3RD PARTY REPORDUCTION

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 slides
nayna patel,kaberi banarjee,pc mahpatra,kd nayyar,rg patel,rajvi mehta
and all the others involved in ART and 3rd party reproduction

Infertility – A Global Problem

normal need for reproduction
One man ----One woman
One sperm and one oocyte
AND “THE STORK”

AND THE SCIENTIFIC ROMANCE
&
THE MIRACLE OF LIFE

origin of reproduction

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)

Rachel’s desperate plea to her
husband Jacob

“Give me children or else I will die”

Anguish or
Cry of female

Sarah & Abraham
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

Human Reproduction – changed

• 25th July, 1978
• Louise Joy Brown
• World’s First Successful Test Tube Baby

Landmark Event in Reproductive Revolution Science Proves Wonders

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 party's 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.

party reproduction & parenting how ?

Oocyte donation

Sperm Donation

Embryo Donation

IVF with gestational carrier

Traditional surrogacy

Adoption

Ovarian Transplantation

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

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)

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

some women have untreatable
uterine abnormality
RKH,endom TB,hystrectomy, etc

the only chance of these couples to
have babies is thru
surrogacy…………third party

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.

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

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)

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

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

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)

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

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

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

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

algorithm oocyte donation
Recipient 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

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 be
resolved by specific legislation pertaining to each
country

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

success rates
Depends on:
 Age of the woman providing the oocytes & that of recipient
 Cause of the couple's 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

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.

Commodification

“There exists some scale
into which every value
inhering in a good can be
translated; . . . and this
scale is money.”

“. . . Money is the
superscale of value.”

E. Richard Gold, Body Parts, p. 148.

donor sperm

SPERM BANKS
IN CHINA
FOR DONORS

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

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.

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.

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%.

• 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

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.

• 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.

IVF with gestational carrier
surrogacy

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.

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

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 …???

Counselling
In depth counseling of all parties
engaged in surrogacy arrangements is of
paramount importance and aims to
prepare all parties contemplating this
treatment of last resort to consider all
the facts which will have an influence on
the future lives of each of them

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

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

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

Screening for the surrogate
A physical examination and pap smear
Infective disease testing
Hysteroscopy
A mock cycle
Psyclogical testing and evaluation

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.

Signing the contract - ART 2010

 Agreement of surrogacy
 Contract - Semen bank and surrogate
- Surrogate and patient
- Semen bank and ART clinic
- Patient and Surrogate

International Surrogacy
Framing international guidelines on the
practice of surrogacy is the challenge of the
day. Legal advice and formal and honest
counseling to all the parties engaged in the
surrogacy contract with a clear agreement on
the terms of payment would be highly
beneficial in protecting surrogacy from
exploitation, avoiding legal, social, and
psychological complications and further
promoting the practice.

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

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.

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?

Realistic expectations for all Parties

1. Transparency of the procedure
2. Trust
3. Commitment of all the people
involved
4. Respect for one another
5. End result - healthy baby – healthy
surrogate

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.

Well being of the Child
The best interest of the child must always be
the most important consideration in surrogacy
agreements.

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

 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.

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 SPERM
DONOR EGG
DONOR EMBRYO
SURROGACY

When a third person—egg donor, sperm donor, or
surrogate—becomes part of the baby-making
process
a couple’s relationship may require extra attention.

• Pre-treatment Counselling is a
must
- understanding of the ethical,
moral and legal issues involved
-
• psychosocial, emotional and
ethical complexities

Our role is to assess whether they (patients) are
ready and knowledgeable psychosocially and
emotionally about proceeding with treatment, be it
IVF with their own gametes or using third party
gametes.

 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

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

Ethics - Definition

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

Ethics & Medicine

Hippocratic Oath
Nightingale Pledge

I 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

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 ?

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

• 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.

Psychological complications
• Blame for the reproductive
failing.
• Emotional responses.
• Social stigma and
community ostracism.
• Economic
impoverishment.
• Lifelong consequences
(poverty in old age) .

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.

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.

• 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.” ?????

Mr .Z - a man who
desperately wanted a
family, resisted the idea
of a sperm donor,
believing this would
mean that another man
could give his wife the
baby he could not.

• 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.

• 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!

• 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.

COUNSELLING
1.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.

COUNSELLING
3.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.

COUNSELLING
4.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.

After the baby is born,
many come to realize that
biological or not, it is daily
parenting that creates and
strengthens the bond you
have with your child.

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.

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.

Donated gametes and uterus

Is commercialization justified ?

Donor and Surrogate –
same person?

IUI or IVF ?

Child through third party
reproduction….

Should he/she know origin?

Human Reproduction – Future

Reproductive Bazar

Designer Babies

Your Comments… ?

Homosexual Man
Lesbians
Single Partner

Right to have babies ???
Bearing or Rearing ???
Legal & Moral Status ???
Production or Reproduction ???

Changing Society – Changing Concept

First Gay couple to have a baby thru
surrogate in India

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

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

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

Across the border 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

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:

IVF Tourism in India
A Boon or a threat ?

Why is India such a favourite destination
for ART ?

What can be done ?
The patients who are coming to India for IVF
treatment are coming via internet and their
Our indian association of the clinic is not complete.
knowledge about assisted reproduction (ISAR) is
underfirst of all of accrediting to be some sortbig leap
So the process there has facilities, which is a of
towards improving the standard of care universally
gradation /rating or information ISAR 2008 about the
clinics which can be easily available for
patients.

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

Democratic India
India’s population and the democratic system
are quite slow, not only because of the
corruption but, also because the complex
nature of our constitution, it will be unfair to
expect the Government to act very swiftly on
any issue in our country. So the immediate
responsibility falls back on the society, on the
Doctor/Clinics to implement the ethical policies
or moral values which they like to follows.
Ashish Modi
Ivf Equipment manufacturer and exporter

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

As the industry grows, raking in money,
infertility specialists are making a quick buck
by advising patients to opt for surrogacy
without weighing the pros and cons,
regulations will take some time to be
implemented.
Dr Anjali Malpani
Infertility specialist(mumbai)

• 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

It is a win ,win situation for
everybody, whether it is the
patients, 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)

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.

thanks for hearing me out on this
issue of 3rd party reproduction I hope
this does not lead to this….. In a few
years from now….

OUR FIRST SURROGATE BIRTHS FOR
AN AMERICAN COUPLE

more to solve this
controversy see you at
BCGiP-COGI 15-18nov at
DELHI

27 hrs credit points by MCI

3RD PARTY REPORDUCTION

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