Tag Archives: Infertility

Breaking News: Surrogacy not for married couples only – singles and gays will have legal rights to have surrogate babies

Single men, single women, gays and lesbians may soon get the legal sanction to undergo surrogacy in India.

The draft bill legalizing the surrogacy process in India has provided for Single parenthood by allowing “Unmarried Couples” and “Single Persons” from India and abroad to have children in India using ART procedures and surrogate mothers.

By conferring the right to have children on unmarried couples and single persons, the bill attempts to achieve several historic feats – legalizing commercial surrogacy, single parenthood, live-in relationships and entitling gays and lesbians to start families using surrogate mothers – at one go.

The bill proposes to set up a mechanism to regulate and supervise surrogacy in India.

The bill, with potential to rewrite the social landscape, may be tabled in the monsoon session of Parliament if the Union Cabinet clears it.

Read more about this on http://epaper.hindustantimes.com//artMailDisp.aspx?article=21_06_2010_001_020&typ=1&pub=264

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Adult stem cells may lead to new infertility treatment

A special class of adult stem cells, known as human induced pluripotent stem (iPS) cells, has for the first time been reprogrammed into cells that develop into human eggs and sperm. The research, carried out by members of the University of California, Los Angeles (UCLA)’s Broad Stem Cell Research Center, was published in the January 27 online edition of the journal Stem Cells. Derived from adult body cells that have been engineered to return to an embryonic state, iPS cells have the ability to become every cell type in the human body – a characteristic they share with embryonic stem (ES) cells. In this study the iPS cells were coaxed into forming the germ line precursor cells that are capable of giving rise to sperm and eggs. ‘This finding could be important for people who are rendered infertile through disease or injury’. said Amander Clark, the senior author of the study. ‘We may, one day, be able to replace the germ cells that are lost, and these germ cells would be specific and genetically related to that patient’. Many infertile couples would see this process as preferable to using eggs or sperm from a donor who would then become one of the child’s genetic parents. However, Clark cautioned that scientists are still many years from offering treatments involving iPS cells to infertile patients. There are many uncertainties and dangers that need to be resolved. For example, the process of reprogramming involves using viruses to deliver genes to the cells, potentially increasing the likelihood of genetic abnormalities and cancers. Crucially, Clark’s team found that the germ line cells derived from iPS cells did not perform certain key regulatory processes as well as those generated from ES cells. The associated increased risk of chromosomal errors, or abnormal growth, could have serious health consequences for any child conceived using egg or sperm obtained in this way. Therefore Clark believes that it is vital that research using human ES cells continues. These cells can be derived from left over embryos used during in vitro fertilisation, and would otherwise be destroyed, yet their use is controversial and the topic remains fiercely debated.

Sources : Los Angeles Times, IVF News

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The Presidential Address at the 56th AGM of the Mumbai Obstetric & Gynaecological Society

It is the best of times, it is the worst of times.

The best because our chosen profession has and is progressing by leaps and bounds and leading the medical world into new fields of research, therapy and hope.Assisted reproduction today is a highly advanced field and practitioners are doing what no one believed was possible.We provided the embryos and the cord blood from where stem cell research took off and is poised to make breakthroughs in irreparable nerve cell or cardiac cell damage, manage cancer, diabetes and liver cell failure.We are at the forefront of the medical world in endoscopy. Surgeons from other specialties to suit themselves, modified procedures and instruments devised by brilliant gynecologists. We are still eons ahead of them. Today there is no pathology that master endoscopists cannot treat laparoscopically. It was a gynecologist Ian Donald who first thought to use sound waves to make images of the unborn child. Today we can diagnose and treat an ailing fetus in its mother’s womb by blood transfusion or draining an over distended bladder. As the world ages, we are still there at the next frontier with our meshes and tapes that repair aging muscle, keeping a woman continent and giving her a new life. We have a variety of options in medications for the older woman to keep her bones strong and her skin tough. That we care deeply for our patients is obvious from the fact that we are among the few surgeons who make the effort of doing a surgery through a pfannensteil or bikini cut incision and painstakingly close it so that the scar does not show. Here too we are busy trying out tummy tucks with hysterectomies or even cesarean sections. It is a matter of pride that all these latest technologies are available in our country and its medical capital, this city of Mumbai. Impossible is nothing! The story of my Presidential year 2009-10 began almost 5 years ago and started with me searching for the promised land that will bring our post-graduates closer to academics, research & newer technologies. These are difficult times with the world at war, terrorism threatening our planet, our country, our beloved city and our way of life. We cannot even hold our cricket matches in our own country. A severe economic recession grips the world and threatens our medical tourism and outsourcing industries. However there is hope as a young new president takes charge of world’s most powerful nation and speaks of change. And the youngest thus far president takes charge of the Mumbai Obstetric and Gynecological society in its 75th year and also promises that this year will be different. This will be an Indo-Israeli year. My reasons for choosing the Israelis to partner us this year, is that we have many cultural and social similarities. We both built our nations from scratch; we value education and hard work. We are quick to adapt to a new methodologies and we thirst for success and recognition. Israel is a first world country doing cutting edge research in infertility and fetal medicine and genetics and has well established protocols and procedures in endoscopy and oncology. She has graciously agreed to help her developing sister country by sending her leading doctors who will share their knowledge and expertise. Since both countries became independent, this is the first scientific collaboration for an entire year between Professional Societies. Not one, but 7 Israeli Medical Organizations have thrown their weight behind the Mumbai Obstetric & Gynecological Society (MOGS) this year! Israel is sending us 14 world leaders in their respective disciplines. Our theme for MOGS this year is: “Technology Saves Lives. Let us learn from the best”. This is what the Indo-Israeli collaboration translates to. Let us also extend this generosity to our fellow gynecologists from other towns and cities who can attend all our academic programs this year. Information about our scientific sessions will be sent all over the country- so we expect a lot of new faces in town this year. To all of you fellow gynecologists I say be the change. Lets not have any negativity this year but contribute enthusiastically as if each one of you were the president of the MOGS and organize innovative, interesting and useful sessions for us as part of our outreach programmes. We are taking the good work started by my predecessors forward. Why partner with Israel? India, the world’s biggest democracy, and Israel, one of the tiniest democracies, surprisingly have much in common. Both are the cradle to the world’s most dominant religions. Thus, for over 5000 years they have sprouted the foundations of human culture as we know it today. Both these countries have many sites which are considered the holiest to the largest number of followers all over the globe.Given India’s strong scientific and technological base, Israel is keen on strengthening professional medical ties with India. The Indo-Israeli Year presents an exciting new means to help physicians from India and Israel to establish a vibrant partnership. This is going to be one of the first official academic collaborations between the two countries ever since they both achieved independence over 60 years ago. We are all looking forward towards an unprecedented opportunity of first-hand exchange of knowledge and experience that can forward our mutual goal of extending the best health care to all women. At this time, I would like to publicly acknowledge the support system at home. Despite me being me, all I got at home was solid support & love. Thank You Swati, Akanksha, Ranveer, Daddy, Titoo, Siddharth.They say a man’s upbringing starts a hundred years before his birth. We Hindus believe our good luck now is the result of past life karma. Someone up there must like me to have blessed me with superb teachers who shaped me as a gynecologist and fertility physician and as a man.My heartfelt respect and gratitude to Dr Snehalata Deshmukh, Dr Pratibha Vaidya, Dr Geetha Niyogi, Dr Vivek Patkar, Dr Sushila Saraf, Dr PB PaiDhungat, Dr Satish Tibrewala, Dr Shashank Parulekar, Prof. O Djahanbakhch & Dr Sadhana Desai. I could not have taken on this responsibility were it it not for my capable team from Rotunda & Deccan, Kaushal, Goral, Sulbha and Anjali who have been my backbone. No man is an island though people often accuse me of being a loner. I would not be where I am today without the help, support and guidance of my dear friends – This year would not have been in its present form without the support of Dr Daniel Seidman & all my other friends. It is just once in your life that you meet someone who can change the way you look at the world. Thousands of candles can be lighted from a single candle, and the life of the candle will not be shortened. Happiness never decreases by being shared. I have never in my life met a person who has so influenced me with his vision, intelligence & philanthropy. Mr Ajit Gulabchand is Chairman and Managing Director of HCC – one of India’s leading construction companies and has been a catalytic factor in the infrastructure growth of India including our own Bandra-Worli sealink & Lavasa – Free India’s largest hill station spread across 12,500 acres, set amidst 7 hills and 60 kms of lakefront. Corporate Social Responsibility remains intrinsic to Mr Gulabchand’s vision for the group encompassing HIV, Education, Water, and Disaster Management initiatives. He has recently endowed a new ‘Ajit Gulabchand Chair’ on Indian Business Studies being set up at Oxford University and is a member of the Oxford International Advisory Board for Executive Education. Upon my request, he has agreed to bequeath a grand sum of Rs ten lakhs to MOGS to set up an overseas training fellowship for a young MOGS member gynecologist in memory of his mother Late Dr Shantabai Gulabchand, who was an eminent gynecologist practicing in our own city. Being an ace ranker in her college, Dr Shantabai Gulabchand secured an easy admission for MBBS in Grant Medical College of the J J Hospital. She passed the MBBS with flying colors, securing various medals to her credit, such as Viceroy’s silver trophy, Lord Sandhurst’s Gold Medal and even the National Scholarship for Indian lady doctors. After completing internship at Cama Hospital, Mumbai, Shantabai was appointed as Lecturer at Bai Motlibai and Petit Hospital. Mumbai. She believed in studies, and perused whole heartedly by completing her F.R.C.S. (Gynecology) at an early age of 26 in London. After obtaining the F.R.C.S. degree, she returned to Mumbai and started her own clinic in Girgaum, Mumbai. She possessed an entrepreneurial streak right from the beginning of her career and started a company called “Altra Laboratories” that manufactured medicines. In June 1947 she married reputed industrialist Seth Gulabchand Hirachand. She served as Director on the Board of Hindustan Construction Ltd for nearly 31 years.Even in the post independence era, Shantabai was actively involved in politics and was associated with the Swatantra Party. She also deeply believed in women empowerment and education. Thank you Sir for partnering MOGS to help out our own post-graduates & to advance science in our own city. I would like to dedicate my own Presidential year to the memory of my late mother Dr(Mrs) Sanyogita Allahbadia who strived that her children be given the best education. I am grateful to my parents for having given me a sound education and made me capable enough to be speaking before this very august audience. We will try our best to offer an amalgam of the highest academic standards with the recent advances in the field. I was particularly impressed by one of President Ronald Reagan’s memorable quotes: Aim for the top, pray to God and Hope for the best. That has been my philosophy & it will be our endeavor to strive for excellence in all aspects of this year. We promise you will we will do our best not to let you down.I believe that a true student is never satisfied or content with the knowledge gleaned . And we will all continue to remain students all our life since education is a continuous process. I’m sure we will enrich ourselves with pearls of wisdom that we will pick up from the deliberations of meetings in 2009-10. The great pleasure in life is in doing what people say you cannot do . Let us all make this a memorable year!

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Debate Over Genetic Screening of Embryos as New Tests Emerge

As more families opt for pre-implantation genetic diagnosis to screen embryos for inherited diseases, determining the regulatory and ethical guidelines to govern such screenings is “proving difficult,” the Chicago Tribune reports. Although the field of embryonic testing initially focused on identifying genetic defects that are certain to cause suffering or death early in life, it has broadened to include tests for genes linked to breast and ovarian cancer, which are not always fatal, occur later in life and affect 50% to 85% of those who carry the gene, according to the Tribune. The leading U.S. genetic diagnosis clinic, which is the largest in the world, conducted more than 1,800 screenings in 2008 “aimed at weeding out embryos that carried worrisome family conditions, from sickle cell anemia to cystic fibrosis,” the Tribune reports. Different countries vary in their regulation of PGD. In the U.S., doctors are allowed to select embryos for a particular sex, a practice that is not allowed in Great Britain, where each instance of PGD must be registered with the British Human Fertilization and Embryology Authority. BFEA has approved the use of PGD for about 70 genetic defects “after intensive public consultation about what is a serious enough problem to justify trying to eliminate it,” the Tribune reports. It is “significantly easier” to conduct PGD in the U.S. because the government only licenses clinics, not individual procedures, the Tribune reports. Mark Hughes, director of the Detroit-based Genesis Genetics Institute, said his company has tested for 171 genetic defects. In the U.S., “there is no approval mechanism,” Hughes said, adding, “No one is saying you can do this to save a sibling but you can’t do this for BRCA1,” a gene linked to breast cancer. According to a John Hopkins University study, nearly 40% of individuals surveyed believed that embryo screening should be regulated more closely for ethical reasons. An additional 19% said the screening should be banned altogether, for reasons ranging from the belief that discarding an embryo is immoral to concerns that selecting against certain diseases will devalue the lives of people already living with those conditions. Clare Williams, a bioethics specialist at Kings College London, said that during public hearings in Britain, “quite a lot of people felt there could well be treatment (for some conditions) by the time these children grow up, and then (their condition) won’t be an issue.” Some experts say it would be beneficial to place limits on the type of genetic defects doctors are allowed to screen for in the U.S., the Tribune reports. The Hopkins study found that, as of 2006, 65% of about 200 U.S. clinics offering embryo screenings allowed clients to choose the gender of the implanted embryo, regardless of the gender of existing children or whether the child was their first. The Tribune reports that such data and a California-based genetics lab’s recent announcement that it would be able to select eye and hair color have raised public concerns about genetic selection of embryos. The lab’s claims have been “disproved,” and many experts believe that expanded embryo screening “probably is not a slippery slope toward designer babies” because PGD is “costly and difficult,” there are a limited number of embryos to choose from and “finding one that includes a number of desired traits would be very difficult,” the Tribune reports. Hughes said the “things you might want to select for in a child — intelligence, athletic prowess, body stature — involve not single genes but many, many genes.” According to the Tribune, PGD, used in conjunction with in vitro fertilization, costs about $3,500 in the U.S. and twice that in Britain (Goering, Chicago Tribune, 3/25).

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Clients of Surrogacy Agency Missing Millions of Dollars After Company Suddenly Closes

The Web site was impressive. An agency called SurroGenesis listed 60 locations worldwide where infertile couples and individuals could find women willing, for a fee, to serve as gestational surrogates. Aspiring parents put up tens of thousands of dollars hoping the agency could help them start families.

Today, SurroGenesis’ main office, in Modesto, Calif., is closed. So is an escrow company, Michael Charles Independent Financial Holding Group, that was supposed to be safeguarding the clients’ money. It turns out that many SurroGenesis locations were post-office boxes. An FBI spokesman, Steve Dupre, said the agency was evaluating the case but had not opened an investigation.

U.S. and international clients of SurroGenesis are missing as much as $2 million after the company suddenly shut down without explanation, according to lawyers familiar with the case, the New York Times reports.

Money gone

SurroGenesis told clients March 13 via e-mail that their money was gone. The shutdown affected about 70 people, some of whom had paid as much as $90,000 for promised gestational surrogacy services. “Many of them have lost their savings, and any chance of having a family is completely destroyed,” said Andrew Vorzimer, a lawyer working with those affected. “We’ve got couples in the midst of pregnancies with no ability to pay the surrogate, or even make insurance payments, which have gone unpaid.”

On the heels of the birth in January of octuplets, conceived by in vitro fertilization to a single California woman who has six other children, the case highlights the lack of oversight in the business of creating babies. There is no licensing requirement for egg-donor and surrogacy companies.

According to the Times, several couples learned about SurroGenesis on the Internet. As part of the agreement for surrogacy services, parents were instructed to deposit money to cover costs in an escrow account. SurroGenesis in a March 13 e-mail told clients that their money was gone and advised them to hire lawyers. The e-mail also said that clients should contact the Modesto Police Department because the escrow company that was supposed to be holding clients’ money — the Michael Charles Independent Financial Holding Group — was no longer paying its bills. California records show that SurroGenesis founder Tonya Collins is also listed as the registered agent for the Michael Charles group, even though it “was supposed to be an independent and bonded escrow company,” according to the Times. FBI spokesperson Steve Dupre said the agency is evaluating the case but has not launched an official investigation. Andrew Vorzimer, a lawyer working with some of the clients, said, “Many of them have lost their savings, and any chance of having a family is completely destroyed.” He added, “We’ve got couples in the midst of pregnancies with no ability to pay the surrogate, or even make insurance payments, which have gone unpaid.” According to the Times, Vorzimer said there is one surrogate carrying twins for a couple who lost more than $50,000. The surrogate is on bed rest, but the couple now is unable to reimburse her for lost wages.

Sources: New York Times, 3/21/2009

Seattle Times, 3/22/2009

Reproductive Health News, 3/24/2009

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Ethical Issues Related to Birth of IVF Octuplets : Not a Cause for Celebration, Doctors Warn

 

Two newspapers recently published two opinion pieces examining the ethical issues surrounding the recent birth of octuplets to a California woman, Nadya Suleman, who reportedly underwent fertility treatments. Summaries appear below.

 


~ Arthur Caplan, Philadelphia Inquirer: “Something has gone terribly wrong when a 33-year-old single woman — who has no home of her own, no job and a mother who worries her daughter is ‘obsessed’ with having children — winds up with 14 of them,” Caplan, director of the University of Pennsylvania Center for Bioethics, writes in an opinion piece. “Examining what exactly went wrong may shed some light on what ought to be done,” Caplan says, adding, “If doctors cannot prevent such shambles from recurring, then society must.” Caplan reports that Suleman became pregnant with all of her 14 children through in vitro fertilization. He writes that the “most obvious questions raised by this sad saga include: How did Nadya Suleman become a fertility patient? And how did she get eight embryos implanted when she already had six young children to care for in a tiny house, with no partner and no income?” Although “[s]ome fertility doctors would answer that it’s not their job to decide how many children a person can have,” Caplan writes that the “idea that doctors should not set limits on who can use reproductive technology to make babies is ethically bonkers.” He continues, “Society needs to discourage mega-multiple births. And it is clear what needs to be done to accomplish that.” Government “needs to get involved,” Caplan says, concluding, “Other nations, such as Britain, keep a regulatory eye on reproductive technologies and those who wish to use them, knowing their use can put kids at risk in ways that nature never envisioned. We owe the same to children born here” (Caplan, Philadelphia Inquirer, 2/6).



~ Ellen Goodman, Miami Herald:  The medical team that delivered the octuplets “expected kudos and high fives,” but “instead of smiles, they saw jaws drop,” syndicated columnist Goodman writes. She continues, “Attention turned from the doctors to the mom, from her courage to her judgment, from the medical success of this delivery team to the ethical failures of fertility treatment.” Questions about whether anyone has “a right to tell anyone else how many kids to have” and whether only women with husbands or certain income levels should have children are “questions that make us feel queasy when we are talking about old-fashioned families,” Goodman writes. She adds, “But they take on a new flavor in the unregulated wild west of fertility technology.” According to Goodman, the “heart of this case” is that “it turns out there are no laws in this country limiting the number of embryos that can be implanted in one womb.” She adds that it is “against all guidelines to implant more than one or two embryos in a woman under 35. Given our experience with the extraordinary high risk of multiple pregnancies for mothers and babies, those who endanger patients ought to lose their licenses.” Goodman also writes that the infants will need “at least $1 million in neonatal care and more if they have the typical range of disabilities for premature babies.” A “reproductive business that generates so much controversy has produced a remarkable consensus,” she says, concluding, “Infertility treatment for an unemployed, single mother of six? Eight embryos in one womb? There must be a proper word in the medical literature to describe this achievement. I think the word is ‘nuts'” (Goodman, Miami Herald, 2/6).

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Preparing for your IVF treatment

Your Emotional Preparedness:

There are many complex emotions that you will be encountering as you are anticipating your IVF cycle. If you are using donor eggs, donor sperm, or a surrogate, the emotions that you have will be even more splintered, as you also must consider the weight of genetics in this equation.

Before you proceed with IVF, you will want to speak with a psychotherapist that is trained in infertility. There are some very natural concerns that you will have and feelings that you will be confronted with. Your therapist can give you gentle guidance as you navigate through these new features, in your pursuit of pregnancy.

Some emotions that you can expect to have are:

• Loss or mourning over lost pregnancies, cycles that failed before and possibly even the loss of your ovaries. If you are having IVF, there is a strong likelihood that you have encountered a great loss to get there. It is natural that you will feel grief, as you are anticipating your cycle.

• Fear of not being a “real” parent is another very normal emotion that you may experience as you are preparing for your IVF cycle. Your child will not be any less than your child, and you will be no less their mother. You’ll still be the one they turn to, when they fall off their first bike. You’re just like any other pregnant woman, only you will have fought harder to get there.

. Being afraid that it won’t work after all of the time, money and emotions that you’ve invested in the procedure is natural. The truth is, it may not work and you need to understand that prior to moving forward. Your counselor will help guide you in this matter.

. You may feel scared that you will let down your donor, if they are a friend or family member. You may feel as though you are personally disappointing someone, who went through an enormous quest to help you, if the cycle fails. It’s important to know that you have no control over the outcome and they have been counseled in the possibilities of a failed cycle, prior to the retrieval.

Don’t be concerned if you start to question the decision to utilize IVF, donor eggs or sperm. When you are faced with a huge decision it’s not unusual to falter now and then. This is a big step and it takes some getting used to.

Finally, after all of these concerns and emotions, you may also feel something you haven’t felt in a long time; you may feel hope. Donor eggs may not be a certainty and IVF may not be 100% successful; but you can permit yourself to enjoy a dash of hope, in your anticipation.

Your Physical Preparedness:

As your cycle approaches, there are a few things that you can do to prepare yourself. It goes without say that you should limit your caffeine intake, eliminate smoking, and drinking alcohol. Light to moderate exercise is beneficial to both your emotional and physical well-being, which ultimately is good for your reproductive health. Consult your doctor before you start a new fitness plan and it’s important to remember that a rigorous routine should be omitted.

Remember that you’re not just preparing for IVF, you’re preparing for a pregnancy. It’s recommended that women who are attempting pregnancy begin taking folic acid, prior to conception and you may want to include prenatal vitamins, in your daily routine. This will create the best environment for your fetus.

A diet that is high in leafy greens, fruits, vegetables, calcium as well as protein, is optimal for your pregnancy. You may want to talk to your doctor or nutritionist about foods that would be most beneficial to you, during your pregnancy, or even to help you build a pre-pregnancy meal plan, to prepare you for conception. Do not begin any restrictive diets, such as low-calorie or low-carbohydrate. Though it’s not ideal to be overweight in pregnancy, this is not the time to start a weight loss plan. You can read more about fertility enhancing food on –  https://therotundaramblings.wordpress.com/2008/09/27/foods-that-make-you-fertile/

The month prior to your transfer your doctor may ask you to participate in a mock cycle, to show that you and your donor respond properly to your respective hormone therapies. The endometrium used to be accessed via biopsy, but this technology did not prove itself reliable. Today you will most likely have an ultrasound about 10-12 days into your estrogen-enhanced cycle to measure your endometrius.

You may need to start birth control pills to regulate your cycle so that you can synchronize with your donor’s. You may also be asked to use a gonadotropin releasing hormone (GnRH) antagonist, which inhibits the luteinizing hormone (LH) surge; so that your own cycle does not get canceled and the uterine lining is ready for the implanted embryo.

You may still feel unprepared when it is time to begin your cycle, but that is completely normal as well. You may never feel completely prepared. The important part is that you have made your decision and are headed toward the next step in your pursuit to have your child.

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