor sperm, the husband’s lack of a biological or physical link Can cause tension in the marriage, and sometimes even make it difficult for a new father to bond with his child.
  76. 76. • Mrs X ;35 year old, who recently spoke of her distress and feelings of being an “outsider” in the birth of her child. Her husband, a man 12 years older, desperately wanted a biological child . But Mrs X had undergone fertility treatments only to discover that she would not be able to conceive or carry a child, and the couple decided to use both a gestational carrier and a donor egg.• As she was awaiting the results of the carrier’s pregnancy test, she said, she felt as if she were waiting to see if she was about to become the babysitter for her husband’s child!
  77. 77. • Another woman, Mrs Y., was consumed with jealousy for the gestational carrier who was bearing her child. In spite of her biological connection with the baby - the embryo was created with her egg and her husband’s sperm - couldn’t silence her intense envy every time she accompanied the pregnant carrier to the doctor’s appointments and watched her own husband and the medical staff shower the carrier with attention.
  78. 78. COUNSELLING1.Your Feelings Are Normal The science may have gotten more complicated, but basically humans are still hardwired to accept a more traditional way of being a family. In making this transition, acknowledge that it’s natural to have a whole range of feelings.2.Grieve Your Link Part of adjusting to this new way of being a family is to say goodbye to the idea of what you hoped your family would be. Spend quiet time with your feelings, and think of meaningful ways to honour and express them.
  79. 79. COUNSELLING3.Talk To Your Spouse Rather than imagining that your spouse can read your mind, share what is true for you. Start off by setting ground rules that there are no feelings or concerns that are off bounds, and that you will commit to mutually addressing all concerns.
  80. 80. COUNSELLING4.Redefine Being a Parent• Be creative about ways to include both partners in every step of the pregnancy and birth process, regardless of the biological link.• For example, after Mr.Z,s’ wife became pregnant using a sperm donor, they decided that every evening they would “talk to the baby,” while he lay his hands on his wife’s belly to feel her move.• After Mrs.X shared her feelings of being left out with her husband, he made sure that she was front and center each time their Surrogate carrier had a doctor’s visit or a sonogram.
  81. 81. After the baby is born,many come to realize thatbiological or not, it is dailyparenting that creates andstrengthens the bond youhave with your child.
  82. 82. Take home message• Couples relationship is 1st priority.• Child to be born is 2nd priority.• If interogation of 3rd party is not acceptable even to one of the intending parents ,we should advice against it.• Adoption can be encouraged in such cases.• Include both partners equally in each step of pregnancy and birth process regardless of the biological link.
  83. 83. Take home message• Expert counselling to be included at every step.• With 3rd party helping in reproduction – aim has to be making a family and not breaking or weakening the relationship of intending parents.
  84. 84. Donated gametes and uterusIs commercialization justified ?
  85. 85. Known donor….why not?
  86. 86. Donor and Surrogate – same person? IUI or IVF ?
  87. 87. Child through third party reproduction….Should he/she know origin?
  88. 88. Human Reproduction – Future Reproductive Bazar Designer Babies Your Comments… ?
  89. 89. Homosexual Man Lesbians Single Partner Right to have babies ??? Bearing or Rearing ??? Legal & Moral Status ??? Production or Reproduction ???Changing Society – Changing Concept
  90. 90. First Gay couple to have a baby thru surrogate in India
  91. 91. ADDITIONAL FACTORS• India is emerging as a leader in international surrogacy• Surrogacy in India is low cost and legal environment is friendly• There was a need to increase international confidence in going in to India for surrogacy.• Manji case as set a landmark decision
  92. 92. HUMAN RIGHTS
  94. 94. 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
  95. 95. Why Surrogacy in India?• Indian surrogates very popular b/o-• Easy availability• Low cost• Price comes to roughly a Non demanding third of whatever is being• Indian clinics are becoming more competetive charged anywhere else in in pricing and retention and hiring of surrogates. the world
  96. 96. Across the border lawsLaws all over the world aredifferent, even different states inUS have different laws,.Difficult to keep trackTill the demand is there,providers are availableLets not forget the safe watersfor abortions and cloning
  97. 97. Surrogacy agreements• . Care has to be taken that the agreement does not violate any of the laws, which do not in ay way match with surrogacy. I would say that each agreement has to be carefully drafted carrying these very essential points:
  98. 98. IVF Tourism in India A Boon or a threat ?Why is India such a favourite destination for ART ?
  99. 99. What can be done ? The patients who are coming to India for IVF treatment are coming via internet and theirOur indian association of the clinic is not complete. knowledge about assisted reproduction (ISAR) isunderfirst of all of accrediting to be some sortbig leap So the process there has facilities, which is a oftowards improving the standard of care universally gradation /rating or information ISAR 2008 about the clinics which can be easily available for patients.
  100. 100. Surrogate mother has become a price• As it happened in the past in every society that any process /method when takes the shape of industry the sensitiveness goes for a toss.• In our case surrogate mother has become “nothing but the price”. Even if we are not able to restrict commercialization of the surrogate practice in India at least there has to be some resolve amongst the clinics to make it expensive or lesser accessible by standardizing the rates and will also compel everybody to think twice before taking a call on surrogacy and it will help clinics to invest in good training, infrastructure for these kind of treatments. Mr Srinivas marketing executive
  101. 101. Democratic IndiaIndia’s population and the democratic systemare quite slow, not only because of thecorruption but, also because the complexnature of our constitution, it will be unfair toexpect the Government to act very swiftly onany issue in our country. So the immediateresponsibility falls back on the society, on theDoctor/Clinics to implement the ethical policiesor moral values which they like to follows. Ashish Modi Ivf Equipment manufacturer and exporter
  102. 102. There always was an inflow of patients from neighbouring countries and West Asia ,but now significant numbers are coming from USA,UK and EUROPE Deloitte Health care researcher two year study
  103. 103. As the industry grows, raking in money,infertility specialists are making a quick buckby advising patients to opt for surrogacywithout weighing the pros and cons,regulations will take some time to beimplemented. Dr Anjali Malpani Infertility specialist(mumbai)
  104. 104. • Definitely a boon ! Provided :• 1. Carried out as per ICMR guidelines.• 2. Complete transparency in the process, especially financial transactions.• 3. Proper medicolegal safety for all parties concerned. Dr Manish Banker
  105. 105. It is a win ,win situation foreverybody, whether it is thepatients, doctors, society, city,or the country.Dr H.D.Pai (Mumbai) Dr Nayana Patel ( Anand)Dr Rama Raju (Vizag) Dr Kanthi Bansal (Ahmadabad) Dr Abha Majumdar (Delhi)
  106. 106. CONCLUSION• The options available through third party reproduction provide many couples• the opportunity to make their dream of parenthood a reality.• The comprehensive nature of the screening and counseling of intended parents and their donors or surrogates ensures that the process meets the needs of all involved.• Finally, as third party reproduction is more widely used, there continues to be a broader• understanding of the ethical, moral and legal issues involved.• The ultimate goal of physicians, mental health professionals, and attorneys specializing in• reproductive law is to enable this process to move forward as smoothly as possible and bring joy and satisfaction to all parties involved in ensuring the conception and delivery of a healthy child.
  107. 107. thanks for hearing me out on thisissue of 3rd party reproduction I hope this does not lead to this….. In a few years from now….
  109. 109. more to solve this controversy see you at BCGiP-COGI 15-18nov at DELHI27 hrs credit points by MCI