Sunday, 4 November 2012

Vicky Donor Sparks Curiosity in Sperm Donation

Pahlajani Test Tube Baby Ccentre Raipur
Vicky Donor has really popularized sperm donation to the extent that young boys are now calling up fertility clinics to see how they can donate sperm and make a quick buck. Sperm donation is one of the many third party reproduction techniques. However, without doubt it’s the easiest and least troublesome though it can only be used when the male partner is infertile or for same-sex couples. If you think any male can pop into the clinic and donate his sperm, you’re wrong. There are a score of tests prospective donors have to undergo before they can donate sperm. There is a round of sperm analysis tests, which checks the sperm’s mobility, count, volume and other parameters.

The donor has to be between the ages of 21-45 and not suffer from HIV, hepatitis B and C, hypertension, diabetes, STDs and genetic disorders. The blood group and Rh status of the individual also needs to be noted. The tests are thorough and need to cover everything including height, weight, age, skin and eye colour, family medical history etc. A little background check including educational qualification and profession also takes place.

The movie ‘Vicky Donor’ is to be believed, one can live his life more than comfortably with his ‘sperm earnings’. However, in reality, the compensation part is in a moral grey area. Although the rules are pretty clear for financial compensation for a surrogate mother the rules for paying sperm donors isn’t very clear. According to guidelines by the Indian Council of Medical Research (ICMR), no remuneration can be paid for any form of donation, be it of kidneys, blood, or sperms. The only compensation that is paid is in the form of expenses incurred during and directly related (travelling expense, etc.) to sperm donation. However, various sperm banks have been known to approach donors directly and promise them certain amounts for successful donations.

An infertile couple can approach a fertility clinic where they are told their various options. These include the various assisted reproduction techniques and one of them is getting a sperm donor. There are various different ways to get sperm donors.  The traditional Indian Council of Medical Research (ICMR) procedure dictates that a sperm donor can only be approached through a sperm bank. The fertility clinic has to obtain sperm from appropriate banks though neither the clinic nor the couple should know the identity of the donor. However, it shall have the donor’s entire information like height, weight, skin colour, educational qualification, ethnicity, profession, etc.  The sperm is usually inseminated using various artificial reproduction techniques.

However, while the film has drawn enthusiastic donors, the absence of a regulatory mechanism is queering the pitch for many serious players in the business. "The business of sperm and egg donation, or surrogacy for that matter, is like playing football without goalposts,". Collecting and storing semen samples is expensive for companies like. These stipulate extensive medical testing of the donor besides the mandatory quarantining of semen samples in liquid nitrogen tanks at -196 degree Celsius for a minimum of six months before use.

Due to lack of stringent adherence to laws, fertility centers are known to approach donors directly although this is illegal. In addition, the internet has given couples another way to directly contact a sperm donor. There are various websites, which allow everyone to put up their information including intending parents, sperm donors, surrogate mothers and egg donor. These websites effectively take away any way to regulate the procedure. Couples who want a child can state their preferences and they can approach the donor after checking out his profile. The profile usually has all the information required for the parents to select a donor including pictures although there is no way to guarantee about the authenticity of the information involved. There are options to find donors in other countries as well and this has led to a sort of fertility tourism where women visit countries where sperm donation is permitted. Sperm donation laws vary all over the world, for example a single woman in India is allowed ART but it’s illegal in various countries so interested couples might travel to India where it is legal.

"The film's social message is significant because it is spurring people from many families to donate sperm. In genetic terms, it is an important development because this would lead to good progeny."
Vicky Donor as milestone cinema whose impact has gone far beyond anything to society, This at a time when lifestyle diseases and stress are causing diminished sperm counts and motility amid many men in their reproductive age. At least one half of the infertility cases referred to clinic is a consequence of the "male factor".  "50 per cent of infertile men are not producing any sperm cells at all. And the other half suffers from lowered sperm counts and low motility".

The absence of regulation has also attracted many unscrupulous players who cut costs by routinely forgoing even basic medical testing of donors or the obligatory quarantining of samples. "You cannot be careful enough,” recalling instances where patients had procured semen samples from local diagnostic laboratories that possess no facilities to wash or Cryo-preserve (freeze) sperm cells. Unlike in the Bollywood film where the protagonist makes a career out of selling his spermatozoa, it is not all that lucrative in the real world. However, refuses to pay anything but out-of-pocket expenses. "No one seems to remember that it is sperm donation,"

"The subject of sperm donation is no longer discussed in whispers. It is openly debated - an accepted option to help in a noble cause and earn some extra money," "The sample is taken and incubated for six-odd months. Tests for all infections are carried out to rule out infections like HIV. It is only after these formalities that the sample is used. Moreover, remuneration is also not all that handsome as the young may believe,"

 "Donating blood helps save a precious life. Egg Donation & Sperm donation would help create new life"

Medico-Legal Aspects of Reproduction and Surrogacy

This important blog describes the medical, ethical and legal aspects of reproduction in the context of recent medical advances, the control of fertility and the modern treatment of childlessness due to both male and female abnormality. Legal and moral issues arising from surrogacy are also discussed, as are the rights of the fetus – with particular attention being given to abortion, injury and treatment in uterus and experimentation. Medico-legal aspects of parenting include the dilemmas consequent upon the birth of a defective child and the provision of treatment for children.

All states of India have slightly different ethical values relating to surrogate decision makers and advance directives. The commonly used names given to surrogates and their powers are state specific with some surrogates having the right to refuse medical treatment on behalf of the people who nominated them. Similarly a range of different advance directives are used across India.

Important medico-legal issues in relation to advance care planning include:

1. Whether a patient is competent to make certain decisions;

2. The legal status of written advance directives or any other statements that a patient makes about their wishes for future care;

3. The legal arrangements for formally appointing surrogate decision makers.

There is significant burden associated with the role of surrogate decision-maker. A systematic review examining how well surrogate decision-makers predicted the patient’s wishes showed that they were accurate in two thirds of the cases. It was suggested that “accuracy” may not be the only benefit which is important to patients when relying on patient-designated surrogates.

Relationships between health care providers and family members, and amongst the family members themselves, have a significant impact on those who participate in end of life decision making. An important area of potential conflict with surrogate decision-makers is in the care of critically children.

In regard to the role and use of surrogate decision-makers, there are significant differences between practices in different national health systems, based on how much focus there is on patient autonomy, the amount of formal reliance on surrogate decision-makers, and the extent to which medical predominance in decision-making is regarded as acceptable or as paternalistic. In some cultures family-centered decision-making is valued much more highly than patient autonomy.

The role of the surrogate decision-maker is to try to ensure that any decisions which are made about the patient’s care are consistent with what is known of the patient's own values and wishes, and they should adhere to any documented advance care plan. This may be difficult for family or friends who are dealing with their own impending loss. Surrogate decision-makers experience considerable stress in their role of supporting the patient. In order to perform this role they need a very supportive relationship with the health care providers caring for the patient, and adequate information.

While formal arrangements for proxy decision-making focus on named individuals who are appointed as surrogates, in practice many families make collective decisions. In some families, there can be resistance to disclosing diagnosis and prognosis to the patient, which makes advance care planning very difficult. Skilled and sensitive communication is required to deal with these conflicting perspectives, whilst at the same time ensuring that patients’ and families’ own values are respected.

Surrogacy: General Considerations & Guidelines for ART Clinics in India

1. Surrogacy by assisted conception should normally be considered only for patients for whom it would be physically or medically impossible / undesirable to carry a baby to term.

2. Payments to surrogate mothers should cover all genuine expenses associated with the pregnancy. Documentary evidence of the financial arrangement for surrogacy must be available. The ART centre should not be involved in this monetary aspect.

3. Advertisements regarding surrogacy should not be made by the ART clinic. The responsibility of finding a surrogate mother, through advertisement or otherwise, should rest with the couple, or a semen bank.

4. A surrogate mother should not be over 45 years of age. Before accepting a woman as a possible surrogate for a particular couple’s child, the ART clinic must ensure (and put on record) that the woman satisfies all the testable criteria to go through a successful full-term pregnancy.

5. A relative, a known person, as well as a person unknown to the couple may act as a surrogate mother for the couple. In the case of a relative acting as a surrogate, the relative should belong to the same generation as the women desiring the surrogate.

6. A prospective surrogate mother must be tested for HIV and shown to be sero-negative for this virus just before embryo transfer. She must also provide a written certificate that (a) she has not had a drug intravenously administered into her through a shared syringe, (b) she has not undergone blood transfusion; and (c) she and her husband (to the best of her/his knowledge) has had no extramarital relationship in the last six months. This is to ensure that the person would not come up with symptoms of HIV infection during the period of surrogacy. The prospective surrogate mother must also declare that she will not use drugs intravenously, and not undergo blood transfusion excepting of blood obtained through a certified blood bank.

7. No woman may act as a surrogate more than thrice in her lifetime.

8.  A child born through surrogacy must be adopted by the genetic (biological) parents unless they can establish through genetic (DNA) fingerprinting (of which the records will be maintained in the clinic) that the child is theirs.

Thursday, 12 January 2012

Does celebrity steps change the Indian society ? 

aamir_kiran_surrogacyविज्ञान का यह चमत्कार यानी आइवीएफ एक तरीके से सरोगेशन है. आइवीएफ (इन विट्रो फर्टिलाइजेशन) में इन विट्रो का मतलब है कृत्रिम या बाहरी वातावरण और फर्टिलाइजेशन यानी निषेचन. निषेचन को हम जीव के पलने की शुरुआत कह सकते हैं. सरोगेशन यानी दूसरे के भ्रूण को अपनी कोख में पालना. सरोगेशन करने वाली महिला को सरोगेट मां कहा जाता है जो किराए पर कोख देकर दूसरों के बच्चों को जन्म देती है.
असिस्‍टेड रिप्रोडक्शन टेक्नीक्स (एआरटी) के विशेषज्ञ डॉ. श्रीमती नीरज पहलाजानी के अनुसार कई तरह की शारीरिक परेशानियों की वजह से कुछ माताएं खुद अपने गर्भ में बच्चा नहीं पाल सकतीं. आइवीएफ तकनीक ऐसी माताओं को भी मातृत्व का सुख देने में मददगार है. स्त्री-पुरुष संसर्ग के दौरान स्त्री के अंडाशय (ओवरी) से निकलने वाले अंडाणु और पुरुष के शुक्राणु के मेल से गर्भधारण होता है. यह मेल या निषेचन (फर्टिलाइजेशन) अंडाशय और गर्भाशय को जोड़ने वाली डिंबवाहिनी नलिका (फैलोपियन ट्यूब) में होता है. लेकिन आइवीएफ एक ऐसी तकनीक है जिसमें बच्चा चाहने वाली स्त्री के अंडाणु और उसके पति के शुक्राणु को टेस्ट ट्यूब में लेकर मेडिकल लैब में इनका मेल कराया जाता है. इस मेल से बना भ्रूण दूसरी महिला (सरोगेट माता) के गर्भ में पलता है. जन्म के बाद बच्चे को उसके असल माता-पिता को सौंप दिया जाता है. सरोगेट मां यानी किराए पर कोख देने वाली महिला की भूमिका बच्चे को अपने गर्भ में पालने और जन्म देने तक सीमित है.
आइवीएफ का रास्ता चुनने वाले परिवार स्त्री की किसी शारीरिक कमजोरी के कारण यह रास्ता चुनते हैं. इनमें ज्‍यादातर वे महिलाएं होती हैं जिनकी दोनों फैलोपियन ट्यूब्स नहीं होतीं या ये किसी सर्जरी या इन्फेक्शन के कारण खराब हो जाती हैं. कई बार महिलाओं में बांझ्पन या बंध्यता के कारण पूरी तरह स्पष्ट नहीं हो पाते. और विभिन्न शारीरिक परीक्षणों के सामान्य नतीजों के बावजूद बांझ्पन की वजह पता नहीं चल पाती.
आइवीएफ की आम प्रक्रिया में सबसे पहले स्त्री को दवाइयां देकर अंडाशय में ज्‍यादा से ज्‍यादा अंडाणु तैयार करने की कोशिश की जाती है. इसके बाद सोनोग्राफी के जरिए अंडाणुओं के विकास का निरीक्षण किया जाता है. एनस्थेसिया देकर स्त्री के अंडाणु प्राप्त किए जाते हैं और इनका लैब में पुरुष के वीर्य से प्राप्त शुक्राणुओं से मेल कराया जाता है. 2 से 5 दिन में भ्रूण बनते हैं जिन्हें सरोगेट मां के गर्भाशय में दाखिल कराया जाता है.
ज्‍यादातर सरोगेट माताएं फर्टिलिटी सेंटरों पर खुद जाकर अपनी सेवा देने की इच्छा जाहिर करती हैं. संतान चाहने वाले पति-पत्नी इनसे सीधे नहीं मिल पाते लेकिन वे मान्यता प्राप्त एजेंसी या फर्टिलिटी सेंटर की मदद से इंटरनेट या अखबारों में विज्ञापन देकर किराए की कोख का इंतजाम कर लेते हैं. ''ज्‍यादातर मामलों में बच्चा चाहने वाले माता-पिता अपने परिवार की ही किसी महिला को सरोगेसी का जिम्मा सौंपने की कोशिश करते हैं. हमारे यहां कुछ ही मामले ऐसे होते हैं, जहां उन्हें अनजान सरोगेट की जरूरत होती है.'' सरोगेट माताएं यह काम पैसे के लिए करती हैं और इनमें सभी तरह की जरूरतमंद महिलाएं होती हैं-कोई महिला अपने बच्चों के लिए अच्छी पढ़ाई का इंतजाम करना चाहती है तो किसी को अपने पति का कर्ज उतारने के लिए हाथ बंटाना होता है. ''सरोगेसी का फैसला हड़बड़ी में नहीं होता. इसके लिए बच्चे के इच्छुक माता-पिता और सरोगेट मां दोनों की ही अच्छी तरह काउंसिलिंग की जाती है. इसके बाद ही कानूनी प्रक्रिया का पालन करते हुए वकील की मौजूदगी में एक अनुबंध पर सभी संबंधित पक्ष हस्ताक्षर करते हैं.''
आर्थिक मजूबरी में सरोगेसी के लिए अपनी कोख किराए पर देना किसी महिला के लिए पेशेवर फैसला हो सकता है. हालांकि इसमें भावनात्मक पेचीदगियां भी कम नहीं हैं. ''भारत में वर्षों के अनुभव के बाद अब अनुबंध की शर्तें इतनी ज्‍यादा स्पष्ट होती हैं कि किसी भी तरह की कानूनी अड़चनें सामने नहीं आतीं. हर सरोगेट मां को आखिरी दिन क्या होगा, यह अच्छी तरह मालूम है. सो बच्चे का हस्तांतरण आसानी से हो जाता है.'' सरोगेट मां का चयन और बच्चा चाहने वाले दंपतियों का उसके साथ होने वाला अनुबंध एक सामाजिक-आर्थिक पहलू है, जिसमें मेडिकल साइंस का कोई दखल नहीं. उनके मुताबिक, ''इनके बीच पैसों के लेन-देन और कानूनी अनुबंध में डॉक्टरों की कोई भूमिका नहीं होती. हमारा काम है तकनीकी और मेडिकल मदद देना. मान्यता प्राप्त एजेंसियां सरोगेट मां का इंतजाम करती हैं और इनके सहयोग से बच्चे के इच्छुक दंपती इनके साथ कानूनसम्मत अनुबंध करते हैं.'' 
भारत में अनुमान है कि यहां 3 करोड़ महिलाएं बंध्यता की शिकार हैं, इनमें करीब 20 फीसदी को आइवीएफ की जरूरत है, लेकिन बमुश्किल 10 फीसदी लोग इसका खर्च वहन करने में सक्षम हैं. बच्चों की चाहत में पिछले कई वर्षों से विदेशी मूल के लोग भारत आते हैं, लेकिन बढ़ती जागरूकता और सफलता की दर को देखते हुए आम भारतीय भी आइवीएफ-सरोगेसी का रास्ता अपनाने लगे हैं.
दरअसल, आइवीएफ-सरोगेशन भारतीय समाज में पिछले एक दशक से मौजूद है लेकिन सामाजिक ताने-बाने की नजाकत और कई किस्म की कानूनी अड़चनों के कारण मातृत्व का यह वैज्ञानिक विकल्प विवाद का विषय रहा है. फिलहाल भारत में सरोगेसी को लेकर कोई स्पष्ट कानून नहीं है. सो भारतीय चिकित्सा अनुसंधान परिषद के 2005 के दिशा-निर्देशों का पालन किया जाता है. इस संबंध में सरोगेसी असिस्टेड रिप्रोडक्टिव टेक्नोलॉजी बिल का मसौदा तैयार है जिसे भारतीय समाज और चिकित्सा विज्ञान के लिए खासा उपयोगी माना जा रहा हैं. उम्मीद करें, इसके बाद संतान सुख पाना आसान होगा.