yes, fertility treatment be given the status of a human right .It appears logical that only after implantation the embryo can be called a person but if one can see the future where there is a possibility of artificial uterus then there will be no true implantation as we know today so again we may have to change the definition of start of life.Other point of view that embryo belongs to a specific couple who have contributed the gametes or have taken the gamete/s from donor and such couples have the same psychological bonding and binding as with a new born so the resultant embryoes has to be treated with the same diligence, care and respect.The embryo which has the potential to be human being also has the right to life, so should be considered as human being in making and its rights should be protected even before implantation.
Yes in my opinion not only for donors but also for surrogates, a fixed sum should be defined by the law .it will be helpful in delivering the deserved amount to the donors and surrogates and will curb the practice of a good share of money going in the pocket of middleman involved. Also for the patients there would be clarity and transparency in the whole system.
Yes a public opinion is always welcome .These days many patients in India are quite educated and well informed thanks to the technology of internet. These patient opinions should be sought on many issues like whether known surrogates from the family should be allowed or whether known donors from the family or friends should be allowed?
It is debatable, around 25 years is an optimal age according to us to know identity of donor, as he has achieved sufficient maturity & stability in life. But in consultation with a psychologist who can analyse mental status and maturity of person to understand entire process.
Yes, there should be a fixed minimum sum for donors. Donors could be inspired by high returns from this option without thinking about the sincerity and sensitivity of work. Donors should be mentally strong enough to understand their role in entire process and secrecy, which they need to maintain. It has become a money making business, so fixing the amount would make the process more transparent and prevent the agencies providing the donors from become more and more greedy. This will also prevent exploitation of poor women, who do this just for feeding their family.
Yes, in view of rising awareness and literacy rate, public opinion should be sought and opinion taken as to what our population feel regarding surrogacy and ART regulations. A clinician and an ART centre left on their own, can be biased regarding surrogacy and guided by money for deciding these matters.
My opinion here is, ethically it appears wrong but, legally and medically no problem as genetic parents are from different sources and of course no incest. When we are into third party reproduction lots of these issues are going to arise and circumstances and opinion of clinician may be deciding factor.
Yes, I see nothing wrong if a sister acts as a gestational surrogate for her brother. It would not be considered an incest because the sister is not a biological mother of her brother’s child. It is not a traditional surrogacy as in this case eggs have been provided by a third person, not by his sister. She would just be carrying the baby like an oven for a bun. What is wrong if Mr Solomon is both the father and the uncle of the little boy? When we have, without any doubt, accepted the fact that a woman’s sister or mother can act as a surrogate for her sister or daughter when commissioned, knowing very well that the relationships would get complicated then why are subjecting this case to scrutiny? The initial investigation of the police leading to the conclusion that no incest has been committed should not raise any further question. In my opinion seeking a further detailed investigation into the issue is useless.
Lesbians can get the insurance cover as infertility but it may be difficult for gays to get it as it is their sperm which is fertile is to be used in a woman.. Personally I think they should be covered under the insurance.
I would say yes. First of all there is no international consensus on health insurance coverage of ART.Only about 30 countries had some form of insurance coverage which always had a limit. Insurance companies generally cover treatment of iatrogenic conditions such as breast reconstruction after mastectomy for Cancer breast and wigs for alopecia after chemotherapy, but not for natural thinning of hair. Ideally fertility preservation should be treated as an aftermath of cancer treatment .
Many insurance companies do not cover infertility and fertility preservation treatment , the reasons being , infertility treatments are experimental, they are elective or boutique treatment and not a medical one. Even CGHS reimburses only part of the treatment of IVF, and fertility preservation not at all. But in some Onco institutes ( www.oncofertility.Northwestern.edu) Fertility preservation has been billed under primary diagnosis of cancer and a secondary diagnosis of procreative management and the patients have been reimbursed. I think this is ideal.
Should we have a regulation towards the number of embryos transferred? Personally I think there should be. There seem to have been a slow progress in regulating the number of embryos transferred in IVF .The ICMR guide lines allows 2 embryos normally and 3 if there are previous failures. Competition between clinics and the drive for success are potent obstruction to change.To prevent multiple births , one can do a blastocyst transfer, results are good. If the lab conditions are not optimal and if a day 2/3 transfer is planned, 2 may be transferred. The American guidelines says Age <35 single embryo, 35—38yrs 2 embryos, 38—40: 2-3 embryos and >40 4 or more. As embryo reduction is permitted according to ICMR guidelines, any number of embryos are transferred and later fetal reduction is done. If national registries are in place these figures can be obtained and the clinics can be regulated so that we can avoid multiple pregnancies and the resulting morbidity.
As we can foresee ,in the future we would be having registered ART egg banks functioning independently as per the ethical clauses applicable to the society and dictated by law. Only denuded, metaphase 2 oocytes would be frozen/vitrified, banked and latter distributed to ART clinics. ICSI is mandatory for frozen thaw oocyte cycles. In case fresh oocyte donation cycles are carried out, the maturity of the oocyte may be checked by the morphological scoring of the OCC but I still feel that due to limited number of oocytes available to the clinics ICSI should be performed.
Since the IVM is more of a research issue presently and wont be clinically applicable to or setups before next 10 years ,GV and M1 oocytes are to be rightfully discarded.
In Canada, laws and policies consistently reject the commodification of human organs and tissues, and Canadian practice is consistent with international standards in this regard. Until the Assisted Human Reproduction (AHR) Act of 2004, gamete donation in Canada was an exception: Canadians could pay and be paid open market rates for gametes (sperm and egg) for use in in vitro fertilization (IVF). As sections of the AHR Act forbidding payment for gametes (Section 6) and permitting only reimbursement of receipted expenses (Section 12) gradually came into effect in 2005, Canada did away with this anomaly. Medical practice and legal prohibitions in assisted human reproduction are now consistent with other areas of medicine where tissues and organs are taken from one person to benefit others: Altruistic donation, rather than selling and buying, will be the norm. The prohibition of payments for gametes introduced with the AHR Act places medical donation for IVF on a par with all other organ and tissue donation for a wide range of medical conditions. Because of the previous anomaly, however, the change has interrupted expectations: Patients who were able to pay to secure egg donations prior to 2004 are no longer able to do so, and the supply of donor sperm also is expected to fall dramatically over a period of time. As per ICMR guidelines chapter – V, sourcing, storage, handling and record keeping for gametes, embryos and surrogates, Para 26, subpara (6) An ART bank may advertise for gamete donors and surrogates, who may be compensated financially by the bank. This is an ideal recommendation and I feel that the gamete donation should be permitted but monitored by legal bodies. This will ensure regular availability of gametes for the needy and bring end to unscrupulous practices bringing smile in life of large number of patients.
I really feel egg sharing should not be done. The couple who has exhausted a good portion of their income and the female partner who has gone through multiple injections and monitoring should get the advantage of all her eggs. This is because each oocyte may not be mature and hence, may not fertilize. Once oocyte banks are available this system is not required.
Stringent laws are required with certain issues. For example, I am not in favor of surrogacy for international couples. We submit our female population, who are not affluent, at risk to our high maternal mortality rate. Here, regulations must be stringent. WHO, UNICEF, UNFPA and The World Bank : Analysis and interpretation of the 2010 estimates that:- Developing countries account for 99% (284 000) of the global maternal deaths. The majority of which are in sub-Saharan Africa (162 000) and Southern Asia (83 000). These two regions accounted for 85% of global burden, with sub-Saharan Africa alone accounting for 56%. The MMR in developing regions (240) was 15 times higher than in developed regions.
Embryo transfer with frozen embryos generated from self or donated oocytes after an interval which may range from few months to many years is a routine in ART practice. Similarly embryos derived from frozen self oocytes after an interval should be treated at par with any frozen embryo transfer. There is no question of considering these women as surrogates for embryos derived from their own genetic oocytes
The identity of sperm/egg donor should be kept anonymous, if the biological father also becomes the psychological parent it may lead to a lot of social trauma on the child
The ICMR guidelines do not allow sharing of personal identity of the donor whether sperm or egg to the recipient. However, the child born out of sperm / egg donation can know the genetic information without the name & address of the donor after the child attains 18 years of age. Thus at the time of signing of consent form by the sperm/ egg donor they should be informed in writing that the child born out of this procedure has the right to procure the information of the sperm/egg donor barring the name & address of the donor.
Yes, fertility treatment should be given the status of human right as every couple has the right to produce children. I would consider embryo a person from the stage of implantation
Yes, assess to genetic heritage should be considered a personal right but identity of the donor should be confidential otherwise no body will volunteer to be donor and may also harm the interest of the child as donor also may demand to know the identity of the baby with some ulterior motives,
yes , fertility treatment be given the status of a human right .It appears logical that only after implantation the embryo can be called a person but if one can see the future where there is a possibility of artificial uterus then there will be no true implantation as we know today so again we may have to change the definition of start of life.Other point of view that embryo belongs to a specific couple who have contributed the gametes or have taken the gamete/s from donor and such couples have the same psychological bonding and binding as with a new born so the resultant embryoes has to be treated with the same diligence, care and respect.The embryo which has the potential to be human being also has the right to life, so should be considered as human being in making and its rights should be protected even before implantation.
Dr Kuldeep Jain 
Dr Bharati Dhorepatil 
Dr Pankaj Talwar 
Dr Gita Radhakrishnan 
Dr Surveen Ghumman 
Dr Neena Malhotra 
Dr Umesh Jindal 
Dr Shweta Gupta 
Dr Rupali Bassi Goyal 
