Assignment ON

INVITRO
FERTILIZATION

SUBMITTED TO: SUBMITTED BY:

MRS.R.BHARATHI PRIYA,M.SC(N),PGDE G.KANIMOZHI,M.SC(N)2 ND YEAR,

HOD OF OBG DEPAARTMENT, OUR LADY OF HEALTH COLLEGE

OUR LADY OF HEALTH COLLEGE OF NURSING OF NURSING,

THANJAVUR. THANJAVUR.

INTRODUCTION  Medically assisted human reproductive technologies are a group of high tech
treatment methods used to combat infertility.  One of the greatest advances in reproductive medicine 
Techniques include  Intrauterine Insemination (IUI)  In Vitro Fertilization and Embryo transfer (IVF –
ET)  Gametic Intra-Fallopian Transfer (GIFT)  Zygotic Intra-Fallopian Transfer (ZIFT)  Tubal
embryo stage transfer (TET)  Intracytoplasmic sperm injection (ICSI)

CAUSES OF INFERTILITY  In males  Oligospermia – reduced conc. of sperm in semen. 

Azoospermia – Total lack or very low conc. of motile sperm  In females  Tubal infertility – non
functional fallopian tube  Non functional ovaries  Non functional uterus  Endometriosis -
Endometrial-like cells in areas outside the uterus  Idiopathic infertility – reason unknown.

IN VITRO FERTILIZATION The technique for conception of a human embryo outside the human
body. In Vitro Fertilization (IVF) is a procedure that offers hope to couples who otherwise are unable to
conceive. This process is important to infertile couples because it gives them another chance of
conceiving a child. In order for normal pregnancy to occur, an egg is released from an ovary and unites
with a sperm in a fallopian tube. However, during the process of IVF, this union occurs in a laboratory
after both eggs and sperm have been collected. The fertilized egg is then transferred into the uterus to
continue growth. Tens of thousands of healthy children born into this world are the results of IVF.
Nevertheless, it is important for anyone considering IVF to fully understand the process as well as its
limitations. The process involves hormonally controlling the ovulatory process, removing ova (eggs) from
the woman's (ovaries) and letting sperm fertilise them in a fluid medium. The fertilised egg (zygote) is
then transferred to the patient's uterus with the intent to establish a successful pregnancy In-vitro
fertilization (IVF) is artificially performed fertilization outside the woman's body i.e. ‘in test tube’. This
procedure involves extraction of a number of eggs from the woman’s ovaries and to do this, she is given a
drug that enables her to superovulate or to produce more eggs in one cycle than she normally does. The
eggs are than surgically removed and fertilized outside the body in the laboratory normally with the
sperm of the husband but it may be done with sperm from donor.

 In vitro fertilization (IVF) is a process of fertilization where an egg is combined with sperm outside the
body, in vitro ("in glass").  IVF is a type of assisted reproductive technology used for infertility
treatment and gestational surrogacy.  In Short, In vitro fertilization (IVF) helps with fertilization,
embryo development, and implantation, so it’s possible to reproduce a baby by this method.  A term
generally used for the babies born by this method is TEST TUBE BABY

INTRA UTERINE INSEMINATION (IUI)  Women (with adequate ovulation & below 40yrs) without
damage to fallopian tube can be treated with IUI.  Women superovulated by gonadotrophins – multiple
egg dev.  IUI is timed to coincide with ovulation  Using a thin soft catheter, sperms are placed either in
the cervix or in the utrine cavity.

ADVANTAGES  This procedure can be an effective solution for men with a low sperm count or poor
sperm motility, where the sperm can't make the long journey to the egg.  Low cost compared to other
ART .

DISADVANTAGES  Timing in the process of insemination is important.  Low success rate, results
are only 10-20 %  Fallopian tubes must be unobstructed
DEFINITION:

In vitro fertilization (IVF) is a type of assistive reproductive technology (ART). It involves retrieving
eggs from a woman’s ovaries and fertilizing them with sperm. This fertilized egg is known as an embryo.
The embryo can then be frozen for storage or transferred to a woman’s uterus.

Depending on situation, IVF can use:

 eggs and partner’s sperm

eggs and donor sperm

 donor eggs and partner’s sperm

 donor eggs and donor sperm

 donated embryos

doctor can also implant embryos in a surrogate, or gestational carrier. The success rate of IVF varies.
According to the American Pregnancy Association, the live birth rate for women under age 35
undergoing IVF is 41 to 43 percent. This rate falls to 13 to 18 percent for women over the age of 40.

REASON IN VITRO FERTILIZATION PERFORMED

IVF helps people with infertility who want to have a baby. IVF is expensive and invasive, so couples
often try other fertility treatments first. These may include taking fertility drugs or having intrauterine
insemination. During that procedure, a doctor transfers sperm directly into a woman’s uterus.

Infertility issues for which IVF may be necessary include:

 reduced fertility in women over the age of 40

 blocked or damaged fallopian tubes

 reduced ovarian function

 endometriosis

 uterine fibroids

 male infertility, such as low sperm count or abnormalities in sperm shape

 unexplained infertility

Parents may also choose IVF if they run the risk of passing a genetic disorder on to their offspring. A
medical lab can test the embryos for genetic abnormalities. Then, a doctor only implants embryos without
genetic defects.

How Do I Prepare for In Vitro Fertilization?

Before beginning IVF, women will first undergo ovarian reserve testing. This involves taking a blood
sample and testing it for the level of follicle stimulating hormone (FSH). The results of this test will give
doctor information about the size and quality of eggs.

doctor will also examine , uterus. This may involve doing an ultrasound, which uses high-frequency
sound waves to create an image of , uterus. doctor may also insert a scope through vagina and into
uterus. These tests can reveal the health of uterus and help the doctor determine the best way to implant
the embryos.

Men will need to have sperm testing. This involves giving a semen sample, which a lab will analyze for
the number, size, and shape of the sperm. If the sperm are weak or damaged, a procedure called
intracytoplasmic sperm injection (ICSI) may be necessary. During ICSI, a technician injects sperm
directly into the egg. ICSI can be part of the IVF process.

Choosing to have IVF is a very personal decision. There are a number of factors to consider.

 What will , do with any unused embryos?

 How many embryos do , wish to transfer? The more embryos transferred, the higher the risk of a
multiple pregnancy. Most doctors won’t transfer more than two embryos.

 How do , feel about the possibility of having twins, triplets, or a higher order multiple pregnancy?

 What about the legal and emotional issues associated with using donated eggs, sperm, and
embryos or a surrogate?

 What are the financial, physical, and emotional stresses associated with IVF?

Complications Associated with In Vitro Fertilization

As with any medical procedure, there are risks associated with IVF. Complications include:

 multiple pregnancies, which increases the risk of low birth weight and premature birth

 miscarriage (pregnancy loss)

 ectopic pregnancy (when the eggs implant outside the uterus)

 ovarian hyperstimulation syndrome (OHSS), a rare condition involving an excess of fluid in the
abdomen and chest

 bleeding, infection, or damage to the bowels or bladder (rare)

 Long-Term Outlook

Deciding whether to undergo in vitro fertilization, and how to try if the first attempt is unsuccessful, is an
incredibly complicated decision. The financial, physical, and emotional toll of this process can be
difficult. Speak with ,r doctor extensively to determine what ,r best options are and if in vitro fertilization
is the right path for , and ,r family. Seek a support group or counselor to help , and ,r partner through this
process.
 

HISTORY OF IVF  The very first in vitro manipulation of eggs/embryos was performed by Walter
Haepe in 1890 , he transferred embryo of one rabbit to other rabbit.  In 1959 M.C. Chang successfully
conducted IVF in Rabbits.  In February 1969 R.G.Edward and collegues published a paper in NATURE
named IN Vitro Fertilization of Human oocyte mature in vitro.  In 1977 the first Human IVF pregnancy
and Birth of Louise Brown.

INDIAN HISTORY OF IVF….  Dr. Subhash Mukhopadhyay , A physician from Kolkata INDIA, who
created the world second and India’s First test tube baby Durga who was born 65 days after first test tube
baby in U.K. .  Unfortunately he was harassed by state government and advice to not share his
achievement with international society.  He commited suicide in 1891  A critically acclaimed film EK
DOCTOR KI MAUT based on his life and give us sufficient knowledge about IVF

ETHICAL & LEGAL CONCERNS IN IVF The legal problems that arise from invitro fertilization are
that number of persons can assert for parental rights extends to the sperm donor, the egg donor, the
surrogate mother, parents who raise the child. Further, if during the time in which the embryos are in
storage, the couple divorces, legal complications may arise as to the custody of the embryo. The spare
embryos are frozen, discarded, donated or used for experimentation. Since some religions believe that life
begins at conception, it may amount to abortion which is contrary to both law and ethics. Expert
indentation is also not permissible as science cannot experiment with someone with basic human rights
without prior permission.

MAJOR STEPS INVOLVED IN IVF Invitro Filtration is an step by step procedure ,starting from the
collection of eggs from the women and till the transfer embryos into uterus of woman . The procedure
involves the following steps Collect eggs from the woman ,Obtain sperm from the man , Creation of
embryos, Transfer embryos into uterus of woman .There may be some side effects during the process but
when compared to the results obtained are to an greater advantage.

PROCEDURE OF IVF (the steps in ivf cycle)  Initial Evaluation  Suppression of natural Hormone
Cycle  Ovarian Stimulation  Collection of Oocytes  Collection of sperms  In vitro fertilization of
oocyte  Embryo transfer

INITIAL EVALUATION Blood Test Seminal Fluid Examination Trans vaginal Ultrasound
Hysterosalpingography (Uterosalpingography)

SUPPRESION OF NATURAL HORMONE CYCLE  Suppresion drugs prevent spontaneous

ovulation.  In an IVF cycle , it is important that natural ovulation should not occur if the eggs leave
ovary the doctor will not able to retrieve them. Drug Used….  Oral Contraceptile pills 
Lupron/Luprolide acetate  Nafarelin  Ganirelix acetate injection/Cetrotide

OVARIAN STIMULATION  Ovarian stimulation is used to produce multiple mature follicles rather
than the single egg normally develop each month.  Produce many good follicles to be fertilized. 
Regulation eggs are stimulated became some eggs will not fertilize or develop normally after fertilization.
 Regulate monitoring by ultrasound scan is done.

POSSIBLE SIDE EFFECTS OF OVARIAN STIMULATION  Discomfort Bruising or swelling at

site of injection.  Rash  Allergic sensitivity  Headache Mood swing  Abdominal discomfort and
Bloating  Chance of multiple pregnancy  Ovarian hypersensitivity syndrome (OHSS)

COLLECTION OF EGGS COLLECTION Of OOCYTE  The oocyte maturation is performed

,generally by an injection of human chorionic gonadotropin (hCG). Commonly known as Trigger shot. 
The egg retrieval is performed at a time usually between 34 and 36 hours after hCG injection.  Egg
retrieval is usually accomplished by transvaginal ultrasound aspiration.  It is done under short general
anesthesia , and is 20 to 30 minute procedure

COLLECTION OF OOCYTE COLLECTION OF SPERMS  Shortly before or after the oocyte

collection the male partner will be asked to give a sperm sample.  Collected about 60-90 minutes prior
to fertilization.  Liquefied ,centrifuged ,suspended in culture medium and incubated for 30-36 minutes at
37 0C.  The most active sperm are located in the surface of the medium.  Sperm may be obtained from
testicle ,epididymis or vas deferens from men whose semen is void of sperm either due to obstruction or
lack of production.

IN VITRO FERTILIZATION OF OOCYTES  Fertilization is started by adding 10,000-50,000

motile sperms to about 100 micro ltr. To 1 ml culture medium in which oocyte is being incubated. 
Intra-cytoplasmic sperm injection (ICSI) is indicated in cases where semen fluid does not contain sperm.
INTRA CYTOPLASMIC SPERM INJECTION IN VITRO FERTILIZATION OF OOCYTES 
Fertilisation check is performed the next day approximately 18 hours after sperm injection or
insemination of the eggs.  Usually 65% to 75% of mature eggs will fertilize after insemination  They
are cultured in special incubators to support division and development.  Pre implantation genetic
diagnosis may be done. Development of Embryo

EMBRYO TRANSFER  Embryo transfer may be performed on day 2,3or 5 Post fertilization.  One or
more embryos suspended in a drop culture medium are drawn in to transfer catheter a long thin sterile
tube with a syringe on one end.  The physician gently guides the tip of the transfer catheter through the
cervix and places the fluid containing the embryos into uterine cavity.

EMBRYO TRANSFER DEVELOPMENT AND PREGNANCY  After embryo transfer about 44 to

60% cases are successfully done  And like Normal pregnancy further development are done.  There are
some variants of IVF Like GIFT and ZIFT but they are rarely used about 1% in compare to IVF.

CRYOPRESERVATION  Preservation in frozen state is regarded as cryopreservation.  Semen,

fertilized eggs and embryos can be cryopreserved.  Human embryos have been successfully preserved in
the presence of cryoprotectant like 1, 2 propanediol or dimethyl sulphoxide or glycerol.  It was stored at
-196OC under liquid nitrogen.  At appropriate time, the embryos are thawed and is transferred to uterus.

ADVANTAGES  Fertilization is confirmed before implantation can occur.  Gives women with
damaged oviducts, the opportunity to carry their own fetus.
 DISADVANTAGES  Implantation in the uterus does not always occur.  Higher risk of twins or
triplets, which also increases the risk of complications and miscarriages.  Side effects associated with
the fertility medication  Higher risk of ectopic pregnancy, especially in women that have had previous
problems with their oviducts

GAMETE INTRA FALLOPIAN TRANSFER (GIFT)

 It involves the transfer of both sperm and unfertilized oocyte into the fallopian tube.  This allows the
fertilization to naturally occur in vivo.  Two oocyte along with 2 – 5 lakhs motile sperms are placed in a
plastic tube container.  Then oocyte sperm combination is injected 4cm into the distal end of fallopian
tube.

ADVANTAGES  There is no much human intervention in the actual fertilization of the eggs.  Because
fertilisation takes place within the fallopian tube, GIFT offers an option for people whose religious beliefs
prohibit conception outside the body.

DISADVANTAGES  Can be performed only if woman have atleast one normal fallopian tube.  GIFT
does not allow for visual confirmation of fertilisation.  GIFT involves a laproscopic surgery

. ZYGOTE INTRA FALLOPIAN TRANSFER (ZIFT)

ZIFT combines aspects of both IVF and GIFT.  Fertilization takes place outside the uterus and placed
into the fallopian tubes  Protocols for ovarian stimulation are similar to those used for IVF and GIFT. 
Eggs are collected and fertilized by the partner’s sperm in the laboratory.  The zygote is transferred to
the fallopian tube within 24hrs, when it is at 1 cell stage.

ADVANTAGES  Fertilization can be confirmed before they are implanted into the fallopian tube. 
Allows a developing embryo to travel into the uterus on its own, which may be important to those who
wish their baby to develop as naturally as possible

DISADVANTAGES  Can be performed only if woman have atleast one normal fallopian tube.  It is
more expensive than GIFT.  ZIFT involves a laproscopic surgery.

TUBAL EMBRYO STAGE TRANSFER (TET)  It combines IVF with tubal transfer  Embryos are
placed into the women’s fallopian tube.  The embryos are transferred back into the woman 2 days after
fertilisation. This is at the ‘2 cell or 4 cell’ stage.  TET allows embryos to make their way to the uterus
for implantation.  Its advantage over ZIFT is that it allows for the assessment of fertilization and embryo
quality.  Success rate higher than ZIFT.

INTRA CYTOPLASMIC SPERM INJECTION (ICSI)

Sperm is injected directly into the eggs in a laboratory.  Used if infertility originates from the male such
as:  Low numbers of sperm  Low sperm motility  Single spermatozoan is directly injected into the
cytoplasm of the oocyte through the micropuncture of zona pellucida.
ADVANTAGES  Can be useful when very low numbers of motile sperm are present and when there are
problems with sperm binding and penetration.

DISADVANTAGES  Altering the nature’s selection process for sperm can lead to an increase risk of
developmental and health issues for ICSI children, as well as a higher risk of miscarriage because of the
poorer genetic material involved.

All About IVF Embryo Grading

More than 1.5 percent of all babies born annually in the United States are the result of ART — or babies
born from pregnancies that were possible thanks to assisted reproductive technology.

Reaching the end of the fertility trail with a prize to cuddle can be a physically and emotionally draining
trek that covers so much uncharted territory. Embryo grading is one of the many bridges , cross along the
way.

Knowing what embryo grading is all about can make the journey easier and even (dare we say it?)
exciting. Let’s dive in.

If day 3 embryos

,’re past egg retrieval. ,’re even past the first discussion of ,r fertilization report and have now hit day 3 —
the exciting day when ,r fertilized embryos are graded for the first time. Some people will have embryos
transferred to the uterus once they reach day 3.

Exactly what are day 3 embryos? At this stage, the cells inside the embryos are dividing — embryologists
call this the “cleavage” stage — but they aren’t growing in size. The embryos are still at the same size as
an unfertilized egg. , can think of them as birthday cakes divided into slices. (The size of the cake doesn’t
change when , slice it, but the number of pieces does.)

Day 3 embryo grading system 

At day 3, embryologists use a high-power microscope to take a look at the morphology (a fancy word for
“structure”) of the embryo. They’re looking mainly at two things:

 the number of cells in the embryo

 what they look like (yes, appearance counts even as early as this stage!)

Cell number

An embryo that’s dividing well should ideally have between 6 to 10 cells by day 3. ResearchTrusted
Source shows that 8 is best. (Day 3 embryos that had 8 or more cells showed a significantly higher live
birth rate).
However, not all good quality embryos follow the rules. Some embryos will have 3, 5, or 6 cells, and
that’s because cells don’t divide at the same time. So, the rule of thumb is that although things aren’t clear
cut, it does seem that the number of cells in an embryo is the best indicator of whether an embryo will
thrive or not.

Cell appearance

While it’s relatively easy to count the number of cells see in a day 3 embryo, cell appearance is harder to
grade. This is especially so because sometimes , aren’t looking at the embryo head-on, but at a tangent.
Day 3 embryos are graded 1 to 4 (or 5) depending on the lab protocol with 1 being the highest grade.

So, what are embryologists looking for? They want to see that each cell has a nucleus and that the cells
are of equal size.

They also check for fragmentation. This sometimes occurs when cells divide. Think of the crumbs falling
off that birthday cake. Up to 20 percent fragmentation is fine. More than that and the cells lose too much
cytoplasm (cell contents) for optimal function.

Other things that fertility specialists will take into account when examining a 3-day embryo are:

 Compaction — are the cells compacted and readying for the next stage, which is forming a
blastocyst?

 Cytoplasmic pitting — are there depressions in the cell contents? Research is divided about what
this means.

 Vacuoles — are there fluid-filled pockets?

BOTTOM LINE: DAY 3 EMBRYO GRADING

Day 3 embryos are graded according to two criteria:

 Number of cells. Not subjective — 8 or higher is ideal)

 Quality of cells. Somewhat subjective — so two different embryologists may have two different
opinions. Clinics use a scale of either 1 to 4 or 1 to 5, with 1 being best.

If have day 5 embryos 

Some fertility clinics prefer to transfer embryos once they reach day 5. ,r embryo (now called a
blastocyst) is hard at work dividing and building up the number of cells. Here’s where division of labor
comes in:

 Some of the cells form the inner cell mass (ICM). These develop into the fetus.

 Some of the cells form the trophectoderm epithelium (TE). These develop into the placenta and
other tissues that ,r body needs for the pregnancy.
At this point, things are getting pretty cramped inside the shell (zona pellucida or ZP for short) that
surrounds the embryo — and the shell is being pushed to its limits. As the embryo readies to burst
through and implant itself in the lining of uterus, the membrane of the ZP shell start to thin out.

Day 5 embryo grading system 

If thought that grading a day 3 embryo was challenging, things get even more complicated with day 5
embryos. Although grading is more or less universal, every fertility center has a unique system and that
accounts for the slight differences that may see in grades.

Heads up: Blastocyst grading is complex and that means that grades aren’t carved in stone and may
change.

What’s being graded this time round?

 The amount that the blastocyst has expanded. The part of the embryo that’s being measured
here is the blastocoel. The blastocoel is the fluid-filled cavity that forms within the embryo.
Grades range from 1 to 6, with 6 being the most developed.

 The quality of the ICM. Remember, the ICM forms the fetus. Here, grades range from A to C,
with A being the best quality.

 The quality of the TE. The TE forms the placenta and other pregnancy-related tissues. Grades
range from A to C, with A being the best quality.

So, as an example, , may have a day 5 embryo that’s graded as 5AA. This would be described as a
hatching blastocyst with the highest quality ICM cells (first letter) and the highest quality TE cells
(second letter).

Day 5 embryo grading charts, explained 

Again, ,r day 5 embryos are typically graded according to a number followed by two letters. These charts
show the options for the number and each letter.

Number: Blastocyst stages of expansion

Grade of
Name Meaning
expansion

Blastocoel cavity is less than half the volume of the

1 Early blastocyst
embryo

2 Blastocyst Cavity is greater than half the volume of the embryo

3 Blastocyst Cavity fills the embryo

 Cavity is greater than the embryo and membrane has
4 Expanding
thinned

5 Hatching TE is starting to burst through the ZP

Completely
6 TE has burst through the ZP
hatched

First letter: Grade of ICM, which develops into the fetus

Grade of
Features noted
ICM

A Cohesive layer of many cells

B Loosely packed cells

C Few large cells

Second letter: Grade of TE, which develops into the placenta and other supporting cells

Grade of
Features noted
TE

A Many tightly packed cells

B Loose layer of cells

C Few cells

Success rates by grade 

There’s still a lot going on here that researchers aren’t sure about. Remember the cytoplasmic pitting we
mentioned? Researchers are divided whether this is a good sign or something to worry about. The one
thing we are sure about is that the grades given to an embryo gets don’t necessarily seal its future.

For example, at first glance, getting a C grade on the quality of ICM may seem like bad news. But that
isn’t necessarily true. An embryo with a C grade ICM may be still developing. Give it another day and the
ICM may compact into an A.

Same goes for blastocoel expansion rates. A 1 can grow into 6 within a day.
So, if have a couple frozen embryos — say, a 5AA and a 4BC — and the highest quality (at least
according to grade) one doesn’t result in a live birth, there still could be good news. The second embryo
may still be successful and result in a perfectly healthy child. In fact, this scenario (the presumably lower
quality embryo resulting in pregnancy and birth) has played out many, many times.

Bottom line: It’s hard to know, based on grading alone, what success will be. We know that’s a less

. SURROGATE MOTHERHOOD Surrogate motherhood involves a woman bearing the child of

another woman. Where the woman cannot produce eggs, they enter into a contract with another woman to
be artificially inseminated with the husband's sperm and she bears the child for them. Also where the
woman can produce eggs but she is unable to carry a child to a term, the embryo is externally formed by
in-vitro fertilization of husband's sperm and wife's ova, the embryo is implanted in surrogate mother's
womb and she bears the child for them.

LEGAL AND ETHICAL CONCERNS IN SURROGATE MOTHERHOOD: Surrogation involves a

contract of sale between the married couple and the surrogate. Certainly, the most serious ethical
objection to commercial surrogacy is that it reduces children to objects of barter by putting a price tag in
them. Morally, it is no less than selling or trafficking of human beings violating the basic fundamental
rights of a human being. Some women could be pressurized into surrogacy by their husbands for money.
In India, the surrogate does not enjoy the same rights as in the west. The Indian medical guidelines allow
doctors to implant five embryos into a surrogate, whereas in Britain, the maximum is two and many
European countries are moving towards a single embryo implant. Under British laws a surrogate mother
who has provided an egg can claim the baby back within two years of child's birth. However in India, she
has no right over the child after delivery. She can cancel the contract only when it is proved that it was
not a valid contract according to Section 23 of Indian Contract Act.

LEGITIMACY OF THE CHILD BORN THROUGH ART A child born through AR is presumed to
be the legitimate child of the couple having been born within the wedlock and with consent of both the
spouses with all the attendant rights of parentage, support and inheritance. Sperm donor should have no
parental right or duties in relation to the child and their anonymity should be protected.

ASSISTED REPRODUCTIVE TECHNOLOGY (REGULATION) BILL 2014 The Supreme Court in

the 2008 Manji case held that commercial surrogacy was permissible in India. Baby Manji was
commissioned by Japanese parents (through an unknown egg donor and the husband’s sperm) and was
born to a surrogate mother in Gujarat. The parents divorced before the baby was born. The genetic father
wanted the child’s custody, but Indian law barred single men from it, and Japanese law didn’t recognize
surrogacy. The baby was ultimately granted a visa, but the case underscored the need for a regulatory
framework for surrogacy in India. This was the genesis of the Assisted Reproductive Techniques
(Regulation) Bill, 2014. The Bill paves the way for the setting up of national and state boards for ART,
and makes registration of ART clinics mandatory. Only a healthy, married woman between the ages of 23
and 35, who has a child of her own above the age of three years, is allowed to become a surrogate mother,
with the consent of her spouse. The commissioning parents must bear all medical expenses, insurance,
etc., and are legally bound to accept the custody of the child/children irrespective of any abnormality that
the child/children may have, and whether the parents separate before the child/children are born.
Violators face imprisonment of up to five years or a fine of Rs 10 lakh, or both, for the first offence. The
Bill prescribes a minimum compensation for the surrogate mother.

GOVERNMENT RECENT STAND OF IVF The Indian government will not allow commercial
surrogacy that involves exchange of money for anything apart from paying for the medical expenses for
the mother and child. Thus, it will allow only ‘altruistic surrogacy’ — which, officials say, could in most
cases involve a close blood relative. In an affidavit to the Supreme Court last week, the government said
it would henceforth “prohibit and penalize commercial surrogacy services” so as to protect the “dignity of
Indian womanhood”, and to prevent “trafficking in human beings” and the “sale of surrogate child”. Only
needy infertile Indian couples would be able to opt for surrogacy of the altruistic kind. This line also
excludes LGBTs, single men or women, couples in live-in relationships, as well as married couples who
are proven to be fertile but choose to opt for surrogacy for reasons other than medical. The government’s
view is based on the ethical stand that a child should not be the product of a transaction, and that
motherhood should not be commoditized. Also, the insistence on surrogacy instead of adoption is seen,
from the gender-rights perspective, as propagating the patriarchal bloodline. The stand also emanates
from health concerns such as the need for the child to be breast-fed for at least six months, or the issues
faced by surrogate children born in India once they are taken by commissioning parents to countries that
ban surrogacy — or those children who are abandoned due to deformities. Officials argue that India
remains one of the few countries that still allow the practice. There is a complete ban on surrogacy in
Germany, Norway, Italy, Sweden and Singapore. Surrogacy, of only the altruistic kind, is allowed in
Canada, in certain Australian states, New Zealand, the UK, Greece, Denmark and the Netherlands. In the
US, some states allow commercial surrogacy, but in a highly regulated environment. The only European
countries where surrogacy is entirely legal are Russia and Ukraine.

NEGETIVE ASPECTS OF ART  Due to administration of hormones and drugs, ovarian

hyperstimulation syndrome (OHSS) can occur.  Risks associated with pregnancy  Multiple pregnancy
 Increased risk of premature labor etc..  Can cause premature menopause.  Increased risk of ovarian
cancer, atleast by 3 times when compared to normal women.

RECENT TRENDS  Innovative design of IVF equipment (PLoS ONE, june 2012)  A novel system
for processing embryos during IVF treatment has been shown to significantly improve the chances of
pregnancy by 27%.  Pioneered by a Newcastle team of fertility experts within the University and NHS,
the innovative design of interlinked incubators provides a totally enclosed and controlled environment
within which every step of the IVF process can be performed.

CONCLUSION Though The Church's teaching on marriage and human procreation affirms the
inseparable connection, willed by God and unable to be broken by man on his own initiative, between the
two meanings of the conjugal act: the unitive meaning and the procreative meaning, In vitro fertilization
treatment provides better prognosis in patients greater than or equal to 32years of age and is
recommended for such patients. The benefits of treatment appear to be greater in patients with more
advanced stages of endometriosis. Thus when compared to the happiness the people cherish after the
outcome of this process this process is not only an great impact to our generation than those spiritual
beliefs.

BIBLIOGRAPHY:

BOOK REFERENCE:

 Annamma Jacob A. A comprehensive textbook of midwifery. Second edition. India; Jaypee

Brothers Medical publishers (P) ltd.

 Cunningham, Leveno, Bloom. (2010)William’s obstetrics. 23rd edition. United states of America;
Mcgraw Hill companies

 Dutta D.C. (2004),Textbook of obstetrics. Sixth edition. Calcutta, India; New Central Book
agency (P) Ltd

 Fraser DM, Cooper MA. Myles(2003) Textbook of Midwives. Fourteenth edition. Edinburgh;
Churchill Livingstone.

 Satyanarayana U, Biotechnology (2010), 1st edition, Books and allied (P) Ltd, Kolkata.
 Joseph. C. Daniel, Methods in mammalian embryology, Ist edition, W.H Freeman and
company, San Fransisco

  Perry, Hockenberry, Lowdermilk et al. Maternal Child Nursing Care. 5th edition;Elsevier
publicaton

 Renu mishra.IAN DONALD’S Practical Obstetric problems.. 7th edition ; Wolters kluwer
publication.

 Pillitteri A. Maternal and child health nursing. Care of the childbearing and childrearing family.
Sixth edition. Philadelphia; Lippincott Williams & wilkins: 2010

 NET REFFERANCE:

www.wikipedia.com

www.pubmad.com