ARTIFICIAL MEANS OF REPRODUCTION

Introduction:

Definition:It encompasses all techniques that attempt to obtain pregnancy by manipulating the sperm or/and oocyte outside the body & transferring the gametes or embryo into the uterus.

Artificial Insemination• Artificial Insemination is the deposition

of semen into the vagina, cervix or uterus by instruments to bring about pregnancy; which is not attained or attainable by sexual intercourse.

Types of AI1. AIH (Artificial Insemination Homologous)

semen of the husband is used2. AID (Artificial Insemination Donor)

semen from some other donor male is used3. AIHD (Artificial Insemination Homologous

Donor)mixture of husband’s semen as well as that of a donor (Pooled Semen) is used.

Procedure of AI• One week abstinence by male• Collection of semen by male after

masturbation• Deposition of 1 ml semen by a sterile

syringe at the level of Internal Os at the time of ovulation of wife

Indication of AI1. Husband is impotent but fertile2. Husband is sterile3. Rh incompatibility between husband

and wife4. Husband suffering from some serious

hereditary disease

MLI OF AI1. Litigation against the doctor:

if a defective child is born. (screen for chromosomal anomalies)

2. Adultery (Section 497 IPC):donor not guilty.

3. Legitimacy:child is illegitimate (has to be legally adopted)

4. Nullity of marriage and divorce:impotency – yes. Sterility – no.

• Legal Problems: A) Adultery B) Legitimacy C) Nullity of marriage & divorce D) Natural birth E) Unmarried women or widow F) Incest

•Complications:• The Delhi Artificial Insemination(Human) bill, 1995:• ARTs: ICMR guidelines• Test tube babies (IVF):• Surrogate Motherhood:• Cloning

ART Procedures:1. Artificial Insemination2. Intrauterine Insemination3. In Vitro Fertilization (IVF) & Embryo Transfer (ET)4. IVF associated Techniques a) Gamete Intrafallopian Tube Transfer (GIFT) b) Tubal Embryo Transfer (TET)5. Intracytoplasmic sperm Injection (ICSI)6. Oocyte donation or Embryo donation

ARTIFICIAL INSEMINATION:

Definition:A procedure of transferring semen into the reproductive system of a woman other than coitus.

• Types:A) AIHB) AIDC) AIHD

Indications:A) AIH: 1. Husband – Impotent, but fertile. 2. Husband unable to deposit semen in vagina due to malformations e.g. hypospediasis.

B) AID: 1. Husband- sterile 2. Husband – with hereditary genetic defect 3. Rh-Incompability 4. The woman is iso-immunized & BOH. 5. Husband – Oligospermia, but can’t afford other sophisticated ARTs.

Procedure of AI• One week abstinence by male• Collection of semen by male after

masturbation• Deposition of 1 ml semen by a sterile

syringe at the level of Internal Os at the time of ovulation of wife

Guiding Principles:A) Consent: All concerned parties i.e. Husband & Wife (Recipient & Donor)B) ConfidentialityC) Donor related- 1. Age < 40 years 2. No relation with recipient 3. Should have children of his own 4. Should be potent & fertile. 5. Healthy- Physically & mentally Free from STDs & hereditary diseases. 6. Physical resemblance with husband of recipient as possible. D) Recipient couple – Counselling E) Witness F) Pooled semen G) Physician related.

Medico-legal Implications:AIH does not raise ML issues.A) Adultery B) Legitimacy C) Nullity of marriage & divorce D) Natural birth E) Unmarried women or widow F) Incest G) Litigation against doctor

Laws regulating AI:1. ICMR guidelines2. The Delhi Artificial Insemination (Human) Act – 1995 - No chromosomal segregation.

Semen Banking:As per ICMR guidelines:1. Donor – Free from HIV, Hepatitis B & C, DM, HTN, STDs, & common genetic disorders.2. Age- 21-45 years3. Blood grouping & Rh typing4. Record – at least 10 years5. Semen must be cryopreserved for at least 6 months before first use.6. Again at the time of first use donor checked for HIV, Heptitis B & C.

ICMR Guidelines for ART:1. Use of gametes and embryos: No more than three oocytes or embryos.2. Single woman recipients allowed.3. Minimum age for ART in a woman shall be 20 years. 4. 20-30 years5. > 30 years.

Posthumous Reproduction:Semen preserved & used after death of husband.Semen retrieval can be done after death of husband.First such case in 1998.Involves many medico legal, ethical & social issues.

Surrogate Birth & Surrogate Motherhood:Surrogacy is an arrangement in which a woman agrees to carry a pregnancy that is genetically unrelated to her or her husband, with an intention to carry it to term & hand over the child to the genetic parents.

Two types:1. Ovum & sperm of couple is fertilized in vitro & embryo implanted in surrogate mother.

2. Sperm of husband utilized & the surrogate female donates her oocyte.

ICMR guidelines on Surrogacy: General Considerations 1 A child born through surrogacy must be adopted2 Surrogacy by assisted conception should normally be considered only for patients whom it would be physically or medically impossible to carry a baby to term . 3 Payments to surrogate mothers 4 Advertisements5 A surrogate mother should not be over 45 years of age. 6 A relative, a known person 7 HIV8 No woman may act as a surrogate more then thrice in her lifetime.

Medico legal Issues:1. Legitimacy2. Name of mother3. Commercial transaction4. revoking of contract.

Important Cases:1. In 2008, SC gave permission for commercial surrogacy.2. Jan Balaz3. Manji Yamada4. Israeli gay couple

The Assisted Reproductive Technology (Regulation) Bill, 20141. Insurance for surrogate mother2. Single parent not allowed

Stem Cell Research:Stem cells are the tissue precursor cells that have the ability to self renew & differentiate into more specific adult cells required by body.

Sources of stem cells:1. Embryonic stem cells2. Umbilical cord stem cells3. Adult stem cells

Uses of Stem cells:1. Reproductive cloning2. replacement of diseased tissue

Indian perspective:1. Embryos -Restricted to first 14 days & with consent of the owner.2. No commercial transaction3. Sale or transfer of ebmryos outside country not allowed.

Cloning:Creation of an organism that is exact genetic copy of a life form.

Types:1. Reproductive2. Therapeutic

ML Issues related with stem cell research & cloning:1. Ethical2. As per law, destruction of embryo (up to 14 days) not crime.3. UNO banned human cloning.4. Exploitation of women.