Third party reproduction ppt by Dr.Gayathiri

THIRD PARTY REPRODUCTION
Dr. Gayathiri Ganesan Ram
MS(O.G), Fellow in Reproductive Medicine and
Andrology.
Consultant Reproductive Medicine Specialist
ARC Fertility Hospitals.
Third party reproduction ppt by Dr.Gayathiri
OOCYTE DONATION
• Feasible only after introduction of IVF.
• Widely used modality for infertility .
USES
• Provides unique oppurtunity for the study and
understanding of the steroid replacement
parameters necessary to induce uterine
receptivity, the synchronisation of embryo
development with uterine receptivity prior to
implanatation and the endocrinology of
pregnancy in the absence of ovarian function
• Affords a scientific oppurtunity to study the
unique biologic participation of the uterus in
the process of human embryo implantation.
Third party reproduction ppt by Dr.Gayathiri
Third party reproduction ppt by Dr.Gayathiri
Third party reproduction ppt by Dr.Gayathiri
SOURCE OF DONORS
• Known donors – recruited by couples.
• Anonymous donors
REQUIREMENT FOR AN OOCYTE
DONOR (ICMR 2010)
• The individual must be free from HIV and Hep
B and C infections, hypertensions, diabetes,
STDs, and identifiable and common disorders
such as Thalassemia.
• The blood gp and Rh status of the individual
must be determined and placed on record.
The blood group and the Rh status of the
individual must be determined and placed on
record.
• 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.
• Age group 21 to 35 years.
Third party reproduction ppt by Dr.Gayathiri
Third party reproduction ppt by Dr.Gayathiri
Success of oocyte donation
• Donor’s age – primary contributor of IVF
outcome.
• Recipient age is inversely propotionate to
success. (Boroni et al 1996)
• Endometrial thickness and pattern.
• Quality of embryo transferred and recipient
midcycle ET.
High pregnancy rates in Ovum
donation programs
• Lack of endometrial hyperstimulation.
• No risk of hyperoestrogenism.
• No premature lutenization.
• Better control of window of receptivity.
PRINCIPLES
• Preparation of recipient endometrium.
• Window of embryo transfer.
• Early pregnancy management with exogenous
hormones.
HRT
• Estradiol valerate and progesterone.
• Oral form better than transdermal patch.
WINDOW OF EMBRYO TRANSFER
• Window for a 2 day embryo from days 17 to
19 of an ideal 28 day cycle or 3 to 5 days after
P4 administration.
• Variable.
PREGNANCIES IN OOCYTE
RECIPIENT
• Exogenous estrogens and progesterones.
Third party reproduction ppt by Dr.Gayathiri
Third party reproduction ppt by Dr.Gayathiri
RESULTS OF DONOR OOCYTE
PROGRAMES
• Pregnancy rates of donor oocyte proceedures
are equal to or possibly higher than routine
IVF programes.
• Transfer of fresh embryos has a higher
pregnancy rate than that of frozen thawed.
• The age of the donor is an important factor.
• The age of recipient is not significant since any
decrease in endometrial lining can be
achieved with HRT.
Third party reproduction ppt by Dr.Gayathiri
Third party reproduction ppt by Dr.Gayathiri
Third party reproduction ppt by Dr.Gayathiri
Third party reproduction ppt by Dr.Gayathiri
Third party reproduction ppt by Dr.Gayathiri
Third party reproduction ppt by Dr.Gayathiri
Third party reproduction ppt by Dr.Gayathiri
Third party reproduction ppt by Dr.Gayathiri
REQUIREMENT OF SPERM DONOR
(ICMR 2010)
• 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.
• The age of the donor must not be below 21 or
above 45 years.
• An analysis must be carried out on the semen
of the individual, preferably using a semen
analyzer, and the semen must be found to be
normal according to WHO method manual for
semen analysis, if intended to be used for ART.
• The blood group and the Rh status of the
individual must be determined and placed on
record.
• 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.
Third party reproduction ppt by Dr.Gayathiri
• Cryopreservation of excess embryos is widely
used.
• Success rate of embryo donation depends on
viability of donated embryo.
RECENT ADVANCES
• As fertility increases and gamete donation
decrease, an alternate source of sex cells may
prove valuable.
• Mouse embyronic cells (ES) can differentiate
into sperms.
• Human ES cells can differentiate into germ
cells in culture.
RIGHTS OF A CHILD BORN THROUGH
VARIOUS ART TECHNOLOGIES
• A child born through ART shall be presumed to
be the legitimate child of the couple, having
been born in wedlock and with the consent of
both the spouses. Therefore, the child shall
have a legal right to parental support,
inheritance, and all other privileges of a child
born to a couple through sexual intercourse.
• Children born through the use of donor gametes,
and their “adopted” parents shall have a right to
available medical or genetic information about
the genetic parents that may be relevant to the
child’s health.
• Children born through the use of donor gametes
shall not have any right whatsoever to know the
identity (such as name, address, parentage, etc.)
of their genetic parent(s). A child thus born will,
however, be provided all other information
• about the donor as and when desired by the
child, when the child becomes an adult. While
the couple will not be obliged to provide the
above “other” information to the child on
their own, no deliberate attempt will be made
by the couple or others concerned to hide this
information from the child as and when asked
for by the child.
• In the case of a divorce during the gestation
period, if the offspring is of a donor
programme – be it sperm or ova – the law of
the land as pertaining to a normal conception
would apply.
LEGAL ISSUES
• Legitimacy of the child born through ART- A
child born through ART shall be presumed to
be the legitimate child of the couple, born
within wedlock, with consent of both the
spouses, and with all the attendant rights of
parentage, support and inheritance.
Sperm/oocyte donors shall have no parental
right or duties in relation to the child, and
their anonymity shall be protected except in
regard to what is mentioned under item
• Rights of an unmarried woman to AID -There is
no legal bar on an unmarried woman going for
AID. A child born to a single woman through AID
would be deemed to be legitimate. However, AID
should normally be performed only on a married
woman and that, too, with the written consent of
her husband, as a two-parent family would be
always better for the child than a single parent
one, and the child’s interests must outweigh all
other interests.
• Adultery in the case of ART - ART used for
married woman with the consent of the
husband does not amount to adultery on part
of the wife or the donor. AID without the
husband’s consent can, however, be a ground
for divorce or judicial separation.
Third party reproduction ppt by Dr.Gayathiri
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Third party reproduction ppt by Dr.Gayathiri

  • 1. THIRD PARTY REPRODUCTION Dr. Gayathiri Ganesan Ram MS(O.G), Fellow in Reproductive Medicine and Andrology. Consultant Reproductive Medicine Specialist ARC Fertility Hospitals.
  • 3. OOCYTE DONATION • Feasible only after introduction of IVF. • Widely used modality for infertility .
  • 4. USES • Provides unique oppurtunity for the study and understanding of the steroid replacement parameters necessary to induce uterine receptivity, the synchronisation of embryo development with uterine receptivity prior to implanatation and the endocrinology of pregnancy in the absence of ovarian function
  • 5. • Affords a scientific oppurtunity to study the unique biologic participation of the uterus in the process of human embryo implantation.
  • 9. SOURCE OF DONORS • Known donors – recruited by couples. • Anonymous donors
  • 10. REQUIREMENT FOR AN OOCYTE DONOR (ICMR 2010) • The individual must be free from HIV and Hep B and C infections, hypertensions, diabetes, STDs, and identifiable and common disorders such as Thalassemia. • The blood gp and Rh status of the individual must be determined and placed on record. The blood group and the Rh status of the individual must be determined and placed on record.
  • 11. • 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. • Age group 21 to 35 years.
  • 14. Success of oocyte donation • Donor’s age – primary contributor of IVF outcome. • Recipient age is inversely propotionate to success. (Boroni et al 1996) • Endometrial thickness and pattern. • Quality of embryo transferred and recipient midcycle ET.
  • 15. High pregnancy rates in Ovum donation programs • Lack of endometrial hyperstimulation. • No risk of hyperoestrogenism. • No premature lutenization. • Better control of window of receptivity.
  • 16. PRINCIPLES • Preparation of recipient endometrium. • Window of embryo transfer. • Early pregnancy management with exogenous hormones.
  • 17. HRT • Estradiol valerate and progesterone. • Oral form better than transdermal patch.
  • 18. WINDOW OF EMBRYO TRANSFER • Window for a 2 day embryo from days 17 to 19 of an ideal 28 day cycle or 3 to 5 days after P4 administration. • Variable.
  • 19. PREGNANCIES IN OOCYTE RECIPIENT • Exogenous estrogens and progesterones.
  • 22. RESULTS OF DONOR OOCYTE PROGRAMES • Pregnancy rates of donor oocyte proceedures are equal to or possibly higher than routine IVF programes. • Transfer of fresh embryos has a higher pregnancy rate than that of frozen thawed. • The age of the donor is an important factor. • The age of recipient is not significant since any decrease in endometrial lining can be achieved with HRT.
  • 31. REQUIREMENT OF SPERM DONOR (ICMR 2010) • 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. • The age of the donor must not be below 21 or above 45 years.
  • 32. • An analysis must be carried out on the semen of the individual, preferably using a semen analyzer, and the semen must be found to be normal according to WHO method manual for semen analysis, if intended to be used for ART.
  • 33. • The blood group and the Rh status of the individual must be determined and placed on record. • 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.
  • 35. • Cryopreservation of excess embryos is widely used. • Success rate of embryo donation depends on viability of donated embryo.
  • 36. RECENT ADVANCES • As fertility increases and gamete donation decrease, an alternate source of sex cells may prove valuable. • Mouse embyronic cells (ES) can differentiate into sperms. • Human ES cells can differentiate into germ cells in culture.
  • 37. RIGHTS OF A CHILD BORN THROUGH VARIOUS ART TECHNOLOGIES • A child born through ART shall be presumed to be the legitimate child of the couple, having been born in wedlock and with the consent of both the spouses. Therefore, the child shall have a legal right to parental support, inheritance, and all other privileges of a child born to a couple through sexual intercourse.
  • 38. • Children born through the use of donor gametes, and their “adopted” parents shall have a right to available medical or genetic information about the genetic parents that may be relevant to the child’s health. • Children born through the use of donor gametes shall not have any right whatsoever to know the identity (such as name, address, parentage, etc.) of their genetic parent(s). A child thus born will, however, be provided all other information
  • 39. • about the donor as and when desired by the child, when the child becomes an adult. While the couple will not be obliged to provide the above “other” information to the child on their own, no deliberate attempt will be made by the couple or others concerned to hide this information from the child as and when asked for by the child.
  • 40. • In the case of a divorce during the gestation period, if the offspring is of a donor programme – be it sperm or ova – the law of the land as pertaining to a normal conception would apply.
  • 41. LEGAL ISSUES • Legitimacy of the child born through ART- A child born through ART shall be presumed to be the legitimate child of the couple, born within wedlock, with consent of both the spouses, and with all the attendant rights of parentage, support and inheritance. Sperm/oocyte donors shall have no parental right or duties in relation to the child, and their anonymity shall be protected except in regard to what is mentioned under item
  • 42. • Rights of an unmarried woman to AID -There is no legal bar on an unmarried woman going for AID. A child born to a single woman through AID would be deemed to be legitimate. However, AID should normally be performed only on a married woman and that, too, with the written consent of her husband, as a two-parent family would be always better for the child than a single parent one, and the child’s interests must outweigh all other interests.
  • 43. • Adultery in the case of ART - ART used for married woman with the consent of the husband does not amount to adultery on part of the wife or the donor. AID without the husband’s consent can, however, be a ground for divorce or judicial separation.